Breathing Retraining Adjuncts - A Systematic Review

Background: The COVID-19 pandemic highlighted the importance of breath and the impact of deficiency of oxygen supply and desaturation on modern medicine. In such situations, positioning, breathing exercises, and counseling are critical to patient survival. Additionally, breathing exercises have been found effective in minimizing pulmonary complications and promoting early recovery in pre and post-surgical conditions. Therefore, this study aimed to identify the existing devices used as adjuncts in breathing retraining and assess their effectiveness in routine chest physiotherapy practice. Method: Randomized controlled trials (RCTs) conducted until July 2022 were included in the review. The electronic databases MEDLINE, PEDro, CINHAL, PUBMED, and Google Patents were searched based on the PRISMA guideline's criteria, and research articles studied devices as adjuncts to physiotherapy in respiratory disorders. Devices that can aid in inspiratory or expiratory exercises with or without resistance are available and can be used during physiotherapy as adjuncts to management. However, not all devices are found to be multifunctional. Conclusion: The study found that devices with functionality involving inspiratory or expiratory exercises with or without resistance can be used during physiotherapy as adjuncts to management. However, not all devices are multifunctional, and further research is needed to identify the most effective devices for use in respiratory disorders. © 2023,Journal for ReAttach Therapy and Developmental Diversities. All Rights Reserved.

The respiratory exercise significance in the olfaction restoration in the postcovid period

One of the pathognomonic COVID19 signs, occurring in 8598% of patients, is olfactory dysfunction, developing in the absence of pronounced nflammation and edema of the nasal mucosa. A promising medicine direction that helps restore microcirculation, increase blood oxygenation, improve metabolism and regenerate olfactory epithelial cells is the Nadi Shodhana breathing exercise technique. Objective: To assess the possibilities of using the pranayama technique as a method of restorative olfactory treatment in the postcovid period. Materials and methods: 79 persons aged 22 to 68 years with olfactory disturbances occurring at COVID19 and persisting in the postcovid period were examined. As a restorative treatment for olfactory disorders, the patients of the main group were offered a course of Nadi Shodhana breathing xercises, which is an alternate nostril breathing. Breathing training consisted of three such cycles performed three times a day at the same time for 5 days. The possibility of using the pranayama technique was assessed according to the visual analog scale. The control group consisted of 74 patients with olfactory disorders after COVID19 comparable in sex and age with the main group. Results: Olfactory disorders are characteristic of postCOVID patients. Using Nadi Shodhana breathing exercise course can significantly reduce the lfactory dysfunction level in this patient category. It was showen that the pranayama technique is more effective in people under 40 years of age. It was lso established that the olfaction restoration largely depends on the duration of the dysfunction period. Conclusion: The study results make it possible to recommend the using breathing exercises in patients underwent COVID19 to restore olfaction n the postCOVID period. Copyright: © 2018 Zhao Qi et al.

Use of a Mobile Biofeedback App to Provide Health Coaching for Stress Self-management: Pilot Quasi-Experiment.

BACKGROUND: Mental health is an increasing concern among vulnerable populations, including college students and veterans. OBJECTIVE: The purpose of this study was to determine if mobile health technology combined with health coaching can better enable a user to self-manage their mental health. METHODS: This study evaluated the mobile app "Biofeedback" that provided health coaching on stress self-management for college student veterans' mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep-breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives and a smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at 2-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile biofeedback app. RESULTS: The deep-breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants' heart rate during the 6-minute time period immediately after conducting the breathing exercises (Spearman rank correlation coefficient -0.61, P<.001; S=9,816,176). There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicated that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. CONCLUSIONS: Participants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app.

