COVID-19 Pneumonia, Respiratory Symptoms
Conditions
Keywords
Respiratory Muscle Training, Walking Exercise, COVID-19, Dyspnea, Post-COVID-19 Recovery, Maximal Inspiratory Pressure
Brief summary
This experimental study was designed to investigate the effects of respiratory muscle training and walking exercise on selected blood, respiratory, functional, dyspnea, sleep quality, and quality-of-life outcomes in women who had recovered from COVID-19-related lung inflammation/pneumonia. The study included women aged 20 to 45 years who had experienced COVID-19 with pneumonia, reported dyspnea, and had reduced quality of life. A total of 80 female participants were divided into four groups: respiratory muscle training plus walking exercise, respiratory muscle training alone, walking exercise alone, and a control group, with 20 participants in each group. Measurements were performed before and after the intervention period. The assessments included pulmonary function testing, maximal inspiratory pressure, the 6-minute walk test, the modified Borg scale for dyspnea, the Nottingham Health Profile, the Pittsburgh Sleep Quality Index, and selected blood parameters. The study aimed to determine whether respiratory muscle training, walking exercise, or their combination could improve respiratory function, inspiratory muscle strength, functional capacity, dyspnea, sleep quality, quality of life, and blood-related parameters in this population.
Detailed description
This was a single-blind, experimental, pretest-posttest intervention study conducted in adult women who had recovered from COVID-19-related pneumonia and continued to experience dyspnea during the post-discharge period. Participants were recruited from routine post-discharge follow-up settings and were informed about the study procedures before participation. Written informed consent was obtained from all participants before any study-related procedures were performed. Before the start of the intervention period, participants completed a familiarization session and trial measurements to reduce learning-related variability during the actual assessments. Baseline measurements were then performed, and participants were allocated into four study groups according to their pretest results: respiratory muscle training, respiratory muscle training plus walking exercise, walking exercise, and control. The respiratory muscle training intervention was performed for 8 weeks using a pressure-threshold respiratory muscle training device. The training load was set at 50% of each participant's maximal inspiratory pressure. Participants in the respiratory muscle training group performed the intervention 5 days per week, twice daily, with 30 breaths in each session. Respiratory muscle strength was reassessed weekly, and the training load was updated according to changes in maximal inspiratory pressure. The combined intervention group completed the same respiratory muscle training protocol in addition to a structured walking exercise program. The walking exercise consisted of 40 minutes of walking, 3 days per week, either outdoors or on a treadmill, at a pace of approximately 4 to 6 km/hour. Exercise intensity was prescribed using a target heart rate approach corresponding to 40% intensity and was monitored during the sessions with an optical heart rate sensor. Before walking exercise, participants completed a 10-minute warm-up and stretching routine for the upper and lower extremities. The walking exercise group completed only the structured walking program using the same frequency, duration, intensity, and monitoring procedures as the walking component of the combined intervention group. The control group did not receive a structured exercise intervention and continued their usual daily routine during the study period. Study data were collected using individual participant forms. These forms included health history, medication use, smoking status, previous physical activity status, basic physical characteristics, and all pre- and post-intervention measurement values. The intervention process and exercise sessions were monitored throughout the study period. Measurements were repeated after the 8-week intervention period to evaluate changes within and between the study groups.
Interventions
BEHAVIORALRespiratory Muscle Training
Participants performed respiratory muscle training for 8 weeks using a pressure-threshold respiratory muscle training device. The training load was set at 50% of each participant's maximal inspiratory pressure. Training was performed 5 days per week, twice daily, with 30 breaths in each session. Maximal inspiratory pressure was reassessed weekly, and the training load was adjusted according to the updated value.
