Breathing exercises versus strength exercises through telerehabilitation in coronavirus disease 2019 patients in the acute phase: A randomized controlled trial

Abstract

Objective To compare the effectiveness of two different exercise-based programs through telerehabilitation in patients with coronavirus disease 2019. Design Randomized, controlled, parallel, double-blinded, three-arm clinical trial. Setting Patients’ homes through telerehabilitation devices. Subjects Subjects with coronavirus disease 2019 in the acute phase. Interventions Subjects were divided into three groups: breathing exercises group, strength exercises group or no treatment/control group. Main measures We analysed visual analogue scale for fatigue, 6-minute walking test, 30-seconds sit-to-stand test, multidimensional dyspnoea-12 questionnaire and Borg scale at baseline and 14 days later. Results From 93 subjects recruited, 88 were enrolled, and 77 patients (mean [SD] age 39.40 [11.71]) completed the 14-days intervention and were included in the analysis: 26 in strength exercises group, 29 in breathing exercises group and 22 in control group. The intergroup analysis shows significant differences between the study groups and control group in all variables ( p < 0.05); Borg scale, multidimensional dyspnoea-12 questionnaire (pre–post intervention score: strength exercises group: 7.85 [6.82] – 4.54[4.82], breathing exercises group: 11.04 [6.49] – 5.32 [3.63], control group: 10.27 [6.49] – 10.59[6.58]), visual analogue scale for fatigue, 6-minute walking test and 30-seconds sit-to-stand test (pre–post intervention score: strength exercises group: 12.19 [4.42] – 13.58 [5.37], breathing exercises group: 11.18 [3.42] – 12.79 [4.00], control group: 10.45 [2.15] – 9.86[1.88]). The greatest effect sizes were found in the variables Borg Scale ( R2 = 0.548) and multidimensional dyspnoea-12 questionnaire ( R2 = 0.475). Conclusions Strength exercises group and breathing exercises group obtained significant improvements in fatigue, dyspnoea, perceived effort, and physical state, compared to control group, although the greatest benefits were found for dyspnoea and aerobic capacity in breathing exercises group.

Telerehabilitation improves physical function and reduces dyspnoea in people with COVID-19 and post-COVID-19 conditions: a systematic review

“…Of these, six randomised controlled trials (reported across seven articles) were included in this review. 25 , 26 , 27 , 28 , 29 , 30 , 31 The 14 studies that did not meet the eligibility criteria were excluded due to ineligible study design (n = 10), ineligible population (n = 3) and ineligible comparator (n = 1) ( Figure 1 ). Twenty-five ongoing studies were also identified: three on the databases and 22 on the ClinicalTrials.gov registry website; see Appendix 2 on the eAddenda for a summary of the ongoing trials.…”

“…Rodriguez-Blanco et al contributed two of the included trials. 25 , 26 In their trial published in 2021, a 7-day strength and resistance exercise program was compared with no intervention. 25 The experimental group received instructions on how to perform the exercises through a website and a daily text message was sent asking about the exercises and as a follow-up method to improve adherence.…”

“…In their trial published in 2022, they compared three groups: breathing exercises, strengthening exercises and control (no intervention). 26 The experimental groups received instructions about the interventions on the first day and evaluators maintained daily communication with participants via a smartphone software application b as a reminder during the treatment period and also to improve adherence. The assessments were conducted through videoconference at baseline and on day 14.…”

“…Only Rodriguez-Blanco et al (2022) 26 reported technology-related issues. One of the participants reported a problem with the telerehabilitation device, which could not be resolved, and decided not to participate.…”

“…The trial by Amaral et al 29 was judged as having a high risk of bias, as there were concerns in two domains (the randomisation process due the difference in the baseline characteristics, and selection of the report result because the authors did not plan an intention-to-treat analysis) and a high risk in the domain of deviations from the intended interventions owing the published result not being completely in accordance with a pre-specified analysis. The 2022 trial by Rodriguez-Blanco et al 26 was judged as having some concerns of bias in the domain of deviations from the intended interventions. The authors were unable to mask the treatment from participants and therapists due to the nature of the interventions.…”