Immediate effect of therapeutic positioning and breathing exercises on oxygen saturation in critically ill non-intubated COVID-19 patients: A retrospective study

Background: COVID-19 presents with symptoms of fever, headache, dry cough, and dyspnea. Acute hypoxemic respiratory failure is the most common complication occurring in 60%–70% of patients admitted to the intensive care unit (ICU). Positioning and breathing exercise formed the mainstay of physiotherapy intervention in patients admitted to COVID ICU. This was primarily aimed at reducing the ventilation/perfusion mismatch. The aim of this study was to retrospectively analyze the immediate effect of breathing exercise and positioning on oxygen saturation (SpO2). Materials and Methods: The available data of COVID-19 patients admitted to an ICU of a tertiary care hospital in Mumbai from June 5 to July 5, 2020 were retrospectively analyzed. Demographics and mode of oxygen delivery were noted. Changes in SpO2 after positioning and breathing exercises during a single session of treatment were analyzed using Wilcoxon paired signed-rank test with a level of significance at P < 0.05. Results: There was a statistically significant improvement in SpO2 after breathing exercises and prone positioning in all patients on oxygen supplementation. Side-lying positioning showed an improvement in oxygen saturation in patients who were on non-invasive ventilation and facemask. Conclusion: Both breathing exercises and positioning show an immediate improvement in oxygen saturation in patients with COVID-19.

Efficacy of physiotherapy management on burnout syndrome amongst IT professionals during the COVID-19 pandemic.

BACKGROUND: Burnout is a state of emotional, physical, and mental exhaustion caused by excessive stress. Burnout weakens the energy of an individual which reduces productivity and leaves this individual helpless, hopeless, cynical, and resentful. Thus, an early diagnosis of this syndrome has to be done and ways to prevent the level of progression and complication of burnout syndrome has to be planned. OBJECTIVE: To determine the efficacy of self-supervised Jacobson's relaxation technique along with Bhastrika Pranayama in reducing the level of burnout among the work-from-home IT professionals during the COVID-19 pandemic. METHOD: Thirty participants with burnout syndrome were randomly divided into two groups (15 participants in each group) using random allocation. The experimental group received Jacobson's relaxation technique along with Bhastrika Pranayama, whereas the control group received diaphragmatic breathing exercises and chest expansion exercises. Pre-test and post-test values using Maslach Burnout Inventory were used to interpret the results. RESULTS: Data collected were analyzed statistically by the Wilcoxon Signed Rank Test. It shows that there is a significant reduction in the level of burnout in the experimental group when compared to the control group at a p-value of 0.001. CONCLUSION: From the results, it is concluded that Jacobson's relaxation technique along with diaphragmatic breathing exercises showed significant improvement in the reduction of burnout levels.

A Pilot Study on a Nurse Rehabilitation Program: Could It Be Applied to COVID-19 Patients?

(1) Background: An aging population, pollution and an increase in life habits that are harmful to respiratory health, and more recently the COVID-19 pandemic, have led to an increase in chronic respiratory diseases. Thus, this pilot study aims to describe an intervention program on the training of respiratory patients to maintain airway permeability and preventing complications. (2) Methods: An observational, analytical, and prospective study was proposed. After the initial evaluation of each user during hospitalization, the program started with two sessions, at discharge for the second phase, and fifteen days after discharge for the third phase. Throughout the program's implementation, the modified Medical Research Council scale and the Barthel Index were applied. (3) Results: The population studied aged between 39 and 76 years, diagnosed with pneumonia or chronic obstructive pulmonary disease, showed a significant improvement in the degrees of dyspnea and levels of functionality, as well as an adequate level of learning. (4) Conclusions: This program positively impacted the patients' independence by reducing dyspnea and increasing functionality of the patients included in this study. The set of exercises and techniques can be replicated at home and may be fundamental in the management of respective recovery, as well as in the COVID-19 pandemic.

