2.3.1. CMEBE Group
pursed lips, forceful
Chest mobilization exercises with breathing exercises were conducted in the CMEBE group.The intervention was administered for six weeks, five times a week, with two 30 min sessions per day, totaling 60 min of exercise per day. During the chest mobilization exercise, the patient was seated upright, and the therapist placed both hands around the lower part of the chest (ribs 8–11) and performed lateral, backward, and upward extension of the lower part of the rib cage while the patient was taking a deep breath through the nose. The subject was then instructed to exhale slowly through pursed lips while maintaining the extended posture as much as possible. After one set consisting of 30 inhalations, the patient rested for one minute before proceeding to the next set; patients performed three sets in total.To integrate breathing exercise into the intervention, a 15 min chest mobilization exercise was followed by a 15 min breathing exercise program, during which the maximum inspiratory pressure (MIP) was measured using K5 (Power breathe, Southam, UK). The patient sat in an upright position with a straight back and waist and exhaled as much air as possible from the lungs through a mouthpiece, followed by a rapid and forceful inhalation, repeating the process 30 times (1 set). After a one-minute rest, the patient proceeded to the next set, performing three sets in total. If the patient felt dizzy or fatigued during the exercise, the exercise was immediately interrupted and resumed after a rest period of comfortable breathing (