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Objective propose: to investigate the effect of home based breathing exercise and chest mobilization on the cardiorespiratory functional capacity of Covid-19 survivors with cardiovascular comorbidity.
Breathing exercise and chest mobilization are proven to increase lung functional capacity in Covid-19 survivors. It is hypothesized that breathing exercise and chest mobilization in Covid-19 survivors will give benefits to Covid-19 survivors with cardiovascular disease.
Lung restrictive disorder is one of the reasons that induce chronic fatigue in COVID-19 (Corona Virus Disease-19) survivors. It also gives a significant effect on cardiovascular patients who are in the second phase of cardiac rehabilitation. Breathing exercise and chest mobilization are proven to increase lung functional capacity in Covid-19 survivors. On the other hand, there is still no research that shows the effectiveness of Breathing exercises and chest mobilization in Covid-19 survivors who are suffering from cardiovascular problems.
Patients in National Cardiac Center Hospital, Jakarta, with a history of Covid-19 and have cardiovascular disease are recruited. They will undergo pre and post-exercise examinations such as blood sampling, do 6 minutes walking test, Peak Cough Flow and Peak Flow Rate test, measuring the chest dimension, treadmill, and answer the European Quality of Life Five Dimension (EQ-5D) questions. With randomization, patients will be determined to treatment or control group. They will be prepared about what exercises should they do at home. Subjects will be supervised digitally and regularly through Zoom meetings. Exercises will be done for 3 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| No Breathing Exercise | Active Comparator | Patients will do the second phase of cardiac rehabilitation for minimum 5 times per week, 30 minutes each time, in 3 months without being supervised |
|
| With Breathing Exercise | Experimental | Patients will do the second phase of cardiac rehabilitation for minimum 5 times per week, 30 minutes each time and breathing and chest mobilization exercise for 3 times per week. They will be supervised through online meetings. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Breathing and chest mobilization exercises | Behavioral | Patients walk regularly 5 times per week and increase the distance day by day according to their improved ability. Patients also do breathing and chest mobilization exercise 3 times per week. It is a recorded moderated exercise for 30 minutes duration. Patients can access the video as a home-based activity through an online videos platform and will be supervised. |
| Measure | Description | Time Frame |
|---|---|---|
| Change of Peak Cough Flow (PC) | to define the functional capacity. Unit of measure : L/min. | Change from Baseline Peak Cough Flow (PC) at 3 months |
| Change of Peak Flow Rate (PFR) | to define the functional capacity. Unit of measure : L/min. | Change from Baseline Peak Flow Rate (PFR) at 3 months |
| Change of Cardiac Exercise Test | Patients walk on treadmill. Unit of measure : minutes, METs (Metabolic Equivalent of Task) | Change from Baseline Cardiac Exercise Test at 3 months |
| Change of 6-minutes walking test | To define initial ability to walk in 30 minutes for second phase cardiac rehabilitation (aerobic exercise). Unit of measure : meter | Change from Baseline 6-minutes walking test at 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change of Hemoglobin | Hemoglobin (g/dL) | Change from Baseline Hemoglobin at 3 months |
| Change of Hematocrit | Hematocrit (%) | Change from Baseline Hematocrit at 3 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Bambang Dwiputra, MD, FIHA | National Cardiovascular Center Harapan Kita Hospital Indonesia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Cardiovascular Center Harapan Kita Hospital Indonesia | Jakarta | 11420 | Indonesia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | 1. WHO Indonesia. Coronavirus Disease 2019 (COVID-19) Situation Report-36. [Internet]. WHO; [2020 Dec 2; cited 2021 Feb 12]. Available from: https://www.who.int/indonesia/news/novel-coronavirus/situation-reports | ||
| 32729939 | Background | Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, Walshaw C, Kemp S, Corrado J, Singh R, Collins T, O'Connor RJ, Sivan M. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2021 Feb;93(2):1013-1022. doi: 10.1002/jmv.26368. Epub 2020 Aug 17. | |
| 32859681 |
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|
| Second phase cardiac rehabilitation | Behavioral | Independently, patients walk regularly 5 times per week and increase the distance day by day according to their improved ability without breathing and chest mobilization exercise. |