The effects of yoga-based breathing techniques and meditation on outpatients' symptoms of COVID-19 and anxiety scores

Context: Decreasing the outpatients' symptoms of COVID-19 is essential. For relieving symptoms, some complementary approaches are suggested. Aims: This study aimed to evaluate the effects of yoga-based breathing techniques and meditation on outpatients' symptoms of COVID-19 and anxiety scores. Setting and Design: This interventional study was conducted on 110 women with positive results of polymerase chain reaction (PCR) test for SARS-COV2 virus referred to PCR testing centers in Rafsanjan city, Iran, in 2021. Materials and Methods: The participants were assigned into intervention (n = 53) and control (n = 57) groups by simple randomization according to a computer-generated assignment list. In this study, the intervention group practiced 20-min yoga-based breathing techniques and 20-min meditation daily for a 6-day period, control group did not receive any contact till 6 th day. The symptoms' severity and headache, myalgia, and anxiety scores were evaluated on the 1 st and 6 th days via call interview by demographic and disease symptoms' checklist and the Spielberger State-Trait Anxiety Inventory. Statistical Analysis Used: The obtained data were then reported as descriptive statistics and were analyzed using Fisher's exact test, Chi-square test, Wilcoxon signed-rank test, t-Test, McNemar's test, Mann-Whitney U-Test, and multivariate analysis of covariance. Results: At six days after intervention, the group that practiced yoga-based breathing techniques and meditation had lower scores of headache (P < 0.001), myalgia (P < 0.001), and anxiety (P < 0.001) and lower severity of cough (P < 0.001), dyspnea (P = 0.019), and weakness (P = 0.006) than the control group. Conclusion: It appears that yoga-based breathing techniques (pranayama) and meditation could be considered effective and easy complementary therapies in COVID-19 patients for reducing the symptom severity and anxiety level. © 2022 Journal of Nursing and Midwifery Sciences ;Published by Wolters Kluwer - Medknow.

Are home-based exercises effective to reduce blood pressure in hypertensive adults? A systematic review.

Sedentarism and chronic non-communicable diseases have been a worldwide health problem that is drastically exacerbated by the COVID-19 pandemic social impacts. Home-based exercises are widely encouraged during social isolation to counterbalance the physical inactive impacts. Although, in the context of hypertension, are home-based exercises effective in blood pressure controlling? Our objective is to conduct a systematic review of high-quality controlled trials comparing the possible effects of different types of home-based exercises in hypertensive patients. The literature search was carried out in three scientific databases: Medline, Europe PMC, and Lilacs. Articles were included following three criteria: analyzing the effect of home-based exercise programs on blood pressure in treated and untreated hypertensive patients; exercises must perform at home and on the frequency, intensity, time, and type (FITT) principle, and the articles were published in English. From the qualitative analysis of 27 original trials screened through 451 identified studies, the main results are the following: 1) both endurance, isometric strength, and respiratory home-based exercise programs were efficient to decrease blood pressure in hypertensive patients; 2) differences in methodological approaches regarding FITT components, distinct blood pressure values at baseline and specific underlying mechanisms must be considered as a potential bias of each home-based interventions. In conclusion, endurance, isometric strength, and breathing home-based programs seems to be effective to reduce blood pressure in hypertensive patients. However, further randomized controlled trials and mechanistic studies must be performing to guide evidence-based recommendations of home-based exercises as antihypertensive therapy.

Exercise and breathing in rehabilitating long COVID

Many people with long COVID are still struggling with symptoms. Aysha Mendes looks at the research into rehabilitation

Breathing and Relaxation Exercises Help Improving Fear of COVID-19, Anxiety, and Sleep Quality: A Randomized Controlled Trial.

