Influence of Manual Diaphragm Release Technique Combined with Inspiratory Muscle Training on Selected Persistent Symptoms in Men with Post-Covid-19 Syndrome: A Randomized Controlled Trial

Abstract

Objective: To determine whether the addition of manual diaphragm release to an inspiratory muscle training programme is more  effective than inspiratory muscle training alone in reducing blood pressure, dyspnoea, fatigue, and aerobic performance capacity in men with post-COVID-19 syndrome.
Design: A prospective, randomized-controlled trial.
Setting: Chest Disease Department, Outpatient Clinic, Cairo University, Egypt.
Participants: Fifty-two men with post-COVID-19 syndrome were allocated randomly to the study and control groups.
Intervention: The study group underwent diaphragm release plus inspiratory muscle training, whereas the control group received inspiratory muscle training only.
Outcome measures: All patients were assessed with the following measures at baseline and 6 weeks postintervention: maximum static inspiratory pressure for inspiratory muscle strength, peripheral arterial blood pressure, Modified Medical Research Council scale for dyspnoea, Fatigue Severity Scale, serum lactate level, and 6-min walk test distance for aerobic performance.
Results: All outcome measures showed a significant improvement in favour of the study group (p < 0.001) over the control group. However, maximum static inspiratory pressure increased significantly, by 48.17% (p < 0.001) in the study group with no significant change in the control group.
Conclusion: Addition of manual diaphragm release to an inspiratory muscle training programme potentiates the role of inspiratory muscle training in the management of men with symptomatic post-COVID-19 syndrome.

LAY ABSTRACT
Patients with post-COVID-19 syndrome may experience a variety of symptoms that limit their ability to perform daily activities, such as breathing difficulties, diaphragmatic weakness, cardio-vascular abnormalities, fatigue, and intolerance to physical exercise. These problems may be resolved by physical therapy interventions, which may also prevent further decline. The aim of this study was to investigate the impact of adding a specific physiotherapy technique (manual diaphragm release) to inspiratory muscle training, delivered via a POWERbreath (PowerBreathe, IMT International Ltd. Southam, Warwickshire; England UK) on inspiratory muscle strength, blood pressure, dyspnoea, fatigue, lactate level, and aerobic performance capability in men with post-COVID-19 syndrome. A total of 52 men with post-COVID-19 syndrome were enrolled, and all completed the study. Twenty-six patients underwent diaphragm release plus inspiratory muscle training, whereas the other 26 received inspiratory muscle training only. The prescribed training lasted for 6 weeks. The results showed positive effects on the investigated parameters of adding the diaphragm release technique to inspiratory muscle training among these patients.