|
| Change of Erythrocyte | Erythrocyte (million/µL) | Change from Baseline Erythrocyte at 3 months |
| Change of Mean Corpuscular Volume | Mean Corpuscular Volume (fL) | Change from Baseline Mean Corpuscular Volume at 3 months |
| Change of Mean Corpuscular Hemoglobin | Mean Corpuscular Hemoglobin (pg) | Change from Baseline Mean Corpuscular Hemoglobin at 3 months |
| Change of Mean Corpuscular Hemoglobin Concentration | Mean Corpuscular Hemoglobin Concentration (%) | Change from Baseline Mean Corpuscular Hemoglobin Concentration at 3 months |
| Change of Red Cell Distribution Width | Red Cell Distribution Width (%) | Change from Baseline Red Cell Distribution Width at 3 months |
| Change of Leucocyte | Leucocyte (/µL) | Change from Baseline Leucocyte at 3 months |
| Change of Platelet | Platelet (thousand/µL) | Change from Baseline Platelet at 3 months |
| Change of European Quality of Life Five Dimension (EQ-5D) | 1=have no problem, 2=have slight problem, 3=moderate problem, 4=severe problem, 5=unable to do. We will compare the points between pre and post exercise and looking the improvement. | Change from Baseline EQ-5D at 3 months |
| Change of Basophil | Basophil (/µL) | Change from Baseline Basophil at 3 months |
| Change of Eosinophil | Eosinophil (/µL) | Change from Baseline Eosinophil at 3 months |
| Change of Neutrophil | Neutrophil (/µL) | Change from Baseline Neutrophil at 3 months |
| Change of Lymphocyte | Lymphocyte (/µL) | Change from Baseline Lymphocyte at 3 months |
| Change of Monocyte | Monocyte (/µL) | Change from Baseline Monocyte at 3 months |
| Change of C-Reactive Protein | to determine infection markers. Unit of measure : mg/L | Change from Baseline C-Reactive Protein at 3 months |
| Change of D-dimer | Unit of measure : ng/mL | Change from Baseline D-dimer at 3 months |
| Background |
| Eapen MS, Lu W, Gaikwad AV, Bhattarai P, Chia C, Hardikar A, Haug G, Sohal SS. Endothelial to mesenchymal transition: a precursor to post-COVID-19 interstitial pulmonary fibrosis and vascular obliteration? Eur Respir J. 2020 Oct 15;56(4):2003167. doi: 10.1183/13993003.03167-2020. Print 2020 Oct. |
| 32793618 | Background | Abdullahi A. Safety and Efficacy of Chest Physiotherapy in Patients With COVID-19: A Critical Review. Front Med (Lausanne). 2020 Jul 21;7:454. doi: 10.3389/fmed.2020.00454. eCollection 2020. |
| 32462177 | Background | Sardari A, Tabarsi P, Borhany H, Mohiaddin R, Houshmand G. Myocarditis detected after COVID-19 recovery. Eur Heart J Cardiovasc Imaging. 2021 Jan 1;22(1):131-132. doi: 10.1093/ehjci/jeaa166. No abstract available. |
| 33419740 | Background | Salman D, Vishnubala D, Le Feuvre P, Beaney T, Korgaonkar J, Majeed A, McGregor AH. Returning to physical activity after covid-19. BMJ. 2021 Jan 8;372:m4721. doi: 10.1136/bmj.m4721. No abstract available. |
| 33512598 | Background | Ogura A, Izawa KP, Tawa H, Kureha F, Wada M, Harada N, Ikeda Y, Kimura K, Kondo N, Kanai M, Kubo I, Yoshikawa R, Matsuda Y. Impact of the COVID-19 pandemic on phase 2 cardiac rehabilitation patients in Japan. Heart Vessels. 2021 Aug;36(8):1184-1189. doi: 10.1007/s00380-021-01783-5. Epub 2021 Jan 29. |
| 32475821 | Background | Barker-Davies RM, O'Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, Ellis H, Goodall D, Gough M, Lewis S, Norman J, Papadopoulou T, Roscoe D, Sherwood D, Turner P, Walker T, Mistlin A, Phillip R, Nicol AM, Bennett AN, Bahadur S. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020 Aug;54(16):949-959. doi: 10.1136/bjsports-2020-102596. Epub 2020 May 31. |
| Background | 9. ESC. Recommendations on how to provide cardiac rehabilitation activities during the COVID-19 pandemic. [Internet] France: European Society of Cardiology; [2020 Apr 8; cited in 2021 Feb 12]. Available from: https://www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/recommendations-on-how-to-provide-cardiac-rehabilitation-activities-during-the-c |
| 39425012 | Derived | Dwiputra B, Ambari AM, Triangto K, Supriami K, Kesuma TW, Zuhdi N, Phowira J, Radi B. The home-based breathing and chest mobility exercise improves cardiorespiratory functional capacity in long COVID with cardiovascular comorbidities: a randomized study. BMC Cardiovasc Disord. 2024 Oct 18;24(1):574. doi: 10.1186/s12872-024-04196-0. |
| ID | Term |
|---|---|
| D000086382 | COVID-19 |
| D002318 | Cardiovascular Diseases |
| ID | Term |
|---|---|
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D014777 | Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| D012119 | Respiration |
| ID | Term |
|---|---|
| D012143 | Respiratory Physiological Phenomena |
| D002943 | Circulatory and Respiratory Physiological Phenomena |
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