Objective: To investigate the effects of breathing and relaxation exercises performed via telerehabilitation on fear, anxiety, sleep quality, and quality of life of individuals without coronavirus disease 2019 (COVID-19) during the ongoing pandemic. Design: A prospective, randomized, controlled single-blind study. Methods: Fifty participants who had not been exposed to the COVID-19 virus earlier were randomly divided into experimental (n = 25) and control groups (n = 25). Both groups received an information session about COVID-19 once at the start of the study via a mobile phone video application. The experimental group also performed a breathing and relaxation exercise program twice daily (morning and evening), 7 days per week, for 4 weeks; one session of the program was conducted under the remote supervision of a physiotherapist as telerehabilitation, and the remaining sessions were performed as a home program. The Fear of COVID-19 Scale (FCV-19S), which was the primary outcome measure, The Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), and EQ-5D-3L were administered to both groups. Results: The FCV-19S, HAMA, and PSQI were statistically significantly improved to compare the controls, with a large effect size (ηp2 = 0.135, 0.313, and 0.200, respectively). The EQ-5D-3L index and EQ-5D-3L visual analog scale were not statistically significantly different compared with the controls; however, a small effect size was detected for the differences between the two groups (ηp2 = 0.056 and 0.013, respectively). Conclusion: Breathing and relaxation exercises appear to be an effective and feasible approach to support mental health and sleep quality during the COVID-19 pandemic. Especially in highly contagious diseases such as COVID-19, telerehabilitation approaches may be useful for safely reaching individuals by eliminating human-to-human contact. Clinical Trial Registration number: NCT04910932.

The effectiveness of rehabilitation of patients after covid pneumonia with osteopathic methods

Introduction. The new coronavirus infection (COVID-19) pandemic has affected the lives of many people. Any infectious and inflammatory process in the lungs can lead to adverse consequences for the whole organism. The pathological process affecting the respiratory structures of the lungs, bronchi leads to disruption of various links of the external respiration system;therefore, timely effective rehabilitation for such patients can improve the quality of life, reduce the period of temporary disability, and most importantly, restore the function of external respiration. The aim was to prove the effectiveness of the osteopathic methods application in the rehabilitation of patients after coronavirus pneumonia. Materials and methods. On the basis of the Primorsky Institute of Vertebroneurology and Manual Medicine (Vladivostok) the rehabilitation of patients with coronavirus pneumonia was carried out using osteopathic methods. 63 patients after suffering from coronavirus pneumonia were randomly divided into 2 groups comparable in terms of clinical and functional characteristics. The first group (main) consisted of 34 people (average age 65.5±1.5 years), of which 44.1 % were men and 55.9 % were women. Group 2 (control) included 28 patients (mean age 64.1±1.6 years), of which 32.1 % were men and 67.9 % were women. To assess the function of external respiration, spirometry was performed and the main indicators of the vital capacity of the lungs were assessed (vital capacity — VC, and FVC — forced vital capacity). To measure the saturation of hemoglobin in arterial blood with oxygen (SpO2), pulse oximetry was performed. Rehabilitation included in the main group osteopathic correction (2 procedures), breathing exercises (4 procedures) and chest massage (4 procedures);in the control group there were breathing exercises (4 procedures) and chest massage (4 procedures). The rehabilitation course lasted 14 days. For the statistical analysis of the obtained data the Statistica-10 software package was used. Results. The studies revealed a pronounced change in the function of external respiration in patients who had undergone coronavirus pneumonia. According to the results of spirometry, more than 90 % of patients showed a statistically significant (p=0.006) decrease in VC compared to the physiological norm — both in the main group (VC down to 80.7 %) and in the control group (VC down to 87.6 %), as well as a significant (p=0.0001) decrease in FVC to 77.7 % in the main group and to 79.1 % in the control group. After rehabilitation, patients in the main group showed a statistically significant improvement in the function of external respiration, manifested in an increase in VC by 12.3 % (p<0.0001), FVC by 12.1 %. In patients in the control group (without osteopathic correction), after the rehabilitation, the main indicators of the function of external respiration also improved, but the changes were not statistically significant. As a result of rehabilitation, the patients of the main group showed a statistically significant SpO2 increasing (from 96.6±0.2 to 97.5±0.2 %, p=0.0013);in the control group, there was also a positive dynamics of these indicators, but the changes were not statistically significant. Conclusion. The results of the study allow to conclude that the inclusion of osteopathic correction methods in the rehabilitation of patients after coronavirus pneumonia has a positive effect on their state, improves the external respiration function indicators — VC and FVC, and also increases the SpO2. The obtained results allow to recommend the inclusion of osteopathic methods in the rehabilitation programs for patients who have undergone coronavirus infection. © Anatoly F. Belyaev, Olga N. Fotina, Tatyana S. Kharkovskaya, Aleksei A. Yurchenko, 2022.

