Central ObesityNCT07718178
Effect of Thoracic Mobilization in People With Central Obesity
A study testing Mulligan Thoracic Mobilization, low carbohydrate and Aerobic Exercise in people with Central Obesity and Ventilatory Function, run by Cairo University at 1 site in Egypt.
Trial summary
The goal of this clinical trial is to learn whether Mulligan thoracic mobilization in extension improves ventilatory functions and chest wall expansion in adults with central obesity. Read more about this study
- Who is it for?
- Ages 25 to 35 years, men only
- Conditions the study is for
- Central Obesity, Ventilatory Function
- What is being tested?
- Mulligan Thoracic Mobilization, low carbohydrate and Aerobic Exercise
- Type of treatment
- Surgery or procedure, Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteEgypt
- Study dates
- 25 Jul 2026to 10 Feb 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 to 35 years
- Men only
- No healthy volunteers
- Adult
Who may be able to join
- Males aged 25-35 years.
- Presence of central obesity, defined as:
- Waist circumference ≥102 cm in males.
- Waist-hip ratio (WHR) ≥0.90 in males.
- BMI from 30-39.9 kg/m².
- Willing to comply with conventional physiotherapy (diet and exercise) and mobilization programs.
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- Medically stable individuals with a restrictive lung pattern (Normal FEV₁/FVC ratio and FVC < 80% of predicted).
- Low level physical activity (using the International Physical Activity Questionnaire-Short Version).
- Non-smokers.
Who cannot join
- Diagnosed COPD, asthma, or other chronic respiratory diseases.
- Recent thoracic spine or rib injury/surgery.
- Cardiovascular instability or uncontrolled hypertension.
- Contraindications to manual therapy (e.g., osteoporosis, rib fractures, or spinal tumors).
- Participation in any structured weight loss program or exercise regimen in the past 6 months.
- History of bariatric surgery (e.g., gastric sleeve, gastric bypass).
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- Use of medications that affect body weight or metabolism (e.g., corticosteroids, antipsychotics, weight loss drugs).
- Neurological or musculoskeletal conditions that limit mobility or exercise participation and interfere with gait.
- Any acute respiratory infections in the past 6 weeks.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effect of Mulligan Thoracic Mobilization on Ventilatory Functions and Chest Wall Expansion in Central Obesity
The goal of this clinical trial is to learn whether Mulligan thoracic mobilization in extension improves ventilatory functions and chest wall expansion in adults with central obesity. It will also evaluate whether adding Mulligan thoracic mobilization to a low-carbohydrate diet and aerobic exercise provides greater benefits than diet and exercise alone.
The main questions it aims to answer are:
Read more
Does Mulligan thoracic mobilization improve ventilatory functions (FVC, FEV₁, FEV₁/FVC ratio, and MVV) in adults with central obesity? Does Mulligan thoracic mobilization improve chest wall expansion, functional capacity, and health-related quality of life?
Researchers will compare Mulligan thoracic mobilization combined with a low-carbohydrate diet and aerobic exercise to a low-carbohydrate diet and aerobic exercise alone to determine whether the addition of thoracic mobilization improves respiratory outcomes.
Participants will:
Be randomly assigned to either the intervention group or the control group. Receive an individualized low-carbohydrate diet and supervised aerobic exercise for 8 weeks.
Receive Mulligan thoracic mobilization in extension three times per week for 8 weeks if assigned to the intervention group.
Undergo assessments of ventilatory functions, chest wall expansion, functional capacity, and quality of life before and after the intervention.
