Review Effectiveness of inspiratory muscle training and multicomponent physical training in patients with post-COVID conditions, 2025, da Costa Correia et al

[rvallee]

Effectiveness of inspiratory muscle training and multicomponent physical training in patients with post-COVID conditions: a systematic review and meta-analysis

Effectiveness of inspiratory muscle training and multicomponent physical training in patients with post-COVID conditions: a systematic review and meta-analysis - Systematic Reviews

Background There is evidence that fatigue and dyspnea are among the most frequently reported symptoms of post-COVID condition. Therefore, several studies have investigated respiratory muscle or global peripheral muscle training as strategies to manage those symptoms. Despite evidence of...

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BMC Systematic reviews

Abstract

Background
There is evidence that fatigue and dyspnea are among the most frequently reported symptoms of post-COVID condition. Therefore, several studies have investigated respiratory muscle or global peripheral muscle training as strategies to manage those symptoms. Despite evidence of potential benefits, conflicting results persist due to the heterogeneity of rehabilitation protocols and assessment tools. Thereby, the objective of this systematic review was to evaluate the effectiveness of inspiratory muscle training and multicomponent physical training in adults with dyspnea and fatigue for at least 12 weeks after COVID-19.

Method
A search was conducted in September 2024, in the Cochrane Library (Cochrane Central Register of Controlled Trials), EMBASE, PubMed/MEDLINE, PEDro, Lilacs/BVS, Web of Science, Scopus, and Epistemonikos databases. The inclusion criteria were randomized clinical trials published in any language that evaluated the effectiveness of inspiratory muscle training and multicomponent physical training to improve fatigue, dyspnea, and/or physical function in adults with persistent post-COVID symptoms. The risk of bias of the included studies and the certainty of the evidence were assessed using the RoB 2 and GRADE tools, respectively.

Results
After the screening process, seven randomized clinical trials were included. The total number of participants included in the studies was 449. Inspiratory muscle training significantly improved inspiratory muscle strength (maximal inspiratory pressure) (MD = 22.70; 95% CI: 13.78 to 31.62), and cardiopulmonary capacity ( O2max) (MD = 4.49; 95% CI: 3.35 to 5.62). Multicomponent physical training significantly improved the upper and lower body muscle strength through the handgrip strength (MD = 3.05; 95% CI: 1.68 to 4.42), sit-to-stand test (MD = 3.55; 95% CI: 1.61 to 5.49), and timed up and go test (MD = − 1.13; 95% CI: − 1.49 to − 0.77) and the physical functioning were assessed through post-COVID-19 functional scale (MD = − 0.64; 95% CI: − 1.13 to − 0.16) and physical aspects through SF-12 and SF-36 (SMD = 0.72; 95% CI: 0.29 to 1.15). No adverse events were reported among participants in the physical training group, and treatment adherence ranged from 78 to 100%.

Conclusion
Inspiratory muscle training improved cardiorespiratory outcomes, while multicomponent physical training improved muscle strength, physical functioning, and fatigue. Both types of training improve physical functioning. The certainty of evidence for the outcomes evaluated was low.

 

[Utsikt]

Exclusion criteria​

The exclusion criteria were studies evaluating rehabilitation exercise programs that lasted less than 6 weeks or were conducted at a frequency of fewer than two sessions per week. Additionally, studies with participants diagnosed with ME/CFS and those who underwent rehabilitation for physical fatigue after COVID-19 with relevant symptoms for less than 3 months were also excluded.

Can’t be generalised to ME/CFS at least..

Some of the studies should not have been included due to risk of bias. I have not looked at them to see if the assessments are reasonable.

Certainty of evidence​

The certainty of evidence was rated as low for all outcomes (FEV₁, FVC, FEV₁/FVC, V̇O₂max, HGS, STS, TUG, PCFS, and physical functioning)

Low and very low means that the evidence can’t be relied upon for clinical decisions. Therefore, it should have been disregarded.

The authors appear to be incapable of recognising this, and go on to make these explicit clinical recommendations:

As clinical implications of this systematic review, we can highlight the following:

Isolated IMT appears insufficient for managing PCC symptoms, requiring combined strategies (e.g., MPT with psychological support). Given the prominent role of peripheral muscle deconditioning in individuals with PCC, participation in an MPT program aimed at improving muscle strength, physical functioning, and fatigue perception is essential.

Rehabilitation protocols should account for the chronic and multisystemic nature of PCC, avoiding direct comparisons with acute COVID-19 or traditional respiratory diseases.

The findings of this systematic review contribute to refining rehabilitation strategies for PCC, emphasizing muscle reconditioning over traditional cardiopulmonary metrics.

It is also important to highlight that pulmonary rehabilitation, delivered either in-person or remotely, remains the standard physical intervention for improving dyspnea, physical function, and quality of life in patients with PCC [99].

Instead, the conclusion should have been that there is no evidence for using exercise as a means to rehabilitate pwLC, and that any future trials of the intervention need to address the methodological limitations identified here, otherwise they should not be conducted.

 

[Sean]

Conclusion
Inspiratory muscle training improved cardiorespiratory outcomes, while multicomponent physical training improved muscle strength, physical functioning, and fatigue. Both types of training improve physical functioning. The certainty of evidence for the outcomes evaluated was low.

So on what basis are you making those recommendations?