[Respiratory physiotherapy in post-acute COVID-19 adult patients: Systematic review of literature]

BACKGROUND: Patients with SARS-CoV-2 present signs and symptoms that primarily involve the respiratory system. The sequelae result in impaired quality of life, pneumonia, dyspnea, fatigue, and joint pain. OBJECTIVE: To sustain with scientific evidence the importance of respiratory physiotherapy and its effects on post-acute COVID-19 adult patients. MATERIAL AND METHODS: A systematic review was conducted in four databases (Scopus, Web of Science, PubMed, and ScienceDirect). The searching period was carried out in February 2021 with a total of one 1229 potential studies. Finally, 5 studies that met the eligibility criteria were included: two clinical trials, two case reports and one cross-sectional study. The methodological quality of the articles was evaluated. RESULTS: Respiratory muscle training, targeted breathing, and strength training provide significant data of improvement of functional performance. Evidence shows positive effects of respiratory physiotherapy in post-acute COVID-19 adult patients, since it increases resistance to exercise, it decreases fatigue, reduces dyspnea, improves functionality and quality of life. CONCLUSIONS: More future studies, such as randomized controlled trials, studies including lower age range groups, and individualized approaches, need to be developed.

Factors behind higher COVID-19 recovery and lower fatality rates in India - Need for a focused study

It is an undisputed fact that the COVID-19 recovery rate of 97.6% and the death per million of 314 in India (as of 28 Aug 2021) are significantly better than the corresponding values in the USA, UK, France, Italy, Spain, and most of Europe, which have much better health infrastructure. Even though the population of the USA is only one-fourth that of India, the number of lives lost in the USA due to COVID is unfortunately 1.5 times that of India. Similarly, the population of Brazil is marginally lower than that of the state of Uttar Pradesh in India, but the fatalities in Brazil are 32.2% higher than that of the whole of India. Clearly, this necessitates a detailed scientific study on the causative factors behind these striking differences. It is time to study what factors cause recovery with minimal medical intervention and what lifestyle and other factors are correlated to serious complications, leading to belated recovery and sometimes death. Obesity, excessive consumption of alcohol, soft drinks, ultra-processed meat, processed food, and maida-sugar baked items may have a role to play in the health scenario in USA. On the other hand, the use of turmeric, black pepper, ginger, lemon, etc. in daily cooking and the enormous increase in awareness and the consequent consumption of Indian gooseberry, Tulasi, different decoctions (Kashaya) and the practice of various immune-boosting and breathing exercises and yogasanas might have had a role in the Indian medical scenario. A detailed study involving a sizable number of cases of recovery and death in India, Brazil, the USA, and some European countries will throw light on the causative factors behind the significant differences. The results shall provide crucial learning for managing future waves and pandemics. © 2021 IEEE.

Development and Feasibility Test of a Mouth Contactless Breathing Exercise Solution Using Virtual Reality: A Randomized Crossover Trial.

