Diaphragmatic Release vs Inspiratory Muscle Training in Pulmonary Fibrosis

This study evaluates the efficacy of adding manual Diaphragmatic Release Technique (DRT) versus Targeted Inspiratory Muscle Training (IMT) to standard medical therapy in patients with stable pulmonary fibrosis. Forty participants are randomly allocated into two equal groups: Group A: Receives manual therapy (cranial and lateral traction to the rib cage for 10-15 minutes) 3 times per week for 12 weeks alongside standard medical care. Group B: Performs targeted inspiratory muscle training using a threshold device (5-7 sets of 6-10 breaths at 30-40% perceived effort) 3 times per week for 12 weeks alongside standard medical care.

Inclusion Criteria: * Confirmed clinical diagnosis of stable pulmonary fibrosis (diagnosed via HRCT scan and medical evaluation). Age 18 years or older (both males and females). Clinically stable condition with no acute pulmonary exacerbations or respiratory tract infections within the last 4 weeks. Mild-to-moderate pulmonary restrictive impairment baseline. Ability to follow verbal instructions and perform spirometry testing, 6-minute walk test, and threshold inspiratory muscle training maneuvers. Exclusion Criteria: * Acute respiratory exacerbation or hospitalization within the past 4 weeks. Severe cardiac comorbidities (e.g., unstable angina, recent myocardial infarction, congestive heart failure, or uncontrolled severe hypertension). Severe orthopedic, neuromuscular, or musculoskeletal conditions that prevent participation in exercise training, manual therapy, or 6MWT testing. Recent chest or abdominal surgery (within the past 3 months). Cognitive impairment or psychiatric disorders that impede understanding of instructions or adherence to intervention protocols. Participation in another formal pulmonary rehabilitation program or clinical trial concurrently or within the past 30 days