The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltration via angiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.

Effect of lower torso training on asthma patients

“…Data from the literature on lower torso muscular endurance on the 6MWT are linked to Pimax. The current study's findings back up prior results with people living with asthma (Chung et al, 2021;Severin et al, 2022). They indicated the influence of Pimax on 6MWT.…”

Associations between Coronavirus and Immune Response, Cardiorespiratory Fitness Rehabilitation and Physical Activity: A Brief Report

“…and "Is it possible to improve cardiorespiratory fitness through a physical activity program to levels similar to uninfected people?" [26,27,29], still remain without evidence-based answers, and we hope that this study will help to resolve some questions. Physical activity levels may play an important role in anti-inflammatory and immunosuppressive effects against COVID-19 [9] and post-disease cardiorespiratory rehabilitation [1][2][3]9].…”

“…The literature about assessing physical activity levels in post-COVID-19 healed persons and their cardiorespiratory fitness is scarce. It is important to know how different physical activity levels are related to the different symptoms of COVID-19 [26,27]. Moreover, there is a need to understand how physical activity can help to improve post-COVID-19 healed persons' cardiorespiratory fitness to similar levels of non-infected people.…”

Respiratory Muscle Strength Training in Patients Post-COVID-19: A Systematic Review

“…Radiologic evidence of lung fibrosis, pulmonary scarring, and interstitial changes have been associated with persistent dyspnea in Long COVID-19 (Yong, 2021). Recent studies hypothesize that the COVID-19 infection may specifically cause damage, resulting in weakness in the respiratory musculature (Severin et al, 2022).…”

“…Radiologic evidence of lung fibrosis, pulmonary scarring, and interstitial changes have been associated with persistent dyspnea in Long COVID-19 (Yong, 2021). Recent studies hypothesize that the COVID-19 infection may specifically cause damage, resulting in weakness in the respiratory musculature (Severin et al, 2022).Respiratory muscle strength training may prove to be a viable option for individuals with persistent dyspnea following COVID-19 infection. Respiratory muscle strength training is known to lead to improved respiratory muscle efficiency, allowing for a reduction in the amount of oxygen needed to perform the work of breathing (Held & Pendergast, 2014).…”