Effects of Inspiratory Muscle Training in Patients with post-COVID-19

Sari, Fulden; BAYRAM>, Selin; Pala, Gamze Gülsün; ÇÖMÇE>, Fatma; Küçük, Hamit; Oskay, Deran

doi:10.35440/hutfd.1136549

Cited by 4 publications

(13 citation statements)

References 31 publications

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“…Six trials 16 , 17 , 18 , 20 , 27 , 29 included patients who had previously been hospitalized due to a COVID-19 infection (range of intensive care unit admission, 6.2%-100%), and 3 trials 19 , 22 , 23 , 30 (4 records) included patients who had not been hospitalized following SARS-CoV-2 infection. Five trials 21 , 24 , 25 , 26 , 28 included a mixed population of both patients who had been hospitalized following initial COVID-19 infection and those who had not been hospitalized following initial COVID-19 infection. The level of dyspnea of the participants at the baseline ranged from mild to severe.…”

Section: Resultsmentioning

confidence: 99%

“…The most common interventions in the treatment group were breathing exercises, either alone 19 , 21 , 24 , 25 , 26 , 30 (6 trials [815 participants]), or in combination with resistance and/or aerobic training 16 , 17 , 20 , 28 , 29 (5 trials [298 participants]). In 2 trials 18 , 22 , 23 (3 records [71 participants]), the intervention included strengthening and aerobic exercises without a breathing exercise component, and 1 trial 27 (60 participants) included only aerobic exercises.…”

Section: Resultsmentioning

confidence: 99%

“…A detailed analysis of the reporting of each component for each study is summarized in eTable 3 in Supplement 1 . The most common comparator was usual care in the form of respiratory training and exercise-based, self-management education 16 , 17 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 (13 studies [14 records; 1156 participants]). A single study 21 (88 participants) used sham or placebo comparisons in the form of a respiratory training with no resistance.…”

Section: Resultsmentioning

confidence: 99%

“…Figure 2 summarizes the risk of bias judgment for each individual trial. Overall risk of bias was deemed low in 1 study 21 (7%), deemed as having some concerns in 6 trials 16 , 17 , 22 , 23 , 26 , 27 , 30 (7 records [43%]), and deemed high in 7 trials 18 , 19 , 20 , 24 , 25 , 28 , 29 (50%). Risk of bias arising from the randomization process and the selection of the reported outcomes was deemed low in 9 trials 16 , 19 , 21 , 22 , 23 , 24 , 26 , 27 , 29 , 30 (10 records [64%]).…”

Section: Resultsmentioning

confidence: 99%

“…The accuracy of these early-evidence syntheses is likely to be compromised due to the small number of included studies. Since then, 11 additional trials 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 have emerged. The increased attention on PCC now allows us to conduct a more comprehensive, methodologically sound, and stable analysis.…”

Section: Introductionmentioning

confidence: 99%

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Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition

Pouliopoulou,

Macdermid,

Saunders

et al. 2023

JAMA Netw Open

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ImportanceCurrent rehabilitation guidelines for patients with post–COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC.ObjectiveTo synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC.Data SourcesA systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial.Study SelectionThis study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers.Main Outcomes and MeasuresThe primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs.ResultsOf 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, −0.56; 95% CrI, −0.87 to −0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94).Conclusions and RelevanceThe findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition

Pouliopoulou,

Macdermid,

Saunders

et al. 2023

JAMA Netw Open

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Effect of Telerehabilitation on Pulmonary Function, Functional Capacity, Physical Fitness, Dyspnea, Fatigue, and Quality of Life in COVID-19 Patients: A Systematic Review and Metanalysis

Martins,

Monteiro,

de Lima

et al. 2024

Telemedicine and e-Health

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Multimodal web-based telerehabilitation for patients with post COVID-19 condition (Mainz PCC TeR Study): Study protocol of a randomized controlled clinical trial (Preprint)

Tomaskovic,

Weber,

Ochmann

et al. 2024

Preprint

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BACKGROUND Patients affected by post COVID-19 condition have long-term and health-related consequences of severe acute respiratory syndrome coronavirus-2, manifesting as persistent fatigue, dyspnea/hyperventilation, limitations in daily activities, cognitive impairment and mental disorders. Consequences exceed individual health, impacting social systems and the economy. Existing evidence indicates that exercise and respiratory therapy based telerehabilitation has the potential to improve cardiorespiratory fitness and hyperventilation and reduce care costs. OBJECTIVE The primary objective of this randomized, controlled clinical trial is to investigate the superiority of our multimodal, web-based telerehabilitation program compared to treatment as usual in terms of cardiorespiratory fitness (VO2peak [ml/min/kg]) and hyperventilation (VE/VCO2 slope [full-slope]) in severely affected post COVID-19 patients. In addition, the clinical and exercise physiological processes associated with the post COVID-19 condition will be investigated. METHODS We designed a waiting list randomized controlled clinical trial with three examination time points and two study phases. Following baseline assessment, patients will be randomly allocated to either the intervention group (IG) or the control group (CG). During the intervention phase (8 weeks), all IG participants receive web-based multimodal and symptom-titrated telerehabilitation program that includes weekly teleconsultations, a pacing approach, exercise and respiratory therapy, while the CG receives treatment as usual (sports medicine consultation about healthy habits and the pacing approach: self-directed management of symptoms and activities). After the primary assessment in the follow-up phase (8 weeks), the IG continued their training but without teleconsultation self-directed, while the CG received the same intervention as the IG followed by follow-up assessment. RESULTS Recruitment started in August 2023. It is estimated that the recruitment period will be 12 months. Data collection is planned to be completed in 2024. CONCLUSIONS This study is the first randomized controlled clinical trial investigating the effects of a multimodal and symptom-titrated TeR in severely affected PCC patients. The integration of various objective diagnostic systems to analyze clinical and exercise physiological processes associated with post COVID-19 condition will provide valuable insights into emerging postviral fatigue syndrome. CLINICALTRIAL https://drks.de/search/de/trial/DRKS00032394. Registered 28 July 2023 prospectively registered in the German Clinical Trials Register (DRKS).

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Effects of Inspiratory Muscle Training in Patients with post-COVID-19

Cited by 4 publications

References 31 publications

Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition

Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition

Effect of Telerehabilitation on Pulmonary Function, Functional Capacity, Physical Fitness, Dyspnea, Fatigue, and Quality of Life in COVID-19 Patients: A Systematic Review and Metanalysis

Multimodal web-based telerehabilitation for patients with post COVID-19 condition (Mainz PCC TeR Study): Study protocol of a randomized controlled clinical trial (Preprint)

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