Our study aimed to evaluate the effectiveness of a 21-day program combining pulmonaryrehabilitation (PR) with progressive muscle relaxation (PMR) in patients experiencinglong-term symptoms of COVID-19. Participants with persistent symptoms will be randomlyassigned to either a PR group or a PR combined with PMR group. The PR program includesaerobic exercises, strength training, and breathing exercises, while the PMR sessionsinvolve systematic muscle tensing and relaxation techniques. We will measure outcomessuch as lung function, exercise capacity, anxiety, depression, and sleep quality usingvalidated questionnaires and clinical tests.
The study aims to evaluate the effectiveness of a 21-day combined pulmonary
rehabilitation (PR) and progressive muscle relaxation (PMR) program on improving physical
and psychological outcomes in patients with long-term COVID-19 symptoms.
This is a parallel, randomized controlled trial (RCT) with two intervention groups: a
pulmonary rehabilitation (PR) group and a PR combined with progressive muscle relaxation
(PR + PMR) group.
The study will enroll adults aged 18-75 with persistent moderate to severe long-term
COVID-19 symptoms, specifically dyspnea and fatigue, lasting at least three months
post-infection. Inclusion criteria include confirmed COVID-19 diagnosis via PCR or
antibody tests, stable medical condition, and mental readiness to participate. Exclusion
criteria include severe comorbid conditions, recent major surgery, severe cognitive or
psychiatric disorders, active respiratory infections, severe mobility impairments, and
high alcohol or substance abuse.
Participants in the PR group will undergo a 21-day pulmonary rehabilitation program
designed to improve lung function, exercise capacity, and overall physical health,
following American Thoracic Society (ATS) guidelines. The program includes aerobic
exercises performed five days per week at moderate intensity (4-6 on the Borg RPE scale)
for 30-45 minutes per session, including warm-up and cool-down periods. Strength training
is conducted three days per week on non-consecutive days, starting at 50% of the
one-repetition maximum (1RM) and progressively increasing to 70% as tolerated, with each
session lasting 20-30 minutes and including 2-3 sets of 8-12 repetitions for major muscle
groups. Daily breathing exercises focusing on controlled techniques such as diaphragmatic
and pursed-lip breathing for 10-15 minutes per session.
In addition to the PR program, participants in the PR + PMR group will perform daily PMR
sessions designed to reduce anxiety and improve sleep quality. Each PMR session will last
20 minutes, involving systematic muscle tensing and relaxation starting from the feet and
progressing to the head, combined with slow, deep breathing.
The primary outcomes include lung function, exercise capacity, anxiety, depression, sleep
quality, and psychological well-being.
Other: Pulmonary rehabilitation protocol
In the initial phase (days 1-7), aerobic exercise sessions will be 20-30 minutes,
strength training will include 1-2 sets at 50% of 1RM, and breathing exercises will last
10 minutes daily. In the progressive phase (days 8-14), aerobic exercise sessions will
increase to 30-40 minutes, strength training to 2-3 sets at 60% of 1RM, and breathing
exercises to 10-15 minutes daily. In the advanced phase (days 15-21), aerobic exercise
sessions will be 40-45 minutes, strength training will be 2-3 sets at 70% of 1RM, and
breathing exercises will continue for 10-15 minutes daily.
Other: Progressive muscle relaxation protocol
Participants in this arm will undergo a 21-day progressive muscle relaxation (PMR)
program aimed at reducing anxiety and improving sleep quality in patients with long-term
COVID-19 symptoms. Each daily session lasts 20 minutes and involves systematic muscle
tensing and relaxation, starting from the feet and progressing to the head, combined with
slow, deep breathing. During the initial phase (days 1-7), the focus is on introducing
PMR techniques and targeting different muscle groups. In the progressive phase (days
8-14), full-body PMR sessions enhance relaxation and breathing techniques. The advanced
phase (days 15-21) maximizes relaxation and incorporates visualization techniques.
Inclusion Criteria:
- Confirmed diagnosis of COVID-19 through documented positive PCR or antibody tests.
- Persistent long-COVID-19 symptoms, specifically moderate or severe dyspnea and
fatigue, lasting for at least three months post-infection.
- Adults aged between 18 and 75 years.
- Stable medical condition with no recent exacerbations or hospital admissions for
other conditions in the past three months.
Exclusion Criteria:
- Severe comorbid conditions such as moderate to severe heart disease, severe ischemic
or hemorrhagic stroke, neurodegenerative diseases, or severe acute illnesses.
- Major surgery or hospitalization for severe conditions within the past six months.
- Severe cognitive or psychiatric disorders, determined through comprehensive
cognitive and psychiatric evaluations.
- Active respiratory infections or immunocompromised status.
- Severe mobility impairments or chronic pain that could limit participation in
rehabilitation exercises.
- High alcohol intake or substance abuse.
Spitalul de Boli Infectioase si Pneumoftiziologie Victor Babes
Timișoara 665087, Timiș County 665091, Romania
Alexandru Crisan, PhD, Principal Investigator
University of Medicine and Pharmacy "Victor Babes" Timisoara