Manual Therapy, Thera-band Exercise and Walking

pulmonary function evaluation via forced spirometry dynamic lung volumes (forced vital capacity, FVC; forced expired volume at 1 second, FEV1).

A measuring tape is used to measure chest expansion in centimetres (cm) at two levels of the rib cage: upper chest expansion and lower chest.

6 Six Minute Walk Test (6MWT). The object of this test is to walk as far as possible for 6 minutes. The patient will walk back and forth around the cones in a hallway and is permitted to slow down, to stop, and to rest as necessary (but resume walking as soon as able).

The smoking index is a unit for measuring cigarettes consumption over a long period and was calculated using the following formula:

Smoking index = Cigarettes Smoked per Day (CPD)× years of tobacco use.

Smoking index categories were non-smoker, <400, 400-799, and ≥800. The CPD was estimated for current and former smokers. We defined heavy smoking as ≥20 CPD and mild smoking as <20 CPD.

The smoking index is a unit for measuring cigarettes consumption over a long period and was calculated using the following formula:

Smoking index = Cigarettes Smoked per Day (CPD)× years of tobacco use.

Smoking index categories were non-smoker, <400, 400-799, and ≥800. The CPD was estimated for current and former smokers. We defined heavy smoking as ≥20 CPD and mild smoking as <20 CPD.

visual analog scale (VAS). The pain VAS is a unidimensional measure of pain intensity, which has been widely used in diverse adult populations.

By Patient Global Impression of Improvement (PGIC).

By SF-8 scale. The SF-8 consists of 8 items comprising 8 dimensions (Bodily Pain, Perceptions, Mental Health, Physical Function, Role-physical, Role-emotional, Social Function, and Vitality).

To assess each dimension, items are aggregated into a score ranging from 0 to 100; being higher scores indicators of good health.

By algometer. Pressure was applied perpendicular to the skin, at a speed of 30kPa/s. Three measurements with 1 minute between measurements were averaged.

Distance between acromion-bed.To assess the position of the upper trunk, the length of the pectoralis minor in the supine position is evaluated by measuring the distance between the posterior edge of the acromion and the stretcher while the patients remain in that position.

By Sit-to-stand test. Participants sit in a 43 cm tall armless chair (Fig. 1) as quickly as possible 5 times. Participants cross their arms over their chest and are instructed to fully stand up and make firm contact when sitting. Time begins with the "go" command and ends when participants sit down after the fifth stand-up.

By FRAIL Questionnaire. The FRAIL scale are short 5-question assessment of fatigue, resistance, aerobic capacity, illnesses, and loss of weight, classified the patients into 3 categories: robust (score = 0), prefrail (score = 1-2), and frail (score = 3-5).

Participation motives are measured with the Exercise Motivation Index. The questionnaire consists of 15 statements followed by a five-point rating scale for each statement, ranging from 0 (not important) to 4 (extremely important). Although the authors found that the index was valid and reliable, they advise that further validation be made. Three subscores (0-4) were calculated by summing the scores for physical, psychological, and social motivation and dividing them by the number of statements for each area (Stenström, 1997; Klompstra, 2015) Cronbach's alpha was 0.889.

Screening sarcopenia: SARC-F. There are 5 components of SARC-F questionnaire: strength, assistance with walking, rise from a chair, climb stairs, and fall. The SARC-F scores range from 0 to 10, with 0 to 2 points for each component. A score ≥4 is predictive of sarcopenia and poor outcomes.