Read the detailed description
The Challenge: Central Obesity and Respiratory Dysfunction
Central obesity is a growing global health concern that affects not only metabolic and cardiovascular health but also respiratory function. Excess accumulation of abdominal and visceral fat mechanically restricts chest wall movement, limits diaphragmatic excursion, and reduces lung volumes, leading to impaired ventilatory function and decreased chest wall expansion. These respiratory limitations can contribute to dyspnea, reduced exercise tolerance, and poorer quality of life. Although weight loss through dietary modification and aerobic exercise remains the cornerstone of obesity management, these approaches do not directly address the mechanical restrictions imposed on the thoracic cage. Therefore, additional physiotherapy interventions targeting thoracic mobility may provide further improvements in respiratory function.
The Goal of the Study
This study aims to determine whether adding Mulligan thoracic mobilization in extension to a standardized low-carbohydrate diet and aerobic exercise program provides greater improvements in ventilatory functions and chest wall expansion than diet and exercise alone in adults with central obesity. The study will also investigate whether this intervention improves functional exercise capacity and health-related quality of life.
How the Study Works
The study will involve 60 adult males with central obesity who meet the study eligibility criteria. Participants will be randomly assigned into two equal groups:
The Mulligan Thoracic Mobilization Group: Participants will receive Mulligan thoracic mobilization in extension performed by a trained physiotherapist three times per week for eight weeks. The mobilization will be applied to the mid-thoracic spine (T6-T8) using the Mobilization with Movement (MWM) concept while participants perform thoracic extension combined with deep inspiration. In addition, participants will follow an individualized low-carbohydrate diet and participate in a supervised aerobic exercise program.
The Control Group: Participants will receive the same individualized low-carbohydrate diet and supervised aerobic exercise program without Mulligan thoracic mobilization.
Both groups will participate in the intervention program for 8 weeks, with regular monitoring to ensure adherence and participant safety.
What Is Being Measured?
To determine the effectiveness of the intervention, the study will evaluate several important clinical outcomes:
Ventilatory Functions: Pulmonary function will be assessed using spirometry by measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), the FEV₁/FVC ratio, and Maximum Voluntary Ventilation (MVV).
Chest Wall Expansion: Chest wall mobility will be measured using a non-elastic tape measure at the fourth intercostal space and at the xiphoid process during maximal inspiration and expiration.
Functional Capacity: The Six-Minute Walk Test (6MWT) will be used to assess participants' functional exercise capacity.
Health-Related Quality of Life: Participants will complete the 36-Item Short Form Health Survey (SF-36) to evaluate physical and mental aspects of quality of life.
Why This Matters
Respiratory impairment associated with central obesity is largely driven by mechanical restriction of the thorax, yet current obesity management strategies rarely address this component directly. By investigating the effects of Mulligan thoracic mobilization in extension, this study aims to identify a safe, non-invasive, and clinically practical physiotherapy intervention that can complement conventional weight management. If effective, this approach may improve respiratory mechanics, enhance chest wall mobility, increase functional capacity, and improve quality of life for adults with central obesity while expanding the evidence base for manual therapy in cardiopulmonary rehabilitation.
- Conditions
- Central Obesity, Ventilatory Function
- Being tested
- Mulligan Thoracic Mobilization, low carbohydrate, Aerobic Exercise
- Medical subject headings
- Obesity, Abdominal
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mulligan Thoracic MobilizationProcedure or surgery
- Technique: Thoracic mobilization with movement (MWM) in extension performed by a trained physiotherapist.
- Performed 3×/week.
- Total program duration: 8 weeks.
- 3 sets × 10 repetitions per spinal level per session.
- Hold time: thoracic extension maintained for approximately 6 seconds at the end of the movement.
- Participant position: sitting at the edge of the treatment table with hands behind the neck.
- Therapist technique: mobilizing force applied using the ulnar border of the hand over the spinous process in a cephalic-anterior direction.
- Movement performed: deep inspiration combined with thoracic extension during the mobilization.
- Target levels: Mid-thoracic region (T6-T8).
- Session duration: The session duration was based on three sets of ten repetitions per spinal level, with each repetition held for approximately 6 seconds. A 30-second rest interval was provided between sets, resulting in an effective application time of about 4-5 minutes per level.
low carbohydrateBehavioural
Standardized low-carbohydrate dietary program administered for 8 weeks.
