This randomized controlled trial aims to investigate the effects of combining virtual reality (VR)-guided diaphragmatic breathing using Flowborne with VR-based aerobic cycling using Kinneta on ventilatory function in male and female patients aged 45-55 years with stable COPD (GOLD Stage II). Participants will be randomly assigned to either an intervention group receiving combined VR-guided breathing and aerobic cycling or a control group receiving conventional pulmonary rehabilitation with an identical session structure. Both groups will participate in three sessions per week for 12 weeks, with aerobic exercise performed at 65-75% of maximum heart rate (HRmax).
The primary outcomes will be diaphragmatic excursion, assessed using ultrasound, and forced expiratory volume in one second (FEV₁), measured using spirometry. Secondary outcomes will include FVC, FEV1/FVC ratio, six-minute walk test (6MWT) distance, dyspnea severity measured using the Borg scale, smoking index, peripheral oxygen saturation (SpO₂), and COPD Assessment Test (CAT) scores. All outcomes will be assessed at the end of the 12-week intervention period following randomization. The study aims to determine whether integrating VR-guided breathing and aerobic exercise produces greater improvements in diaphragmatic function, pulmonary function, exercise capacity, and overall COPD-related health status compared with conventional pulmonary rehabilitation.
