Effect of manual therapy and exercise on mild chronic obstructive pulmonary disease: A randomised controlled trial

Dr Roger Engel1, Associate Professor Peter Gonski2, Associate Professor Subramanyam Vemulpad1, Dr Petra Graham1

1Macquarie University, North Ryde, Australia, 2Sutherland Hospital, Miranda, Australia


Chronic obstructive pulmonary disease (COPD) is characterised by declining lung function and decreasing exercise capacity. Exercise capacity is a prognostic indicator for long-term survival. In COPD, regular physical activity is associated with increases in exercise capacity and quality of life but not lung function. Pulmonary rehabilitation programs play a key role in promoting physical activity for people with moderate to severe COPD. Recent evidence has shown that combining manual therapy (MT) with exercise delivers additional benefits in exercise capacity and quality of life compared to exercise alone over the medium-term for moderate COPD. The aim of this study was to investigate whether MT and exercise delivers additional benefits for mild COPD over the long-term.


71 participants aged 50-65 years with stable mild COPD were randomly allocated to two groups: Exercise (n=35) and MT+Exercise (n=36). Both groups received a 16-week, progressively  intensive exercise program with the MT+Ex group also receiving eight MT sessions in weeks 5-8 of the exercise program. Exercise capacity, lung function and quality of life were measured by blinded assessors at baseline, 4, 8, 16, 24, 32 and 48 weeks.


There was no difference in effect between groups. However, results suggested clinically meaningful average improvements in exercise capacity (p=<0.001), lung function (p=<0.001) and four of the six quality of life measures (p= <0.003) over time for both groups.


Notwithstanding the absence of any additional benefits from MT, the improvements in exercise capacity and quality of life suggest that physical activity is beneficial for mild COPD. The sustained increases in lung function following progressively intensive exercise is worthy of further investigation as it highlights the potential of exercise to slow progression of COPD from mild to moderate.

The study received ethics approval from the South Eastern

Sydney Local Health District Human Research Ethics Committee (HREC): Approval number 13/004.


Roger is an allied health practitioner with over 35 year’s clinical experience in both private practice and public hospitals. He currently holds appointments as a Senior Lecturer at Macquarie University, Adjunct Professional Fellow at Southern Cross University and Honorary Clinical Research Fellow at Sutherland Hospital in Sydney. Roger has a PhD in the field of chronic respiratory disease. As part of this work, he has developed a special interest in the early detection and management of chronic obstructive pulmonary disease (COPD). His research interests extend to aged care where he is currently working on a project to deliver multi-disciplinary care as a strategy to prevent the onset of frailty. Roger is a regular speaker at both national and international conferences.

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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