Can inspiratory muscle training benefit patients with COVID‐19? A systematic review and meta‐analysis

Abstract

The possible benefits of inspiratory muscle training (IMT) on mechanical and clinical outcomes in patients with Coronavirus disease‐2019 (COVID‐19) remain controversial. We conducted a meta‐analysis to evaluate the effect of IMT in the rehabilitation strategy of patients with COVID‐19. The Pubmed, Embase, Web of Science (WOS), and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify trials evaluating the efficacy of IMT in the treatment of patients with COVID‐19. The primary outcome included change from baseline of VO2max, maximal inspiratory pressure (PImax), 6‐min walk test(6MWT), forced expiratory volume in the first second predicted (FEV1%pred), and quality of life (QOL). Six studies with 349 participants were analyzed. Significant improvements were found in change from baseline of VO2max (MD: 4.54, 95% confidence interval [CI]: 1.79–7.30, Z = 3. 32, I2 = 0, p = 0.001), PImax (MD: 21.43, 95% CI: 1.33–41.52, Z = 2.09, I2 = 90%, p = 0.04), 6MWD (MD: 40.13, 95% CI: 24.92–55.35, Z = 5.17, I2 = 0, p < 0.00001) and FEV1%pred (MD: 8.73, 95% CI 3.07–14.39, Z = 3.02, p = 0.002) while no statistical improvements were found in QOL (SMD: 0.70, 95% CI: 0.37–1.03, Z = 4.15, I2 = 89% p = 0.32) between IMT group and control group. The application of IMT might elicit mechanical and clinical improvement in patients with COVID‐19. IMT could be recommended as an effective strategy of pulmonary rehabilitation for COVID‐19. However, the proper timing, optimal duration, as well as appropriate frequency and intensity of IMT remain uncertain and further studies are needed.

Inspiratory muscle training for COVID‐19: Benefits appear promising but findings remain uncertain

“…1 They found that IMT was associated with significant improvements in the change from baseline VO 2max , maximal inspiratory pressure (PI max ), 6-min walk distance, and forced expiratory volume in the first second predicted. 1 This manuscript presents a comprehensive analysis of the efficacy of IMT in the rehabilitation of COVID-19 patients.…”

“…However, despite this encouraging finding, the findings should be interpreted with caution because of the high heterogeneity (I 2 > 50%) of the PI max outcome. 1 The observed variability in this outcome may be due to differences in study designs, such as varying control groups (e.g., no intervention, 3,4 sham IMT, 5 other forms of pulmonary rehabilitation [6][7][8] ), patient populations (i.e., hospitalized COVID-19 patients, 3,6,8 outpatients 7 or individuals with "long COVID" [3][4][5][6][7] ), and methodologies (including variations in IMT protocols, training devices, load intensity, session length and frequency, and overall program duration), [3][4][5][6][7][8] potentially impacting the generalizability of the findings.…”

“…Even though the findings from a meta-analysis generally indicate a significant positive effect, it is plausible that future studies could reveal a negative or clinically insignificant effect, especially if the characteristics of the sample vary greatly from those in the studies analyzed. The prediction intervals can be calculated using the equation proposed by Riley et al 11 Accordingly, we calculated 95% prediction intervals by applying the raw data from the original metaanalysis 1 to provide a more comprehensive assessment of the evidence. Comprehensive Meta-Analysis software (Version 4, Biostat) was used for analysis.…”

“…To the Editor, We read with interest the systematic review and meta-analysis by Chen et al examining whether inspiratory muscle training (IMT) benefits patients with COVID-19. 1 The authors meticulously conducted a meta-analysis examining various studies to deduce the overall effectiveness of IMT in improving respiratory function in these patients. 1 They found that IMT was associated with significant improvements in the change from baseline VO 2max , maximal inspiratory pressure (PI max ), 6-min walk distance, and forced expiratory volume in the first second predicted.…”

“…1 The authors meticulously conducted a meta-analysis examining various studies to deduce the overall effectiveness of IMT in improving respiratory function in these patients. 1 They found that IMT was associated with significant improvements in the change from baseline VO 2max , maximal inspiratory pressure (PI max ), 6-min walk distance, and forced expiratory volume in the first second predicted. 1 This manuscript presents a comprehensive analysis of the efficacy of IMT in the rehabilitation of COVID-19 patients.…”