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Effect of respiratory rehabilitation on quality of life in individuals with post-COVID-19 symptoms: a randomised controlled trial [with consumer summary]
Del Corral T, Fabero-Garrido R, Plaza-Manzano G, Izquierdo-Garcia J, Lopez-Saez M, Garcia-Garcia R, Lopez-de-Uralde-Villanueva I
Annals of Physical and Rehabilitation Medicine 2025 Feb;68(1):101920
clinical trial
10/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: Yes; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Inspiratory and expiratory muscle training (RMT) has been shown to have beneficial effects in individuals with long-term post-COVID-19 symptoms. OBJECTIVE: To assess the effects of adding RMT to an aerobic exercise (AE) training program for health-related quality of life (HRQoL) and exercise tolerance in individuals with long-term post-COVID-19 symptoms, and to evaluate the effects on physical and lung function, and psychological status. METHODS: 64 individuals with long-term post-COVID-19 symptoms of fatigue and dyspnoea were randomly assigned to AE plus RMT or AE plus RMT sham groups for an 8-wk intervention (AE: 50min/day, 2 times/wk; RMT: 40min/day, 3 times/wk). Primary outcomes were HRQoL (EuroQol-5D questionnaire) and exercise tolerance (cardiopulmonary exercise test). Secondary outcomes were physical function: respiratory muscle function (inspiratory/expiratory muscle strength and inspiratory muscle endurance), lower and upper limb strength (1-min Sit-to-Stand and handgrip force); lung function: spirometry testing and lung diffusing capacity; and psychological status (anxiety/depressive levels). RESULTS: Postintervention, there were no statistically significant improvements in HRQoL or exercise tolerance in the AE plus RMT compared with the AE plus RMT sham group. In the AE plus RMT group, large improvements in respiratory muscle function (d = 0.7 to 1.3) and low-moderate improvements in peak expiratory flow (d = 0.4) occurred compared with the AE plus RMT sham group. Lung function outcomes, lower and upper limb strength and psychological status did not increase more in the AE plus RMT group than in the AE plus RMT sham group. CONCLUSION: For individuals with long-term post-COVID-19 symptoms, combining RMT with an AE training program resulted in improvements in respiratory muscle strength, inspiratory muscle endurance and peak expiratory flow; however, the differences between groups were not statistically significant for HRQoL, exercise tolerance, psychological distress, and lung diffusing capacity. DATABASE REGISTRATION: United States Clinical Trials Registry (NCT05597774).

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