Breathing Exercises for Post-COVID Syndrome

Overseen By Farha Ikramuddin, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Minnesota

Must not be taking: Antidepressants

Disqualifiers: Lung disease, Smoking, Coronary artery disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 6 months

24 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if breathing exercises can aid individuals with lingering symptoms after recovering from COVID-19. It targets those experiencing shortness of breath, chest tightness, or fatigue, common in Post-Acute Sequelae of COVID-19 (PASC). Participants will either continue their usual care or engage in specific breathing exercises, known as Diaphragmatic Breathing Exercises, to assess potential improvements in symptoms and overall quality of life. The study seeks individuals who tested positive for COVID-19 at least four weeks ago and are experiencing these new or ongoing symptoms, but have not been hospitalized for more than five days or required intensive care. As an unphased trial, this study offers a unique opportunity to explore new ways to enhance quality of life.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, it mentions that participants should have a stable dose of antidepressants prior to COVID-19 infection, suggesting that some medications may be continued if they are stable.

What prior data suggests that these breathing exercises are safe for post-COVID syndrome?

Research has shown that diaphragmatic breathing exercises are generally safe, even for people recovering from COVID-19. Studies have found that these exercises can improve breathing without causing serious side effects.

Participants in similar breathing exercises reported deeper breathing and reduced shortness of breath. There are no major reports of problems caused by the exercises themselves.

Overall, diaphragmatic breathing exercises appear safe and well-tolerated, making them a promising option for those with breathing difficulties after COVID-19. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about diaphragmatic breathing exercises for post-COVID syndrome because they offer a non-invasive and drug-free approach to managing symptoms. Unlike standard treatments, which often involve medication to alleviate symptoms like fatigue and breathlessness, diaphragmatic breathing focuses on strengthening the diaphragm, improving lung capacity, and enhancing overall respiratory function. This method has the potential to empower patients to gain more control over their recovery process with a simple, self-administered technique that can be practiced anywhere.

What evidence suggests that diaphragmatic breathing exercises are effective for post-COVID syndrome?

Studies have shown that diaphragmatic breathing exercises can aid recovery for people with COVID-19. Research suggests these exercises improve lung function and boost physical activity. In this trial, participants will be randomized into two groups: one receiving usual care and the other participating in a diaphragmatic breathing (DB) program. For those with long COVID, also known as post-acute sequelae of COVID-19 (PASC), these exercises can alleviate issues like shortness of breath and fatigue. Specifically, one study found that patients who practiced these breathing exercises experienced significant relief from symptoms such as fatigue and anxiety. These exercises can strengthen the lungs and enhance the overall quality of life for those dealing with ongoing COVID-19 symptoms. ^{3 5 6 7 8}

Who Is on the Research Team?

Farha Ikramuddin, MD

Principal Investigator

University of Minnesota

Are You a Good Fit for This Trial?

This trial is for individuals experiencing diaphragmatic dysfunction after COVID-19, which includes symptoms like shortness of breath and fatigue. Participants should have a history of COVID-19 and be facing ongoing respiratory issues.

Inclusion Criteria

Patients did not need hospitalization of 5 days or more and did not need ICU admission via chart review or history taking

PCR or home kit positive 4 weeks prior to the development of the PASC symptoms

I experience shortness of breath, chest tightness, or fatigue.

Exclusion Criteria

My anxiety medication and dosage have been stable for the last 4 weeks.

I cannot move my shoulders fully.

Individual or group with a serious health condition for which there are no satisfactory standard treatments

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo diaphragmatic breathing exercises to address diaphragmatic dysfunction and improve symptoms such as fatigue and dyspnea

6 months

Regular visits for assessment and monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of quality of life, depression, anxiety, and physical health

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Diaphragmatic Breathing Exercises

Trial Overview The study tests two approaches to treat post-COVID diaphragmatic dysfunction: a specific Diaphragmatic Breathing (DB) program with manipulation techniques versus traditional care methods. The goal is to see which method better improves breathing, reduces fatigue, and enhances quality of life.

