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Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial

Melitta McNarry Orcid Logo, Ronan M G Berg, James Shelley, Joanne Hudson Orcid Logo, Zoe L Saynor, Jamie Duckers Orcid Logo, Keir Lewis, Gwyneth Davies Orcid Logo, Kelly Mackintosh Orcid Logo

European Respiratory Journal, Volume: 59, Issue: 6, Start page: 2103101

Swansea University Authors: Melitta McNarry Orcid Logo, James Shelley, Joanne Hudson Orcid Logo, Gwyneth Davies Orcid Logo, Kelly Mackintosh Orcid Logo

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Abstract

Background: Many people recovering from COVID-19 experience prolonged symptoms, particularly breathlessness. We urgently need to identify safe and effective COVID-19 rehabilitative strategies. The aim of the current study was to investigate the potential rehabilitative role of inspiratory muscle tra...

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Published in: European Respiratory Journal
ISSN: 0903-1936 1399-3003
Published: European Respiratory Society (ERS) 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa59407
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We urgently need to identify safe and effective COVID-19 rehabilitative strategies. The aim of the current study was to investigate the potential rehabilitative role of inspiratory muscle training (IMT).Methods: 281 adults (46.6±12.2 years; 88% female) recovering from self-reported COVID-19 (9.0±4.2 months post-acute infection) were randomized 4:1 to an eight-week IMT or a “usual care” wait list control arm. Health-related quality of life and breathlessness questionnaires (King’s Brief Interstitial Lung Disease (KBILD) and Transition Dyspnoea Index (TDI)), respiratory muscle strength and fitness (Chester Step Test) were assessed pre- and post-intervention. The primary endpoint was KBILD total score, with the KBILD subdomains and TDI being key secondary outcomes. Results: According to intention to treat (ITT), there was no difference between groups in KBILD total score post-intervention (Control: 59.5±12.4; IMT: 58.2±12.3; P&lt;0.05) but IMT elicited clinically meaningful improvements in the KBILD subdomains of breathlessness (Control: 59.8±12.6; IMT: 62.2±16.2; P&lt;0.05) and chest symptoms (Control: 59.2±18.7; IMT: 64.5±18.2; P&lt;0.05), along with clinically meaningful improvements in breathlessness according to TDI (Control: 0.9 ± 1.7 vs. 2.0 ± 2.0; P&lt;0.05). IMT also improved respiratory muscle strength and estimated aerobic fitness. Conclusions: IMT may represent an important home-based rehabilitation strategy for wider implementation as part of COVID-19 rehabilitative strategies. Given the diverse nature of long-COVID, further research is warranted on the individual responses to rehabilitation - the withdrawal rate herein highlights that no one strategy is likely to be appropriate for all.</abstract><type>Journal Article</type><journal>European Respiratory Journal</journal><volume>59</volume><journalNumber>6</journalNumber><paginationStart>2103101</paginationStart><paginationEnd/><publisher>European Respiratory Society (ERS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0903-1936</issnPrint><issnElectronic>1399-3003</issnElectronic><keywords>Long COVID; breathlessness; dyspnoea; fitness; physical activity; post-COVID; quality of life</keywords><publishedDay>2</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-03-02</publishedDate><doi>10.1183/13993003.03101-2021</doi><url/><notes/><college>COLLEGE NANME</college><department>Sport and Exercise Sciences</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>STSC</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2022-07-26T09:34:10.3863586</lastEdited><Created>2022-02-16T09:00:54.6834225</Created><path><level id="1">College of Engineering</level><level id="2">Sports Science</level></path><authors><author><firstname>Melitta</firstname><surname>McNarry</surname><orcid>0000-0003-0813-7477</orcid><order>1</order></author><author><firstname>Ronan M