Influence of Manual Diaphragm Release Technique Combined with Inspiratory Muscle Training on Selected Persistent Symptoms in Men with Post-Covid-19 Syndrome: A Randomized Controlled Trial

Abstract

Objective: To determine whether the addition of manual diaphragm release to an inspiratory muscle training programme is more effective than inspiratory muscle training alone in reducing blood pressure, dyspnoea, fatigue, and aerobic performance capacity in men with post-COVID-19 syndrome.Design: A prospective, randomized-controlled trial.Setting: Chest Disease Department, Outpatient Clinic, Cairo University, Egypt.Participants: Fifty-two men with post-COVID-19 syndrome were allocated randomly to the study and control groups.Intervention: The study group underwent diaphragm release plus inspiratory muscle training, whereas the control group received inspiratory muscle training only.Outcome measures: All patients were assessed with the following measures at baseline and 6 weeks postintervention: maximum static inspiratory pressure for inspiratory muscle strength, peripheral arterial blood pressure, Modified Medical Research Council scale for dyspnoea, Fatigue Severity Scale, serum lactate level, and 6-min walk test distance for aerobic performance.Results: All outcome measures showed a significant improvement in favour of the study group (p < 0.001) over the control group. However, maximum static inspiratory pressure increased significantly, by 48.17% (p < 0.001) in the study group with no significant change in the control group.Conclusion: Addition of manual diaphragm release to an inspiratory muscle training programme potentiates the role of inspiratory muscle training in the management of men with symptomatic post-COVID-19 syndrome.

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

“…Six eligible studies were added together in our meta‐analysis, which all in all, resulted in 210 patients in the experimental group and 139 patients in the control group. Five studies enrolled patients with post‐COVID‐19 conditions 14–16,19,20 . Three studies included patients who had been hospitalized for COVID‐19 15,19,21 and one study included patients who had never been hospitalized for COVID‐19 20 .…”

Respiratory Muscle Strength Training in Patients Post-COVID-19: A Systematic Review

“…Four studies reported significant outcomes in maximal inspiratory pressure (MIP) (Del Corral et al, 2023b; McNarry et al, 2022; Nagy et al, 2022; Nopp et al, 2022). All four studies incorporated IMST with two studies using IMST alone A recent randomized controlled trial reported a minimally clinical important difference (MCID) value of 18 cm H 2 0 for the MIP within the post-COVID-19 population in an attempt to assess whether the improvements noted in MIP are clinically meaningful (Del Corral et al, 2023b).…”

“…Some studies did not mention or have blinding processes related to study design, leading to n/a ratings in this category (Table 1). Using the OCEBM instrument to evaluate the level of evidence for each study, six of the studies had a 1b level of evidence (Del Corral et al, 2023a;Jimeno-Almazan et al, 2023;Liu et al, 2020;McNarry et al, 2022;Nagy et al, 2022;Palau et al, 2022), three had a 2b level of evidence (Abodonya et al, 2021;Hayden et al, 2021;Nopp et al, 2022), and two had a 2c level of evidence (Hockele et al, 2022;Morgan et al, 2023) (Table 2). These relatively high levels of methodological quality led to the inclusion of these studies in the review.…”

“…Among the 11 included studies, five were randomized controlled trial studies (Del Corral et al, 2023a;Jimeno-Almazan et al, 2023;McNarry et al, 2022;Nagy et al, 2022;Palau et al, 2022), one was quasi-experimental (Liu et al, 2020), and five were prospective (Abodonya et al, 2021;Hayden et al, 2021;Hockele et al, 2022;Morgan et al, 2023;Nopp et al, 2022). All of the studies focused on respiratory muscle strength training in individuals experiencing post-COVID-19 symptoms, with four including an aerobic or peripheral strengthening exercise component in the intervention (Hayden et al, 2021;Hockele et al, 2022;Liu et al, 2020;Nopp et al, 2022), and one including a diaphragmatic release intervention (Nagy et al, 2022).…”

“…Dyspnea was measured in all but three of the included studies (Liu et al, 2020;Morgan et al, 2023;Palau et al, 2022). The MCID for patient-reported dyspnea has not yet been established for the post-COVID-19 population, but for the five studies that used the modified Medical Research Council Dyspnea Scale (Hayden et al, 2021;Hockele et al, 2022;Jimeno-Almazan et al, 2023;Nagy et al, 2022;Nopp et al, 2022), outcomes exceeded the MCID of −1 that is reported in the chronic obstructive pulmonary disease (COPD) population (Ammous et al, 2023). All studies that reported dyspnea scores reported statistically significant improvements in dyspnea ratings in the respiratory muscle strength training groups (Table 3).…”