BEHAVIORALWalking Exercise
Participants performed a structured walking exercise program for 8 weeks. Walking exercise was performed 3 days per week for 40 minutes at an intensity corresponding to 40% based on the target heart rate method. Walking was performed either outdoors or on a treadmill at an approximate pace of 4 to 6 km/hour. Exercise intensity was monitored using a Polar Verity Sense optical heart rate sensor. Before walking, participants completed a 10-minute warm-up and stretching protocol for the upper and lower extremities.
Sponsors
Hitit University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
The study was designed as a single-blind experimental trial. Participants were assigned to one of four groups: respiratory muscle training, respiratory muscle training plus walking exercise, walking exercise, or control. Participants were masked to the comparative study hypotheses and were not informed which intervention was expected to be superior.
Intervention model description
Participants were assigned to one of four parallel study groups for the duration of the 8-week intervention period: respiratory muscle training, respiratory muscle training plus walking exercise, walking exercise, or control. Each group included 20 participants, and all groups underwent pre- and post-intervention assessments.
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Female participants aged 20 to 45 years * History of COVID-19-related pneumonia * Presence of dyspnea after COVID-19 * Modified Borg dyspnea score between 1 and 7 after the 6-minute walk test * Resting oxygen saturation between 90% and 95% * Incomplete resolution of COVID-19-related lesions on chest radiography * Voluntary agreement to participate in the study * Signed written informed consent form
Exclusion criteria
* Modified Borg dyspnea score between 0 and 1 * Modified Borg dyspnea score greater than 7 * History of chronic obstructive pulmonary disease, heart failure, or pulmonary fibrosis causing dyspnea before COVID-19 pneumonia * Upper abdominal or thoracic surgery within the previous 3 months * Cancer * Pregnancy * Presence of another disease contributing to dyspnea in addition to COVID-19-related dyspnea * Cardiovascular, musculoskeletal, or nervous system involvement related to COVID-19 * Mental disorder or mental instability * Language barrier preventing understanding of Turkish * Refusal to participate or withdrawal from the study at any stage * History of being a competitive athlete * Lack of voluntary participation or refusal to sign the written informed consent form
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Maximal Inspiratory Pressure | Baseline and Week 8 | Change in maximal inspiratory pressure from baseline to post-intervention. Maximal inspiratory pressure was used to assess inspiratory respiratory muscle strength. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Forced Vital Capacity | Baseline and Week 8 | Change in forced vital capacity from baseline to Week 8. Forced vital capacity was assessed using pulmonary function testing and reported in liters. |
| Change in Forced Expiratory Volume in 1 Second | Baseline and Week 8 | Change in forced expiratory volume in 1 second from baseline to Week 8. Forced expiratory volume in 1 second was assessed using pulmonary function testing and reported in liters. |
| Change in Peak Inspiratory Flow | Baseline and Week 8 | Change in peak inspiratory flow from baseline to Week 8. Peak inspiratory flow was assessed as a respiratory function parameter and reported in liters per second. |
| Change in Inspiratory Volume | Baseline and Week 8 | Change in inspiratory volume from baseline to Week 8. Inspiratory volume was assessed as a respiratory function parameter and reported in liters. |
| Change in 6-Minute Walk Test Distance | Baseline and Week 8 | Change in functional exercise capacity from baseline to post-intervention, assessed by the 6-minute walk test. |
| Change in Modified Borg Dyspnea Score | Baseline and Week 8 | Change in perceived dyspnea from baseline to post-intervention, assessed using the modified Borg scale. |
| Change in Nottingham Health Profile Score | Baseline and Week 8 | Change in health-related quality of life from baseline to post-intervention, assessed using the Nottingham Health Profile. |
| Change in Pittsburgh Sleep Quality Index Score | Baseline and Week 8 | Change in sleep quality from baseline to post-intervention, assessed using the Pittsburgh Sleep Quality Index. |
| Change in Blood Parameters | Baseline and Week 8 | Change in selected blood parameters from baseline to post-intervention, including leukocyte count, erythrocyte count, and hemoglobin. |
Countries
Turkey (Türkiye)
Outcome results
None listed