Intermittent Hypoxic–Hyperoxic Training During Inpatient Rehabilitation Improves Exercise Capacity and Functional Outcome in Patients With Long Covid: Results of a Controlled Clinical Pilot Trial

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2024-11-19 DOI:10.1002/jcsm.13628

Wolfram Doehner, Azadeh Fischer, Banafsheh Alimi, Jasmin Muhar, Jochen Springer, Christoph Altmann, Per Otto Schueller

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引用次数: 0

Abstract

Introduction

Long COVID-19 illness is a severely disabling disease with shortness of breath, weakness and fatigue as leading symptoms, resulting in poor quality of life and substantial delay in return to work.

No specific respiratory therapy has been validated for patients with long COVID. The intermittent hypoxia–hyperoxia training (IHHT) is a respiratory therapeutic modality to improve exercise performance via controlled respiratory conditioning. The purpose of the present study is to investigate the therapeutic effect of IHHT on functional and symptomatic recovery of patients with long COVID syndrome.

Methods

A prospective, controlled, open-treatment interventional study was conducted in patients with long COVID who were admitted to an inpatient rehabilitation programme. Patients were assigned nonrandomized to receive IHHT in addition to the standardized rehabilitation programme (IHHT group) or standard rehabilitation alone (control group). The IHHT group received supervised sessions of intermittent hypoxic (10–12% O₂) and hyperoxic (30–35% O₂) breathing three times per week throughout the rehabilitation period. Primary endpoint was improved walking distance in a 6-min walk test (6MWT) between study groups. Secondary endpoints were change in stair climbing power, dyspnoea (Borg dyspnoea Scale), fatigue assessment scale (FAS) and change in health-related quality of life (HRQoL) assessed by patient global assessment (PGA), EQ-5D analogue scale and the MEDIAN Corona Recovery Score (MCRS). Further assessments included maximum handgrip strength, nine hole peg test, timed up-and-go, respiratory function and functional ambulation category (FAC), serum analyses and safety of the intervention.

Results

A total of 145 patients were included in the study (74% female, mean age 53 ± 12 years) and assigned to IHHT (n = 70) or standard care (n = 75). The 6MWT distance improved 2.8-fold in the IHHT group compared to the control group (91.7 ± 50.1 m vs. 32.6 ± 54.2 m, ANCOVA p < 0.001). Stair climbing power improved 3.7-fold in the IHHT group compared to controls (−1.91 ± 2.23 s vs. −0.51 ± 1.93 s, p < 0.001). Secondary endpoints on dyspnoea, fatigue and HRQoL (PGA, EQ-5D and MCRS) improved significantly in the IHHT group compared to controls. The IHHT group exhibited a significant decrease in blood pressure, heart rate and increase in haemoglobin levels that was not observed in the control group. No adverse events were observed.

Conclusion

Respiratory treatment with IHHT in addition to a multidisciplinary rehabilitation programme improves functional capacity, symptomatic status and quality of life in patients with disabling long COVID. IHHT has been demonstrated to be safe, well tolerated and feasible to be integrated in an inpatient rehabilitation programme to improve outcome in long COVID.

Abstract Image

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住院康复期间的间歇性低氧-高氧训练可提高长 Covid 患者的运动能力和功能结果：一项对照临床试点试验的结果。

导言：长程 COVID-19 疾病是一种严重致残性疾病，以气短、虚弱和疲劳为主要症状，导致生活质量低下和重返工作岗位的时间大大延迟。目前还没有针对长期 COVID 患者的特定呼吸疗法。间歇性缺氧-高氧训练（IHHT）是一种呼吸治疗方法，可通过控制呼吸调节来改善运动表现。本研究旨在探讨间歇性缺氧-高氧训练对长COVID综合征患者功能和症状恢复的治疗效果：一项前瞻性、对照、开放式治疗干预研究针对住院康复计划的长 COVID 患者进行。患者被非随机分配到在接受标准化康复计划的同时接受 IHHT 治疗（IHHT 组）或单独接受标准康复治疗（对照组）。IHHT组在整个康复期间每周接受三次间歇性缺氧（10-12%氧气）和高氧（30-35%氧气）呼吸的指导。主要终点是研究组之间在6分钟步行测试（6MWT）中步行距离的改善。次要终点是爬楼梯能力的变化、呼吸困难（博格呼吸困难量表）、疲劳评估量表（FAS）以及健康相关生活质量（HRQoL）的变化，通过患者总体评估（PGA）、EQ-5D 模拟量表和 MEDIAN Corona 恢复评分（MCRS）进行评估。进一步的评估包括最大握力、九孔钉试验、定时起立行走、呼吸功能和功能性行走类别（FAC）、血清分析和干预的安全性：共有 145 名患者（74% 为女性，平均年龄为 53 ± 12 岁）参与了研究，并被分配接受 IHHT（70 人）或标准护理（75 人）。与对照组相比，IHHT 组的 6MWT 距离缩短了 2.8 倍（91.7 ± 50.1 米 vs 32.6 ± 54.2 米，ANCOVA p 结论：在实施多学科康复计划的同时使用 IHHT 进行呼吸治疗，可改善致残性长期 COVID 患者的功能、症状和生活质量。事实证明，IHHT 安全、耐受性好，可纳入住院康复计划以改善长期 COVID 患者的治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.