Aerobic ExerciseBehavioural
Moderate-intensity aerobic exercise program for 8 weeks, 5 sessions per week, at 55-69% HRmax or Borg RPE 12-14, progressing from 30 to 45 minutes per session.
| Study group | Role | What they receive |
|---|---|---|
| Mulligan Thoracic Mobilization | Experimental | will receive Mulligan thoracic mobilization in extension three times per week for 8 weeks in addition to a standardized diet and aerobic exercise. Receives: Procedure: Mulligan Thoracic Mobilization; Behavioral: low carbohydrate; Behavioral: Aerobic Exercise |
| low carbohydrate and Aerobic Exercises | Active comparator | will receive standardized diet and aerobic exercise. Receives: Behavioral: low carbohydrate; Behavioral: Aerobic Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Forced Vital Capacity
Measured using spirometry and expressed as a percentage of the predicted value (% predicted).
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Forced Expiratory Volume in One Second
Measured using spirometry and expressed as a percentage of the predicted value (% predicted).
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Ratio of Forced Expiratory Volume in One Second to Forced Vital Capacity
Measured as a percentage using spirometry.
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Maximum Voluntary Ventilation
Measured in liters per minute using spirometry.
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Chest Wall Expansion at the Fourth Intercostal Space
Chest wall expansion measured in centimeters using a non-elastic tape measure at the fourth intercostal space.
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Chest Wall Expansion at the Xiphoid Process Level
Chest wall expansion measured in centimeters using a non-elastic tape measure at the level of the xiphoid process.
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Secondary outcomes (2)
Functional capacity
assessed by 6-Minute Walk Test (6MWT)
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Change in Health-Related Quality of Life
Change in Health-Related Quality of Life will be assessed using the Physical Functioning domain of the 36-Item Short Form Health Survey (SF-36). Scores range from 0 to 100, with higher scores indicating better physical functioning.
Measured: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Jul 2026
- Study start25 Jul 2026
- Primary completion15 Dec 2026 (estimated)
- Study completion10 Feb 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Central ObesityStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Abd El-Rahman Ayman Mohamed Abd El-Monem, Cairo University
- Investigators
- Mona A Abdelwahab, Assistant Prof, Study chair, Cairo UniversityShaimaa T Mohamed, Lecturer, Study director, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07718178
- Sponsor's protocol ID
- P.T.REC/012/006582
- Status last verified
- Oct 2026
- First submitted
- 14 Jul 2026
- Last updated
- 5 Oct 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Individual participant data will not be shared to maintain participant privacy and strictly adhere to confidentiality agreements.
Study at a glance
From the registry record, last updated by the sponsor on 5 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Mulligan Thoracic Mobilization on Ventilatory Functions and Chest Wall Expansion in Central Obesity
- ClinicalTrials.gov ID
- NCT07718178
- Acronym / sponsor ID
- P.T.REC/012/006582
- Conditions
- Central Obesity, Ventilatory Function
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 25 Jul 2026 (actual)
- Primary completion
- 15 Dec 2026 (estimated)
- Study completion
- 10 Feb 2027 (estimated)
- First posted
- 21 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to learn whether Mulligan thoracic mobilization in extension improves ventilatory functions and chest wall expansion in adults with central obesity. It will also evaluate whether adding Mulligan thoracic mobilization to a low-carbohydrate diet and aerobic exercise provides greater benefits than diet and exercise alone.
The main questions it aims to answer are:
Does Mulligan thoracic mobilization improve ventilatory functions (FVC, FEV₁, FEV₁/FVC ratio, and MVV) in adults with central obesity? Does Mulligan thoracic mobilization improve chest wall expansion, functional capacity, and health-related quality of life?