How Is the Trial Designed?

Group I: arm 2 Experimental Treatment 1 Intervention

participants randomize to diaphragmatic breathing (DB) program

Group II: arm 1 Active Control 1 Intervention

Participants randomized to usual care

Who Is Running the Clinical Trial?

University of Minnesota

Lead Sponsor

Trials

1,459

Recruited

1,623,000+

Published Research Related to This Trial

A systematic review of 11 studies found that respiratory muscle strength training significantly improves dyspnea, physical capacity, and quality of life in individuals experiencing post-COVID-19 symptoms.

The training was effective both as a standalone intervention and when combined with aerobic and peripheral muscle strength training, indicating its versatility in rehabilitation for post-COVID-19 patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Respiratory Muscle Strength Training in Patients Post-COVID-19: A Systematic Review. Morgan, SP., Visovsky, C., Thomas, B., et al.[2023]

A study involving 60 mild COVID-19 patients showed that modified rehabilitation exercises significantly improved respiratory symptoms over time, indicating their efficacy in enhancing pulmonary function and easing expectoration.

The integration of acupressure with these exercises further supports recovery, making the modified rehabilitation exercises a recommended approach for managing respiratory issues in mild COVID-19 cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modified rehabilitation exercises for mild cases of COVID-19. Zha, L., Xu, X., Wang, D., et al.[2020]

Breathing exercises delivered via telemedicine significantly improved pulmonary function and exercise capacity in post-Covid-19 individuals, with the intervention group showing marked increases in FEV1, FVC, and MVV values after 5 weeks of training.

Participants in the intervention group also increased their six-minute walk distance by an average of 54.27 meters, compared to only 4.69 meters in the control group, highlighting the efficacy of telemedicine-based breathing exercises in enhancing quality of life for those experiencing dyspnea.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating the Efficiency of Breathing Exercises via Telemedicine in Post-Covid-19 Patients: Randomized Controlled Study. Okan, F., Okan, S., Duran Yücesoy, F.[2022]

Pulmonary rehabilitation (PR) is recommended for COVID-19 patients, especially those recovering from mechanical ventilation, and includes techniques like diaphragmatic breathing and resistance-breathing training to improve respiratory function.

While there is limited high-quality research on PR for COVID-19, it is suggested that comprehensive approaches including oxygen therapy, early mobilization, and nutritional support are beneficial, but further studies are needed to assess the long-term effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pulmonary Rehabilitation in COVID-19 patients: A scoping review of current practice and its application during the pandemic. Siddiq, MAB., Rathore, FA., Clegg, D., et al.[2020]

Breathing exercises, particularly pursed-lip breathing (PLB) and ventilatory feedback combined with exercise, significantly improve ventilation metrics such as respiratory rate and tidal volume in COPD patients, based on a review of 19 studies involving 745 participants.

While these breathing exercises enhance ventilation and quality of life, they do not significantly reduce dyspnea compared to control groups, indicating that their benefits may be more focused on improving breathing efficiency rather than alleviating breathlessness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis. Ubolnuar, N., Tantisuwat, A., Thaveeratitham, P., et al.[2020]

A 12-week home-based pulmonary rehabilitation program significantly improved pulmonary symptoms and functional performance in 19 post-COVID-19 patients experiencing ongoing dyspnea.

The program also enhanced expiratory resistance capabilities, suggesting it could be an effective and low-cost strategy for managing post-COVID respiratory issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Home-Based Pilot Pulmonary Program for Dyspneic Patients Post-COVID-19. Morgan, S., Visovsky, C., Thomas, B., et al.[2023]

A six-week pulmonary rehabilitation program for nine patients with post-COVID-19 syndrome significantly improved key respiratory functions, including peak expiratory flow and forced vital capacity, indicating enhanced lung function.

