Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory tract disease. The most common clinical manifestation of severe COVID-19 is acute respiratory failure. Respiratory rehabilitation can be a crucial part of treatment, but data lack for patients with COVID-19. This study investigates the effects of short-term respiratory rehabilitation (i.e., breathing exercises) on respiratory recovery among non-ICU hospitalised patients with COVID-19.

Methods: This was a quasi-experimental, pre-and post-test study. The study recruited 173 patients hospitalised with moderate to severe COVID-19. All the patients received standardised care for COVID-19, and 94 patients in the intervention group also received the intervention of breathing exercises, which included breathing control, followed by diaphragmatic breathing, deep breathing, or thoracic expansion exercise, and huffing (forced expiratory technique) and coughing. Data on the mean values of peripheral oxygen saturation (SpO2), need for oxygen therapy (litre/min), respiratory rate (breaths/minute), and heart rate (beats/minute) and were collected at baseline, 4 days, and 7 days after the baseline assessment. Analysis of variance on repeated measures was applied to compare the mean value of outcome measures of all the time points.

Results: The mean (± SD) age of the intervention (69.6% men) and control group (62.1% men) were 50.1 (10.5) and 51.5 (10.4) years, respectively. At 4-day of follow-up, SpO2 (96.6% ± 1.9 vs. 90.7% ± 1.8, P < 0.001), need for oxygen therapy (0.8 ± 2.6 vs. 2.3 ± 2.9, P < 0.001), respiratory rate (20.5 ± 2.3 vs. 22.3 ± 2.5, P < 0.001), and heart rate (81.2 ± 9.5 vs. 89.2 ± 8.9, P < 0.001) improved in the intervention group compared to the control group. At 7-day follow-up, differences remained significant concerning the oxygen saturation and the need for oxygen therapy (P < 0.001) between the groups.

Conclusions: Our results indicate that breathing exercise, even for a short period, effectively improves specific respiratory parameters in moderate to severe COVID-19 patients. As a non-invasive and cost-effective respiratory rehabilitation intervention, breathing exercise can be a valuable tool for a health care system overwhelmed by the COVID-19 pandemic. These results should be considered preliminary until they are replicated in larger samples in different settings.

Keywords: Bangladesh; Breathing; COVID; Chest PT; Oxygen saturation; Physiotherapy; Pulmonary exercise; Respiratory rehabilitation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

Flow diagram of patients through phases of a 2-group parallel quasi-experimental design. ICU intensive care unit

Fig. 2

A Oxygen saturation (SpO2) over three time points (i.e., 1 = baseline; 2 = 4-day follow-up; 3 = 7-day follow-up) between groups (i.e., intervention and control group) (P < 0.001 at the time point 2 and 3); B Need of oxygen (liter/minute) over three time points between groups (P < 0.001 at the time point 2 and 3); C Respiratory rate (breaths/minute) over three time points between groups (P < 0.001 at the time point 2, and P = 0.09 at the time point 3); D Heart rate (beats/minute) over three time points between groups (P < 0.001 at the time point 2, and P = 0.47 at the time point 3)