Abstract
The incidence of persistent respiratory symptoms after acute post-COVID-19 infections, referred to as post-COVID-19 syndrome, is high. This study aimed to determine the feasibility and the acute effects of the combination of aerobic, strength and breathing exercises on pulmonary function and oxygen saturation among women post-COVID-19. This study involved 36 women post-COVID-19, with a mean age of 34.4±9.1 years, in a 45-minute aerobic, strength, and breathing exercise with an intensity of 65-75% maximum heart rate. The pulmonary function was measured with spirometry, while oxygen saturation was measured with an oximeter. These measurements were taken pre and post-exercise. Feasibility was determined as participants’ ability to complete the exercise and the incidence of adverse effects. A pair-t-test and effect size were assessed to estimate the acute effects of the exercise on Cohen’s d estimation. All patients complied, and no adverse events were reported, thus, supporting the feasibility of the exercise protocol. There was an increase in most post-exercise pulmonary function and oxygen saturation compared to pre-exercise (p <.001 to 0.03), with effect sizes ranging from 0.5 to 0.8, indicating medium to large effects of the exercise program on pulmonary functions and oxygen saturation. In conclusion, the combination of aerobic, strength, and breathing exercises is feasible and safe for women post-COVID-19 and potentially improves most pulmonary functions. Further research is recommended to evaluate the longer adaptation of the exercise on the pulmonary function in post-COVID-19.
References
Anastasio, F., Barbuto, S., Scarnecchia, E., Cosma, P., Fugagnoli, A., Rossi, G., Parravicini, M., & Parravicini, P. (2021). Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life. Eur Respir J, 58. https://doi.org/10.1183/13993003.04015-2020
Angulo, J., Assar, M., Álvarez-Bustos, A., & Rodríguez-Mañas, L. (2020). Physical activity and exercise: Strategies to manage frailty. Redox Biology, 35(January), 1–21. https://doi.org/10.1016/j.redox.2020.101513
Arovah, N. I., & Heesch, K. C. (2021). The association between cardiorespiratory fitness and metabolic syndrome diagnosis: A cross-sectional study in Indonesian middle-aged and older adults. Physical Activity Review, 9(2), 101–110. https://doi.org/10.16926/par.2021.09.26
Arovah, N. I., & Heesch, K. C. (2022). Social cognitive measures related to exercise behaviour: Validation in Indonesian middle-aged and older adults. Clinical Epidemiology and Global Health, 14, 100975. https://doi.org/10.1016/J.CEGH.2022.100975
Campoi, H. G., Campoi, E. G., Lopes, R. F. T., Alves, S. A., Regueiro, E. M. G., Regalo, S. C. H., Taube, O. L. S., da SILVA, G. P., Verri, E. D., & Fabrin, S. C. V. (2019). Effects of physical activity on aerobic capacity, pulmonary function and respiratory muscle strength of football athletes and sedentary individuals. Is there a correlation between these variables? Journal of Physical Education and Sport, 19(4), 2466–2471. https://doi.org/10.7752/jpes.2019.04374
Cavigli, L., Fusi, C., Focardi, M., Mandoli, G. E., Pastore, M. C., Cameli, M., Valente, S., Zorzi, A., Bonifazi, M., D’Andrea, A., & D’Ascenzi, F. (2023). Post-Acute Sequelae of COVID-19: The Potential Role of Exercise Therapy in Treating Patients and Athletes Returning to Play. In Journal of Clinical Medicine (Vol. 12, Issue 1). MDPI. https://doi.org/10.3390/jcm12010288