PURPOSE: The purpose of this study was to develop a novel mouth contactless breathing exercise solution based on virtual reality (VR), and to test its feasibility. METHODS: We developed the Virtual Reality-based Breathing Exercise System (VR-BRES), a self-regulating biofeedback breathing exercise with gaming characteristics and a soft stretch sensor. The feasibility and efficacy of the VR-BRES prototype were investigated through a randomized crossover trial. Fifty healthy adults participated in the trial, and their respiratory parameters and user evaluation of the VR-BRES were compared with conventional deep breathing (CDB) exercises. RESULTS: The respiratory parameters, forced vital capacity (Z = 4.82, 4.95, p < .001), forced expiratory volume in one second (t = 6.02, 6.26, p < .001), and peak expiratory flow (t = 5.35, 5.68, p < .001) were significantly higher during breathing exercises using the VR-BRES. User evaluation was also significantly higher for the VR-BRES in terms of efficiency (Z = 3.86, p < .001), entertainingness (Z = 5.00, p < .001), and intention to use (Z = 3.22, p = .001) compared to CDB. However, there was no difference in convenience between the two methods (Z = -0.90, p = .369). CONCLUSION: The VR-BRES has the potential to be an efficient breathing exercise solution. We recommend a clinical study that evaluates the effects of the VR-BRES for a certain period of time for people who need breathing exercises.

Effect of deep breathing exercise with Triflo on dyspnoea, anxiety and quality of life in patients receiving covid-19 treatment: A randomized controlled trial.

AIMS AND OBJECTIVES: Determination of the effect of deep breathing exercise applied with Triflo on dyspnoea, anxiety and quality of life in patients who are hospitalized for COVID-19 and have dyspnoea. BACKROUND: COVID-19 is a viral infection that can cause severe pulmonary disease. Deep breathing exercise with Triflo in patients with COVID-19 may contribute to the reduction/elimination of dyspnoea and anxiety, and improvement of respiratory and quality of life. DESIGN: The study was a randomized controlled clinical trial and conducted in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines. METHODS: The study was conducted in the clinic of COVID-19 of a tertiary hospital. A total of 44 eligible participants were enrolled from January to April 2021. Primary outcomes included oxygen saturation in the blood, respiratory assessment and dyspnoea level. Secondary outcomes included anxiety and quality of life. In the statistical analysis of the data, the independent sample t-test, Wilcoxon test, Mann-Whitney U test and Spearman correlation were used to examine the intervention effect on primary outcomes and secondary outcomes, according to numbers, percentage, mean, standard deviation and conformity to normal distribution. RESULTS: It was determined that the patients in the deep breathing group had a statistically significant shorter hospitalization time (3.04 ± 0.65), higher SpO2  level (97.05 ± 1.46) and higher quality of life (77.82 ± 6.77) compared with the patients in the usual care group (p < 0.05). CONCLUSIONS: Deep breathing exercise with Triflo increases the SpO2  level and quality of life in patients with COVID-19 and contributes to a decrease in dyspnoea and anxiety levels. Moreover, the duration of hospital stay is shortened in patients who are applied deep breathing exercise with Triflo. RELEVANCE TO CLINICAL PRACTICE: With deep breathing exercise applied with Triflo, respiratory rate reaches normal limits in a short time, SpO2  levels increase significantly, and quality of life improves significantly in patients with COVID-19 pneumonia. CLINICAL TRIALS REGISTRATION NUMBER: https://clinicaltrials.gov; NCT04696562.

Breathing exercises versus strength exercises through telerehabilitation in coronavirus disease 2019 patients in the acute phase: A randomized controlled trial.