Researchers will compare Mulligan thoracic mobilization combined with a low-carbohydrate diet and aerobic exercise to a low-carbohydrate diet and aerobic exercise alone to determine whether the addition of thoracic mobilization improves respiratory outcomes.
Participants will:
Be randomly assigned to either the intervention group or the control group. Receive an individualized low-carbohydrate diet and supervised aerobic exercise for 8 weeks.
Receive Mulligan thoracic mobilization in extension three times per week for 8 weeks if assigned to the intervention group.
Undergo assessments of ventilatory functions, chest wall expansion, functional capacity, and quality of life before and after the intervention.
Detailed description
The Challenge: Central Obesity and Respiratory Dysfunction
Central obesity is a growing global health concern that affects not only metabolic and cardiovascular health but also respiratory function. Excess accumulation of abdominal and visceral fat mechanically restricts chest wall movement, limits diaphragmatic excursion, and reduces lung volumes, leading to impaired ventilatory function and decreased chest wall expansion. These respiratory limitations can contribute to dyspnea, reduced exercise tolerance, and poorer quality of life. Although weight loss through dietary modification and aerobic exercise remains the cornerstone of obesity management, these approaches do not directly address the mechanical restrictions imposed on the thoracic cage. Therefore, additional physiotherapy interventions targeting thoracic mobility may provide further improvements in respiratory function.
The Goal of the Study
This study aims to determine whether adding Mulligan thoracic mobilization in extension to a standardized low-carbohydrate diet and aerobic exercise program provides greater improvements in ventilatory functions and chest wall expansion than diet and exercise alone in adults with central obesity. The study will also investigate whether this intervention improves functional exercise capacity and health-related quality of life.
How the Study Works
The study will involve 60 adult males with central obesity who meet the study eligibility criteria. Participants will be randomly assigned into two equal groups:
The Mulligan Thoracic Mobilization Group: Participants will receive Mulligan thoracic mobilization in extension performed by a trained physiotherapist three times per week for eight weeks. The mobilization will be applied to the mid-thoracic spine (T6-T8) using the Mobilization with Movement (MWM) concept while participants perform thoracic extension combined with deep inspiration. In addition, participants will follow an individualized low-carbohydrate diet and participate in a supervised aerobic exercise program.
The Control Group: Participants will receive the same individualized low-carbohydrate diet and supervised aerobic exercise program without Mulligan thoracic mobilization.
Both groups will participate in the intervention program for 8 weeks, with regular monitoring to ensure adherence and participant safety.
What Is Being Measured?
To determine the effectiveness of the intervention, the study will evaluate several important clinical outcomes:
Ventilatory Functions: Pulmonary function will be assessed using spirometry by measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), the FEV₁/FVC ratio, and Maximum Voluntary Ventilation (MVV).
Chest Wall Expansion: Chest wall mobility will be measured using a non-elastic tape measure at the fourth intercostal space and at the xiphoid process during maximal inspiration and expiration.
Functional Capacity: The Six-Minute Walk Test (6MWT) will be used to assess participants' functional exercise capacity.
Health-Related Quality of Life: Participants will complete the 36-Item Short Form Health Survey (SF-36) to evaluate physical and mental aspects of quality of life.
Why This Matters
Respiratory impairment associated with central obesity is largely driven by mechanical restriction of the thorax, yet current obesity management strategies rarely address this component directly. By investigating the effects of Mulligan thoracic mobilization in extension, this study aims to identify a safe, non-invasive, and clinically practical physiotherapy intervention that can complement conventional weight management. If effective, this approach may improve respiratory mechanics, enhance chest wall mobility, increase functional capacity, and improve quality of life for adults with central obesity while expanding the evidence base for manual therapy in cardiopulmonary rehabilitation.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Mulligan Thoracic Mobilization | Experimental | Procedure: Mulligan Thoracic Mobilization, Behavioral: low carbohydrate, Behavioral: Aerobic Exercisewill receive Mulligan thoracic mobilization in extension three times per week for 8 weeks in addition to a standardized diet and aerobic exercise. |
| low carbohydrate and Aerobic Exercises | Active comparator | Behavioral: low carbohydrate, Behavioral: Aerobic Exercisewill receive standardized diet and aerobic exercise. |
Who may qualify
- Ages
- 25 to 35 years
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (9 listed)
- Males aged 25-35 years.