Çelik, Z., Güzel, N. A., Kafa, N., & Köktürk, N. (2022). Respiratory muscle strength in volleyball players suffered from COVID-19. Irish Journal of Medical Science, 191(5), 1959–1965. https://doi.org/10.1007/s11845-021-02849-z
Choi, K., Kim, M., Lee, S. M., & Kim, J. (2021). Exercise-based pulmonary rehabilitation for a post-COVID-19 pulmonary fibrosis patient A case report. https://doi.org/10.1097/MD.0000000000027980
Delbressine, J. M., Machado, F. V. C., Goërtz, Y. M. J., van Herck, M., Meys, R., Houben-Wilke, S., Burtin, C., Franssen, F. M. E., Spies, Y., Vijlbrief, H., van ’t Hul, A. J., Janssen, D. J. A., Spruit, M. A., & Vaes, A. W. (2021). The impact of post-covid-19 syndrome on self-reported physical activity. International Journal of Environmental Research and Public Health, 18(11), 1–11. https://doi.org/10.3390/ijerph18116017
Dominelli, P. B., Molgat-Seon, Y., Weatherald, J., Humbert, M., & Riha, R. (2022). Sex, gender and the pulmonary physiology of exercise Number 5 in the Series “Sex and gender in lung disease” Edited by. Europian Respiratory Review, 31, 1–14. https://doi.org/10.1183/16000617.0074-2021
Eksombatchai, D., Wongsinin, T., Phongnarudech, T., Thammavaranucupt, K., Amornputtisathaporn, N., & Sungkanuparph, S. (2021). Pulmonary function and six-minute-walk test in patients after recovery from COVID-19: A prospective cohort study. PLoS ONE, 16(9), 1–10. https://doi.org/10.1371/journal.pone.0257040
Fernández-De-las-peñas, C., Palacios-Ceña, D., Gómez-Mayordomo, V., Cuadrado, M. L., & Florencio, L. L. (2021). Defining post-covid symptoms (Post-acute covid, long covid, persistent post-covid): An integrative classification. International Journal of Environmental Research and Public Health, 18(5), 1–9. https://doi.org/10.3390/ijerph18052621
Greulich, T., Kehr, K., Nell, C., Koepke, J., Haid, D., Koehler, U., Koehler, K., Filipovic, S., Kenn, K., Vogelmeier, C., & Koczulla, A. R. (2014). A randomized clinical trial to assess the influence of a three months training program (Gym-based individualized vs. Calisthenics-based non-invidualized) in COPD-patients. Respiratory Research, 15(1), 1–8. https://doi.org/10.1186/1465-9921-15-36
Hafen, B. B., & Sharma, S. (2021). Oxygen Saturation. In StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK525974/
Huang, Y., Tan, C., Wu, J., Chen, M., Wang, Z., Luo, L., Zhou, X., Liu, X., Huang, X., Yuan, S., Chen, C., Gao, F., Huang, J., Shan, H., & Liu, J. (2020). Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respiratory Research, 21(163), 1–10. https://doi.org/10.1186/s12931-020-01429-6
Humphreys, H., Kilby, L., Kudiersky, N., & Copeland, R. (2021). Long COVID and the role of physical activity: a qualitative study. BMJ Open, 11(3), 1–8. https://doi.org/10.1136/bmjopen-2020-047632
Huntula, S., Punsawad, C., & Lalert, L. (2022). Alteration in salivary cortisol and interleukin-6 levels during two different intensities of acute aerobic exercise. Journal of Physical Education and Sport ® (JPES), 22(6), 1363–1371. https://doi.org/10.7752/jpes.2022.06171
Jann, B. (2021). 20 Home Strength Training Best Exercise to Burn Fats, Build Muscles, Boosts Strength and Stamina. In Morgan. Morgan.
Jiménez-Pavón, D., Carbonell-Baeza, A., & Lavie, C. J. (2020). Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Progress in Cardiovascular Diseases, 63(3), 386–388. https://doi.org/10.1016/j.pcad.2020.03.009
Kokhan, S., Kolokoltsev, M., Vorozheikin, A., Gryaznykh, А., Romanova, E., Guryanov, M., Faleeva, E., Tarasov, A., & Aganov, S. (2022). Physical rehabilitation of patients with post-COVID syndrome. Journal of Physical Education and Sport ® (JPES), 22(9), 2005–2011. https://doi.org/10.7752/jpes.2022.09255
Lewis, K. L., Helgeson, S. A., Tatari, M. M., Mallea, J. M., Baig, H. Z., & Patel, N. M. (2021). COVID-19 and the effects on pulmonary function following infection: A retrospective analysis. EClinicalMedicine, 39. https://doi.org/10.1016/j.eclinm.2021.101079
Lim, J. (2021). Oximeters and COVID-19 | Health Plus. Health Plus. https://www.mountelizabeth.com.sg/healthplus/article/oximeter
Lin, L., Luo, S., Qin, R., Yang, M., Wang, X., Yang, Q., Zhang, Y., Wang, Q., Zhu, R., Fan, H., Wang, H., Hu, Y., Wang, L., & Hu, D. (2020). Long-term infection of SARS-CoV-2 changed the body’s immune status. Clinical Immunology, 218(July). https://doi.org/10.1016/j.clim.2020.108524
Listiarini, D., Kushartanti, W., & Arovah, N. I. (2022). The Caffeine Supplementation in a Moderate-Intensity Aerobic Exercise in Obese Asian Women. Women in Sport and Physical Activity Journal, 1–7. https://doi.org/10.1123/wspaj.2022-0035
Liu, K., Zhang, W., Yang, Y., Zhang, J., Li, Y., & Chen, Y. (2020). Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complementary Therapies in Clinical Practice, 39(101166), 1–4. https://doi.org/10.1016/J.CTCP.2020.101166
Maulana, G. F., & Arovah, N. I. (2022). The Psychometric Evaluation of the Immune Status Questionnaire in Indonesia. East J Med, 27(3), 380–388. https://doi.org/10.5505/ejm.2022.93764
Mohamed, A. A., & Alawna, M. (2020). Role of increasing the aerobic capacity on improving the function of immune and respiratory systems in patients with coronavirus (COVID-19): A review. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 14(4), 489–496. https://doi.org/10.1016/j.dsx.2020.04.038
Moore, V. C. (2012). Spirometry: step by step. Breathe, 8(3), 232–240. https://doi.org/10.1183/20734735.0021711
Moreno-pérez, O., Merino, E., Leon-ramirez, J., Andres, M., Manuel, J., Arenas-jiménez, J., & Asensio, S. (2021). Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. Journal of Infection, 82(January), 373–378.
Moulson, N., Gustus, S. K., Scirica, C., Petek, B. J., Vanatta, C., Churchill, T. W., Guseh, J. S., Baggish, A., & Wasfy, M. M. (2022). Diagnostic evaluation and cardiopulmonary exercise test findings in young athletes with persistent symptoms following COVID-19. British Journal of Sports Medicine, 56(16), 927–932. https://doi.org/10.1136/bjsports-2021-105157
Naralia, T., Kesehatan, H. P.-S. J. I., & 2021, undefined. (2021). The Effectiveness of Breathing Exercises for Post Covid-19 Patients during Rehabilitation: A Literature Review. Sjik.Org, 10(1), 844–850. https://doi.org/10.30994/sjik.v10i1.717
National Insitute for Health and Care Excellence. (2020). COVID-19 guideline scope: management of the long-term effects of COVID-19. October 2020, 1–7.
Ponce, M. C., & Sharma, S. (2021). Pulmonary Function Tests. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482339/
Ranu, H., Wilde, M., & Madden, B. (2010). Pulmonary function tests. Ulster Med J, 80(2), 84–90. www.ums.ac.uk
Rawashdeh, A., & Alnawaiseh, N. (2018). The effect of high-intensity aerobic exercise on the pulmonary function among inactive male individuals. Biomedical and Pharmacology Journal, 11(2), 735–741. https://doi.org/10.13005/bpj/1427
Roldan, C. (2021). Moves Try the 10-Minute Home Workout and Boost Your Activity Level. In https://us.macmillan.com/piracy. macmillan.