OBJECTIVE: To compare the effectiveness of two different exercise-based programs through telerehabilitation in patients with coronavirus disease 2019. DESIGN: Randomized, controlled, parallel, double-blinded, three-arm clinical trial. SETTING: Patients' homes through telerehabilitation devices. SUBJECTS: Subjects with coronavirus disease 2019 in the acute phase. INTERVENTIONS: Subjects were divided into three groups: breathing exercises group, strength exercises group or no treatment/control group. MAIN MEASURES: We analysed visual analogue scale for fatigue, 6-minute walking test, 30-seconds sit-to-stand test, multidimensional dyspnoea-12 questionnaire and Borg scale at baseline and 14 days later. RESULTS: From 93 subjects recruited, 88 were enrolled, and 77 patients (mean [SD] age 39.40 [11.71]) completed the 14-days intervention and were included in the analysis: 26 in strength exercises group, 29 in breathing exercises group and 22 in control group. The intergroup analysis shows significant differences between the study groups and control group in all variables (p < 0.05); Borg scale, multidimensional dyspnoea-12 questionnaire (pre-post intervention score: strength exercises group: 7.85 [6.82] - 4.54[4.82], breathing exercises group: 11.04 [6.49] - 5.32 [3.63], control group: 10.27 [6.49] - 10.59[6.58]), visual analogue scale for fatigue, 6-minute walking test and 30-seconds sit-to-stand test (pre-post intervention score: strength exercises group: 12.19 [4.42] - 13.58 [5.37], breathing exercises group: 11.18 [3.42] - 12.79 [4.00], control group: 10.45 [2.15] - 9.86[1.88]). The greatest effect sizes were found in the variables Borg Scale (R2 = 0.548) and multidimensional dyspnoea-12 questionnaire (R2 = 0.475). CONCLUSIONS: Strength exercises group and breathing exercises group obtained significant improvements in fatigue, dyspnoea, perceived effort, and physical state, compared to control group, although the greatest benefits were found for dyspnoea and aerobic capacity in breathing exercises group.

Pulmonary rehabilitation for COVID-19: A living systematic review protocol. / Rehabilitación pulmonar en COVID-19: protocolo de una revisión sistemática viva.

OBJECTIVE: This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. DESIGN: This is the protocol of a living systematic review. DATA SOURCES: We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. ETHICS AND DISSEMINATION: No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

OBJETIVO: Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de la rehabilitación pulmonar en el tratamiento de los pacientes con COVID-19. DISEÑO: Es el protocolo de una revisión sistemática viva. FUENTE DE DATOS: Realizaremos búsquedas en la plataforma L·OVE (Living OVerview of Evidence) para COVID-19, un sistema que mapea los componentes de las preguntas de investigación (PICO) en un repositorio mantenido a través de búsquedas regulares en bases de datos electrónicas, servidores de pre-impresión, registros de ensayos y otros recursos relevantes para COVID-19. No se aplicarán restricciones de fecha ni de idioma. CRITERIOS DE ELEGIBILIDAD PARA LA SELECCIÓN DE ESTUDIOS Y MÉTODOS: Se adaptó un protocolo común ya publicado para revisiones sistemáticas paralelas múltiples a las especificidades de la pregunta. Se incluirán ensayos aleatorios que evalúen el efecto de la rehabilitación pulmonar como monoterapia o en combinación con otras intervenciones frente a un tratamiento simulado o ningún tratamiento en pacientes con COVID-19. Dos revisores examinarán de forma independiente cada estudio para determinar su elegibilidad, extraerán los datos y evaluarán el riesgo de sesgo. Se agruparán los resultados mediante un metaanálisis y se aplicará el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la certeza de las pruebas para cada resultado. ÉTICA Y DIFUSIÓN: No se considera necesaria la aprobación ética. Los resultados de esta revisión se difundirán ampliamente a través de publicaciones revisadas por pares, redes sociales y medios de comunicación tradicionales.

Short-Term Effects of a Respiratory Telerehabilitation Program in Confined COVID-19 Patients in the Acute Phase: A Pilot Study.

The COVID-19 pandemic has caused distress for healthcare providers due to the respiratory problems it causes, among others. In this situation, rehabilitation of the respiratory system has been suggested and implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel program based on breathing exercises through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Forty subjects were randomized in an experimental group, based on pulmonary rehabilitation, and in a control group, of which the subjects did not perform physical activity. Thirty-eight subjects, with nineteen in each group, completed the one-week intervention. We performed measurements using the Six-Minute Walk Test, Multidimensional Dyspnoea-12, Thirty-Second Sit-To-Stand Test, and Borg Scale. Both groups were comparable at baseline. Significant differences were found for all of the outcome measures in favour of the experimental group. Ninety percent adherence was found in our program. A one-week telerehabilitation program based on respiratory exercises is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage.