Chronic Obstructive Pulmonary Disease (COPD) is a common disease that can be prevented and
treated, usually characterized by persistent respiratory symptoms and airway restriction due
to airway and / or alveolar abnormalities due to exposure to harmful particles or gases. At
the same time, it was emphasized that COPD is a systemic disease according to GOLD (Global
Initiative for Obstructive Lung Diseases) and extrapulmonary involvement and comorbid
conditions adversely affect the severity and prognosis of the disease. COPD is a chronic
condition in which physical function, social function and general health are severely
affected. Treatment in COPD is mainly aimed at effective disease management, prevention of
disease progression, improvement of symptoms, and improvement of exercise tolerance. In the
treatment guidelines for chronic lung diseases, extrapulmonary systems and symptoms should
also be evaluated. In this context, the number of studies on the effects of postural
stability, balance and fall has increased recently, especially in COPD patients. It is
reported that the ability of the trunk to participate in postural stability due to increased
resting breathing load, weakness of the muscle strength of the diaphragm, one of the major
muscles with significant impact on balance, weakness of peripheral muscle and systemic
inflammation lead to postural stability and balance risk in COPD patients. Clinical
investigations of COPD patients in proportion to the severity of the disease; functional
balance, coordination and mobility. Postural stability is defined as the act of maintaining,
obtaining or recovering an equilibrium state during any posture or activity. Loss of postural
control is one of the most common comorbidities in elderly individuals. Impaired postural
control is more common when the elderly person has a chronic disease. The PLATINO study
showed an increased prevalence of COPD in elderly individuals. Factors such as lower
extremity muscle weakness, functional performance deficit and adaptive capacity, and reduced
physical activity level in the elderly with COPD affect postural stability. In individuals
with COPD, responses to postural perturbations have been shown to decrease compared to
healthy controls. However, the ability to produce a successful postural reaction depends not
only on motor performance but also on the efficient use of proprioceptive inputs. In a
comprehensive study characterizing proprioceptive postural control in COPD, patients
concluded that postural stabilization was impaired compared to healthy controls using ankle
muscle proprioceptive signals more and back muscle proprioceptive signals less during balance
control. These findings may be a potential risk factor for the likelihood of falls in COPD
patients. Among the problems associated with COPD, there is considerable evidence that the
risk of falls in these individuals increases. Falling problems and COPD are two major
problems that bring great costs to the health system and especially affect elderly people.
The well-known fall risk factors in COPD patients are lower limb muscle weakness and loss of
mobility, characterized by a decrease in daily living activities. Although the efficacy of
pulmonary rehabilitation (PR) in COPD is well defined, it provides minimal gains in postural
control and balance. Alternative treatments are needed to improve balance and fall in COPD
patients.
Body Awareness Therapy (BAT) is an alternative method developed by French exercise instructor
and psychotherapist Jacques Dropsy in the early 1970s following the emergence of the concept
of body awareness and adapted to rehabilitation programs by Swedish and Norwegian
physiotherapists. Traditional physiotherapy methods are the basis of BAT. Focusing on the
senses, proprioceptive exercises aiming to improve the quality of movement, rhythm and
coordination with sensory stimuli. BAT treats the individual physically, physiologically,
psychologically and socially with a holistic approach and the treatment program is shaped
according to the patient's needs. Breathing exercises, relaxation exercises, movement
approaches specific to sensory awareness, positioning, stabilization, improving rhythm and
coordination, and improving the ability to perform the exercise with maximum awareness are
used in physiotherapy methods used in BAT. It consists of specific exercises, which include
focusing on how the body is used during movements, aiming at improving one's awareness,
ability to be careful, and quality of movement. In the literature, it is seen that Body
Awareness Therapy reduces pain, fatigue, eating and sleep problems in various patient groups
and increases the quality, coordination, balance, postural control, quality of life and
mind-body integration of the exercise.
VFT has been gaining popularity in recent years among many health professionals, especially
physiotherapists. In BAT, movement is expressed by how one copes with the balance of the
person and associates himself / herself with the place and vertical axis in relation to the
environment. The integrity of postural stability is essential for comfortable breathing and
awareness, key points for dynamic balance, and quality of movement. Although VFT consists of
simple repetitive movements that maintain the ability to use stability limits, its main
component is to increase the individual's awareness of his / her movements. Thanks to the
neuroplasticity of the brain; multiple slow repetitive movements allow the participant to
experience the body and its limits. Movement consciousness that develops by cortical
processing of information about movement in the brain and facilitation of proprioceptive;
postural control improves balance and coordination. In many cases that require treatment as a
principled movement training technique behind mind-body interaction, which emphasizes motion
teaching based on sensory motor awareness and cognitive perception of movement. BAT aims to
normalize posture, balance, muscular tension and stiffness. Experiences learned by patients
help them divide difficult movements into simpler, lighter movements with less energy
consumption. Movement awareness and mind-body interaction during movement therapy can help
regulate emotional, mental, social and behavioral factors that affect health. In addition to
improving coping skills and cognitive behaviors among COPD patients, investigators think that
integrating them into pulmonary rehabilitation sessions can have positive effects on postural
stability, balance and fall, as they can help them move better and help postural control and
thus improve their ability to perform daily living activities.