Saeki, T., Ogawa, F., Matsumiya, M., Yamamura, M., Oritsu, H., Nonogaki, M., Uesugi, J., Takeuchi, I., & Nakamura, T. (2021). Long-Term Decreased Exercise Capacity of COVID-19 Patients Who Received Mechanical Ventilation in Japan: A Case Series. American Journal of Physical Medicine and Rehabilitation, 100(8), 737–741. https://doi.org/10.1097/PHM.0000000000001803
Sewa, D. W., & Ong, T. H. (2014). Pulmonary function test: Spirometry. Proceedings of Singapore Healthcare, 23(1), 57–64. https://doi.org/10.1177/201010581402300110
Shokri, I. S. M., Suhaimi, N. S., Illias, N. F., Adnan, R., & Ismail, H. (2022). The effect of cardiovascular responses on aerobic exercise and relationship between pulmonary function and body composition among sedentary students. Journal of Physical Education and Sport ® (JPES), 22(9), 2012–2017. https://doi.org/10.7752/jpes.2022.09256
Suhaimi, N. S. M., Shokri, I. S. M., Illias, N. F., Adnan, R., & Ismail, H. (2022). The cardiovascular responses on difference exercise intensity and the relationship with body composition among sedentary college students. Journal of Physical Education and Sport ® (JPES), 22(10), 2340–2345. https://doi.org/10.7752/jpes.2022.10298
Tang, Y., Jiang, J., Shen, P., Li, M., You, H., Liu, C., Chen, L., Wang, Z., Zhou, C., & Feng, Z. (2021). Liuzijue is a promising exercise option for rehabilitating discharged COVID-19 patients. Medicine, 100(6), e24564. https://doi.org/10.1097/MD.0000000000024564
Thompson, B. (2020). Strength Training After 40: A Practical Guide to Building and Maintaining a Healthier, Leaner, and Stronger Body.
Torres-Castro, R., Vasconcello-Castillo, L., Alsina-Restoy, X., Solis-Navarro, L., Burgos, F., Puppo, H., & Vilaró, J. (2021). Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis. Pulmonology, 27(4), 328–337. https://doi.org/10.1016/J.PULMOE.2020.10.013
Tran, V.-T., Riveros, C., Clepier, B., Desvarieux, M., Collet, C., Yordanov, Y., & Ravaud, P. (2022). Development and validation of the long coronavirus disease (COVID) symptom and impact tools: A set of patient-reported instruments constructed from patients’ lived experience. Clinical Infectious Diseases Clinical Infectious Diseases, 74(2), 278–287. https://doi.org/10.1093/cid/ciab352
Williams, Z., & Hull, J. H. (2022). Respiratory complications following COVID-19 in athletic populations: A narrative review. Scandinavian Journal of Medicine and Science in Sports. https://doi.org/10.1111/sms.14275
Woods, J. A., Hutchinson, N. T., Powers, S. K., Roberts, W. O., Gomez-Cabrera, M. C., Radak, Z., Berkes, I., Boros, A., Boldogh, I., Leeuwenburgh, C., Coelho-Júnior, H. J., Marzetti, E., Cheng, Y., Liu, J., Durstine, J. L., Sun, J., & Ji, L. L. (2020). The COVID-19 pandemic and physical activity. Sports Medicine and Health Science, 2(2), 55–64. https://doi.org/10.1016/j.smhs.2020.05.006
World Health Organization. (2023, January). WHO coronavirus (COVID-19) dashboard. https://covid19.who.int/
Yang, S., Liu, T., Xiong, J., Teng, Y., Guo, Y., Yu, S., & Zeng, F. (2021). Traditional Chinese exercise potential role as prevention and adjuvant therapy in patients with COVID-19. Complementary Therapies in Clinical Practice, 43, 1–4. https://doi.org/10.1016/j.ctcp.2021.101379
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.