- Presence of central obesity, defined as:
- BMI from 30-39.9 kg/m².
- Willing to comply with conventional physiotherapy (diet and exercise) and mobilization programs.
- Medically stable individuals with a restrictive lung pattern (Normal FEV₁/FVC ratio and FVC < 80% of predicted).
Key exclusion criteria (9 listed)
- Diagnosed COPD, asthma, or other chronic respiratory diseases.
- Recent thoracic spine or rib injury/surgery.
- Cardiovascular instability or uncontrolled hypertension.
- Contraindications to manual therapy (e.g., osteoporosis, rib fractures, or spinal tumors).
- Participation in any structured weight loss program or exercise regimen in the past 6 months.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mulligan Thoracic Mobilization* Technique: Thoracic mobilization with movement (MWM) in extension performed by a trained physiotherapist. * Performed 3×/week. * Total program duration: 8 weeks. * 3 sets × 10 repetitions per spinal level per session. * Hold time: thoracic extension maintained for approximately 6 seconds at the end of the movement. * Participant position: sitting at the edge of the treatment table with hands behind the neck. * Therapist technique: mobilizing force applied using the ulnar border of the hand over the spinous process in a cephalic-anterior direction. * Movement performed: deep inspiration combined with thoracic extension during the mobilization. * Target levels: Mid-thoracic region (T6-T8). * Session duration: The session duration was based on three sets of ten repetitions per spinal level, with each repetition held for approximately 6 seconds. A 30-second rest interval was provided between sets, resulting in an effective application time of about 4-5 minutes per level. | Procedure or surgery | Mulligan Thoracic Mobilization |
| low carbohydrateStandardized low-carbohydrate dietary program administered for 8 weeks. | Behavioural | Mulligan Thoracic Mobilization, low carbohydrate and Aerobic Exercises |
| Aerobic ExerciseModerate-intensity aerobic exercise program for 8 weeks, 5 sessions per week, at 55-69% HRmax or Borg RPE 12-14, progressing from 30 to 45 minutes per session. | Behavioural | Mulligan Thoracic Mobilization, low carbohydrate and Aerobic Exercises |
Primary outcome
Forced Vital Capacity
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Measured using spirometry and expressed as a percentage of the predicted value (% predicted).
Forced Expiratory Volume in One Second
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Measured using spirometry and expressed as a percentage of the predicted value (% predicted).
Ratio of Forced Expiratory Volume in One Second to Forced Vital Capacity
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Measured as a percentage using spirometry.
Maximum Voluntary Ventilation
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Measured in liters per minute using spirometry.
Chest Wall Expansion at the Fourth Intercostal Space
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Chest wall expansion measured in centimeters using a non-elastic tape measure at the fourth intercostal space.
Chest Wall Expansion at the Xiphoid Process Level
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Chest wall expansion measured in centimeters using a non-elastic tape measure at the level of the xiphoid process.
2 secondary outcomes
Functional capacity
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Change in Health-Related Quality of Life
Time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Oct 2026.
- Individual participant dataSharing planned: No. Individual participant data will not be shared to maintain participant privacy and strictly adhere to confidentiality agreements.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mona A Abdelwahab, Assistant Prof study chair
Cairo University
Shaimaa T Mohamed, Lecturer study director
Cairo University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mulligan Thoracic Mobilization, low carbohydrate and Aerobic Exercise in people with Central Obesity and Ventilatory Function, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 9 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 5 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Forced Vital Capacity (time frame: Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Oct 2026.