Effects of Respiratory Muscle Training in Patients With Post COVID-19
Condition: Covid19
MeSH terms: COVID-19
Study type: Interventional

Summary: 
      The coronavirus disease 2019 (COVID-19) outbreak first appeared in Wuhan, China's Hubei
      Province in December 2019 and has quickly turned into a worldwide pandemic. As of 28 July
      2020, 16,465,707 cases of COVID-19 have been reported. COVID-19 is a highly contagious
      respiratory disease that causes respiratory, physical and psychological dysfunction in
      patients.

      Severe respiratory symptoms have been observed in COVID-19 patients. Fever (88.7%), cough
      (57.6%) and shortness of breath (45.6%) were observed in an average of 81% of the patients.
      However, patients with comorbidities such as hypertension and diabetes, usually over 65 years
      of age, may have very serious pulmonary sequelae of the infection. Due to lung fibrosis as a
      result of pneumonia in COVID-19, some patients experience severe respiratory failure
      requiring pulmonary rehabilitation. In the study of Complaints such as peripheral and
      respiratory muscle weakness, shortness of breath on exertion, and decreased exercise capacity
      may be seen in patients who have had COVID-19. In addition, while anxiety and depression
      increase, quality of life may decrease. In a study conducted with geriatric patients who had
      COVID-19 and were discharged; Peripheral and respiratory muscle strengthening exercises were
      given to the patient after discharge, and as a result of the study, it was found that the
      patient's walking distance and cough strength increased, while the complaints of shortness of
      breath, anxiety and depression decreased significantly. As a result of this; We can say that
      while shortness of breath, anxiety-depression and complications are reduced with the
      pulmonary rehabilitation program in patients with pulmonary involvement who have had
      COVID-19, participation in daily life activities and quality of life increase.

      Telerehabilitation is an emerging method that aims to provide rehabilitation to patients and
      clinicians by reducing barriers such as distance, time and cost by using information and
      communication technologies. Telerehabilitation enables patients who cannot access
      rehabilitation due to geographic, economic or physical disabilities to benefit from
      rehabilitation services. At the same time, the importance of social distance is emphasized
      for the continuation of the pandemic process and protection from the highly contagious
      COVID-19 infection.
    

Detailed description: 
      Outpatients with pulmonary involvement who have had COVID-19 was included in the study.
      Patients who had COVID-19 and pulmonary problems was divided into two groups as randomized
      controlled. Individuals in the first group was given respiratory exercises (diaphragmatic
      breathing, thoracic expansion, exercises to increase chest compliance with respiratory
      control with exercise band and leg strengthening exercises) and inspiratory muscle training
      with the Threshold IMT (T-IMT) device. The T-IMT (Threshold IMT, Respironics, USA) is a
      device that provides the same pressure with each breath for the strength and endurance of the
      inspiratory muscles, regardless of whether the patient is breathing rapidly or slowly. This
      device provides a constant pressure during inspiration with its flow-independent one-way
      valve. At the same time, the tool has an adjustable pressure mechanism. The instrument
      consists of the pressure section, the mouthpiece and the nose clip. When the patient breathes
      deeply, a constant pressure is applied to inspiration by the valve and the respiratory
      muscles are strengthened. In the study, individuals was divided into two groups by
      randomization method. In the first group, inspiratory muscle training was applied for 30
      minutes, 3 times a day, 7 days a week for 6 weeks. In practice, individuals was asked to sit
      in a relaxed upper chest and shoulders position. After the nose clip was in place, the
      patient was taught to inhale and exhale by closing their lips tightly around the mouthpiece
      of the instrument. After 8-10 breathing cycles, the patient was asked to continue this cycle
      for 10 minutes at a time, by checking the breathing for 3-4 breaths. The presence of symptoms
      such as dizziness, fatigue and shortness of breath was also questioned during the training.
      In the second group; only breathing exercises (diaphragmatic breathing, thoracic expansion,
      exercises to increase chest compliance with respiratory control with exercise band, and leg
      strengthening exercises) was given and a youtube video was sent to the patients so that they
      could follow the exercises and they was interviewed regularly every week. In the second
      group; breathing exercises (diaphragmatic breathing, thoracic expansion, exercises to
      increase chest compliance with respiratory control with exercise band and leg strengthening
      exercises) was taught and only the exercise link with these exercises was sent.
    

Intervention name(s): Exercise training group; Control training group
Intervention type(s): Other; Other
Intervention description(s): A regular advanced exercise program was given and followed.; Basic exercises was given at the beginning and did the same exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: COVID-19; inspiratory muscle training; respiratory muscle training; exercise