Comprehensive Physical Rehabilitation for Respiratory Muscle Dysfunction and Pulmonary Ventilation in Post‑COVID Syndrome

Vollständiger Abstract

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Introduction : Post-COVID syndrome is characterized by persistent respiratory disorders, a key element of which is dysfunction of the respiratory muscles, especially the inspiratory muscles. This leads to dyspnea, reduced exercise tolerance, and decreased quality of life. Objective : To evaluate the clinical efficacy of a physical rehabilitation program combining osteopathic correction, specialized breathing exercises, and classical chest massage in patients with residual effects after COVID-19-associated pneumonia. Materials and methods : A prospective randomized study included 87 patients (mean age 64.8 ± 7.2 years) admitted to the third stage of rehabilitation between 4 weeks and 6 months after hospital discharge. The main group (n=44) received the full rehabilitation complex (osteopathic correction, breathing exercises, and massage), while the comparison group (n=43) received only breathing exercises and massage. Spirometric parameters (VC, FVC, FEV1), maximal inspiratory (MIP) and expiratory (MEP) mouth pressures, saturation (SpO 2 ), 6-minute walk test (6MWT), dyspnea by mMRC scale, anxiety and depression levels (HADS), and quality of life (EQ-5D) were assessed before and after a 14-day rehabilitation course. Results : Initially, all patients showed a reduction in MIP by 38% of normal (p < 0.001) and MEP by 22% (p < 0.01), as well as restrictive ventilation disorders (VC 83.1 ± 10.4% of predicted). After the course, the main group showed significant increases in MIP (by 24.6%, p=0.003), MEP (by 18.3%, p=0.008), VC (by 12.4%, p=0.0001), and FVC (by 10.9%, p=0.0002), whereas in the comparison group the dynamics were not significant for most parameters. Exercise tolerance (6MWT) increased in the main group by 68.5 m (p=0.0001), and dyspnea (mMRC) decreased from 1.6 to 0.3 points (p=0.0001). Anxiety and depression levels decreased by 5.2 points on HADS (p