G</firstname><surname>Berg</surname><order>2</order></author><author><firstname>James</firstname><surname>Shelley</surname><order>3</order></author><author><firstname>Joanne</firstname><surname>Hudson</surname><orcid>0000-0003-4732-8356</orcid><order>4</order></author><author><firstname>Zoe L</firstname><surname>Saynor</surname><order>5</order></author><author><firstname>Jamie</firstname><surname>Duckers</surname><orcid>0000-0003-3004-279x</orcid><order>6</order></author><author><firstname>Keir</firstname><surname>Lewis</surname><order>7</order></author><author><firstname>Gwyneth</firstname><surname>Davies</surname><orcid>0000-0003-1218-1008</orcid><order>8</order></author><author><firstname>Kelly</firstname><surname>Mackintosh</surname><orcid>0000-0003-0355-6357</orcid><order>9</order></author></authors><documents><document><filename>59407__23843__b6762f5ae76442bcb54884a920932e13.pdf</filename><originalFilename>59407 with licence.pdf</originalFilename><uploaded>2022-04-13T17:11:29.2202830</uploaded><type>Output</type><contentLength>817093</contentLength><contentType>application/pdf</contentType><version>Accepted Manuscript</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright ©The authors 2022. 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spelling v2 59407 2022-02-16 Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial 062f5697ff59f004bc8c713955988398 0000-0003-0813-7477 Melitta McNarry Melitta McNarry true false 120b09997c79f9494ca91b8a7706efe4 James Shelley James Shelley true false 304341cf2cd1bdb99d7d6ccf0f030d99 0000-0003-4732-8356 Joanne Hudson Joanne Hudson true false 92d69cf8519a334ced3f55142c811d95 0000-0003-1218-1008 Gwyneth Davies Gwyneth Davies true false bdb20e3f31bcccf95c7bc116070c4214 0000-0003-0355-6357 Kelly Mackintosh Kelly Mackintosh true false 2022-02-16 STSC Background: Many people recovering from COVID-19 experience prolonged symptoms, particularly breathlessness. We urgently need to identify safe and effective COVID-19 rehabilitative strategies. The aim of the current study was to investigate the potential rehabilitative role of inspiratory muscle training (IMT).Methods: 281 adults (46.6±12.2 years; 88% female) recovering from self-reported COVID-19 (9.0±4.2 months post-acute infection) were randomized 4:1 to an eight-week IMT or a “usual care” wait list control arm. Health-related quality of life and breathlessness questionnaires (King’s Brief Interstitial Lung Disease (KBILD) and Transition Dyspnoea Index (TDI)), respiratory muscle strength and fitness (Chester Step Test) were assessed pre- and post-intervention. The primary endpoint was KBILD total score, with the KBILD subdomains and TDI being key secondary outcomes. Results: According to intention to treat (ITT), there was no difference between groups in KBILD total score post-intervention (Control: 59.5±12.4; IMT: 58.2±12.3; P<0.05) but IMT elicited clinically meaningful improvements in the KBILD subdomains of breathlessness (Control: 59.8±12.6; IMT: 62.2±16.2; P<0.05) and chest symptoms (Control: 59.2±18.7; IMT: 64.5±18.2; P<0.05), along with clinically meaningful improvements in breathlessness according to TDI (Control: 0.9 ± 1.7 vs. 2.0 ± 2.0; P<0.05). IMT also improved respiratory muscle strength and estimated aerobic fitness. Conclusions: IMT may represent an important home-based rehabilitation strategy for wider implementation as part of COVID-19 rehabilitative strategies. Given the diverse nature of long-COVID, further research is warranted on the individual responses to rehabilitation - the withdrawal rate herein highlights that no one strategy is likely to be appropriate for all. Journal Article European Respiratory Journal 59 6 2103101 European Respiratory Society (ERS) 0903-1936 1399-3003 Long COVID; breathlessness; dyspnoea; fitness; physical activity; post-COVID; quality of life 2 3 2022 2022-03-02 10.1183/13993003.03101-2021 COLLEGE NANME Sport and Exercise Sciences COLLEGE CODE STSC Swansea University 2022-07-26T09:34:10.3863586 2022-02-16T09:00:54.6834225 College of Engineering Sports Science Melitta McNarry 0000-0003-0813-7477 1 Ronan M G Berg 2 James Shelley 3 Joanne Hudson 0000-0003-4732-8356 4 Zoe L Saynor 5 Jamie Duckers 0000-0003-3004-279x 6 Keir Lewis 7 Gwyneth Davies 0000-0003-1218-1008 8 Kelly Mackintosh 0000-0003-0355-6357 9 59407__23843__b6762f5ae76442bcb54884a920932e13.pdf 59407 with licence.pdf 2022-04-13T17:11:29.2202830 Output 817093 application/pdf Accepted Manuscript true Copyright ©The authors 2022. This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contactpermissions@ersnet.org true eng https://creativecommons.org/licenses/by-nc/4.0/
title Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial
spellingShingle Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial
Melitta McNarry
James Shelley
Joanne Hudson
Gwyneth Davies
Kelly Mackintosh
title_short Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial
title_full Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial
title_fullStr Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial
title_full_unstemmed Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial
title_sort Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial
author_id_str_mv 062f5697ff59f004bc8c713955988398
120b09997c79f9494ca91b8a7706efe4
304341cf2cd1bdb99d7d6ccf0f030d99
92d69cf8519a334ced3f55142c811d95
bdb20e3f31bcccf95c7bc116070c4214
author_id_fullname_str_mv 062f5697ff59f004bc8c713955988398_***_Melitta McNarry
120b09997c79f9494ca91b8a7706efe4_***_James Shelley
304341cf2cd1bdb99d7d6ccf0f030d99_***_Joanne Hudson
92d69cf8519a334ced3f55142c811d95_***_Gwyneth Davies
bdb20e3f31bcccf95c7bc116070c4214_***_Kelly Mackintosh
author Melitta McNarry
James Shelley
Joanne Hudson
Gwyneth Davies
Kelly Mackintosh
author2 Melitta McNarry
Ronan M G Berg
James Shelley
Joanne Hudson
Zoe L Saynor
Jamie Duckers
Keir Lewis
Gwyneth Davies
Kelly Mackintosh
format Journal article
container_title European Respiratory Journal
container_volume 59
container_issue 6
container_start_page 2103101
publishDate 2022
institution Swansea University
issn 0903-1936
1399-3003
doi_str_mv 10.1183/13993003.03101-2021
publisher European Respiratory Society (ERS)
college_str College of Engineering
hierarchytype
hierarchy_top_id collegeofengineering
hierarchy_top_title College of Engineering
hierarchy_parent_id collegeofengineering
hierarchy_parent_title College of Engineering
department_str Sports Science{{{_:::_}}}College of Engineering{{{_:::_}}}Sports Science
document_store_str 1
active_str 0
description Background: Many people recovering from COVID-19 experience prolonged symptoms, particularly breathlessness. We urgently need to identify safe and effective COVID-19 rehabilitative strategies. The aim of the current study was to investigate the potential rehabilitative role of inspiratory muscle training (IMT).Methods: 281 adults (46.6±12.2 years; 88% female) recovering from self-reported COVID-19 (9.0±4.2 months post-acute infection) were randomized 4:1 to an eight-week IMT or a “usual care” wait list control arm. Health-related quality of life and breathlessness questionnaires (King’s Brief Interstitial Lung Disease (KBILD) and Transition Dyspnoea Index (TDI)), respiratory muscle strength and fitness (Chester Step Test) were assessed pre- and post-intervention. The primary endpoint was KBILD total score, with the KBILD subdomains and TDI being key secondary outcomes. Results: According to intention to treat (ITT), there was no difference between groups in KBILD total score post-intervention (Control: 59.5±12.4; IMT: 58.2±12.3; P<0.05) but IMT elicited clinically meaningful improvements in the KBILD subdomains of breathlessness (Control: 59.8±12.6; IMT: 62.2±16.2; P<0.05) and chest symptoms (Control: 59.2±18.7; IMT: 64.5±18.2; P<0.05), along with clinically meaningful improvements in breathlessness according to TDI (Control: 0.9 ± 1.7 vs. 2.0 ± 2.0; P<0.05). IMT also improved respiratory muscle strength and estimated aerobic fitness. Conclusions: IMT may represent an important home-based rehabilitation strategy for wider implementation as part of COVID-19 rehabilitative strategies. Given the diverse nature of long-COVID, further research is warranted on the individual responses to rehabilitation - the withdrawal rate herein highlights that no one strategy is likely to be appropriate for all.
published_date 2022-03-02T09:34:09Z
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