The program also strengthened respiratory muscles and increased the thickness of the diaphragm and quadriceps, suggesting overall improvements in muscle health and endurance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of a rehabilitation protocol on pulmonary and respiratory muscle function and ultrasound evaluation of diaphragm and quadriceps femoris in patients with post-COVID-19 syndrome: a series of cases. Vieira da Costa, K., Tainá Cordeiro de Souza, I., Felix, JVDS., et al.[2023]

Patients recovering from COVID-19, whether shortly after infection or long after (4-20 months), commonly experience pulmonary issues such as diaphragm dysfunction and dysfunctional breathing patterns, highlighting the need for diagnostic awareness.

A specialized rehabilitation program that includes respiratory therapy, muscular training, and psychological support significantly improves pulmonary recovery and helps most patients return to work, demonstrating its efficacy for both immediate and long-term post-COVID care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pulmonary recovery directly after COVID-19 and in Long-COVID. Altmann, CH., Zvonova, E., Richter, L., et al.[2023]

Diaphragm function was significantly impaired in patients hospitalized with COVID-19, but showed marked improvement over time, with thickening fraction (TF) increasing from 0.56 at admission to 1.54 after 12 months, indicating a prolonged recovery period.

The study involved 49 patients, with 28 completing a 1-year follow-up, suggesting that diaphragm ultrasound could be an important tool for monitoring diaphragm function in post-COVID-19 patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sonographic follow-up of diaphragm function in COVID-19: an exploratory study. Veldman, C., de Boer, WS., Kerstjens, HAM., et al.[2023]

In a study involving 52 men with post-COVID-19 syndrome, adding manual diaphragm release to an inspiratory muscle training program significantly improved blood pressure, dyspnoea, fatigue, and aerobic performance compared to inspiratory muscle training alone.

The study group showed a remarkable 48.17% increase in maximum static inspiratory pressure, highlighting the effectiveness of combining diaphragm release with training for enhancing respiratory muscle strength.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Nagy, EN., Elimy, DA., Ali, AY., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11182030/

DIAPHRAGMATIC STRENGTHENING EXERCISES FOR ... In the present study, respiratory muscle training using IS or DB resulted in improved clinical and physical performance in patients with post-COVID-19 condition ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06330376?cond=Post-Acute%20COVID19%20Syndrome&limit=100&aggFilters=status:rec&rank=7

Diaphragmatic Breathing Exercises for Post-COVID-19 ... The purpose of this study is to address Diaphragmatic Dysfunctional (DD) breathing seen in patients with Post-Acute Sequelae of COVID-19 (PASC), which results ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S258953702500344X

Effects of therapeutic interventions on long COVID: a meta- ... Primary outcomes included cardiopulmonary function, exercise capacity, fatigue, and olfactory recovery. Data were pooled using random-effects models, with ...

4. mdpi.com mdpi.com/2077-0383/14/21/7730

Effectiveness of Breathing Exercises and Stabilization ... Results: Patients who received respiratory exercises and stabilization techniques showed significant improvements in MBS (p = 0.0001) and BCSS scores (p = 0.002) ...

5. respiratory-research.biomedcentral.com respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-02857-4

Effectiveness of pulmonary rehabilitation programmes and/or ... Impact Of Active Cycle Of Breathing Technique On Selected Pulmonary Outcomes In Post-COVID Syndrome Patients. J Pharm Negat Results. 2023;14 ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT06330376

Diaphragmatic Breathing Exercises for Post-COVID-19 ... The purpose of this study is to address Diaphragmatic Dysfunctional (DD) breathing seen in patients with Post-Acute Sequelae of COVID-19 (PASC), which results ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1746068925000471

Breathing Retraining and Manual Therapy for long COVID Breathing retraining and manual therapy may both potentially benefit particular long COVID patient phenotypes such as those with dysfunctional ...

8. reaganudall.org reaganudall.org/clinical-trial/diaphragmatic-breathing-exercises-post-covid-19-diaphragmatic-dysfunction-dd

Diaphragmatic Breathing Exercises for Post-COVID-19 The purpose of this study is to address Diaphragmatic Dysfunctional (DD) breathing seenin patients with Post-Acute Sequelae of COVID-19 (PASC), which results ...