Skip to main content Skip to main navigation menu Skip to site footer

The effectiveness of incentive spirometry exercise on pulmonary function in COVID-19 survivors: a randomized controlled trial study

  • Rosa Indah Kusumawardani ,
  • Damayanti Tinduh ,
  • Andriati ,
  • Dewi Poerwandari ,
  • Isnin Anang Marhana ,
  • Soenarnatalina Melaniani ,


Abstract

Background: COVID-19 survivors often result in persistent symptoms, even months after being discharged, that lead to decreased lung function. Incentive spirometry is commonly used in pulmonary rehabilitation as it encourages the patient to take slow and deep inspiration through visual feedback. This study aimed to analyze the effects of incentive spirometry exercise on pulmonary function in COVID-19 survivors.

Method: Twenty COVID-19 survivors aged 18-59 were enrolled in the study and divided randomly into two groups; ten survivors in the experimental group that received incentive spirometry exercise and ten survivors in the control group that received diaphragmatic breathing exercise. Both exercises were performed five times daily, with ten repetitions each for four weeks. Peak expiratory flow (PEF) was measured by a peak flow meter before and after the treatment in both groups. The data were analyzed statistically.

Result: There was a significant increase in pulmonary function in the experimental group (p=0.001) and control group (p=0.001). However, the two groups had no significant difference in pulmonary function (p=0.198). The incentive spirometry exercise shows a more significant effect on pulmonary function rather than diaphragmatic breathing.

Conclusion: Incentive spirometry exercise could be an alternative therapy to improve the pulmonary function of COVID-19 survivors.

Keywords: COVID-19 survivors incentive spirometry peak expiratory flow (PEF)

References

  1. Wulandari L, Hamidah B, Pakpahan C, et al. Initial study on TMPRSS2 p.Val160Met genetic variant in COVID-19 patients. Hum Genomics. 2021;15(29). p1-9. https://doi.org/10.1186/s40246-021-00330-7.
  2. Moy FM, Hairi NN, Lim ERJ, Bulgiba A. Long COVID and its associated factors among COVID survivors in the community from a middle-income country-An online cross-sectional study. PLoS One. 2022;17(8):e0273364. Published 2022 Aug 30. doi:10.1371/journal.pone.0273364.
  3. Khairsyaf O, Masrul B, Nuriman A, Hamdani K, and Gorga H. Long Covid Incidence and Influencing Factors of Covid-19 Survivors in the Working Area of Lubuk Begalung Health Center, Padang. Journal of Biomedicine and Translational Research. 2022;6(4). p1666–1674. http://dx.doi.org/10.37275/bsm.v6i4.492.
  4. World Health Organization. Clinical Management of Severe Acute Respiratory Infection (SARI) When COVID-19 Disease Is Suspected: Interim Guidance. 2020.
  5. Michelen M, Manoharan L, Elkheir N, et al. Characterising long COVID: a living systematic review. BMJ Glob Health. 2021;6(9):e005427. doi:10.1136/bmjgh-2021-005427.
  6. Kusuma VP, Ardiany D. The Pathophysiology and Outcomes of Diabetic Patients with Coronavirus Disease 2019 (COVID-19). Biomolecular and Health Science Journal. 2021;4(2). p31-136. http://dx.doi.org/10.20473/bhsj.v4i2.30030.
  7. Hasanudin H, Sukartini T, Makhfudli M, Rosyid AN, Revita NCT, Aini HN. The Effectiveness of Pulmonary Rehabilitation on Pulmonary Function among Adults Patients of COVID-19 Survivors: A Systematic Review. JR. 2022;8(1):15-2. https://doi.org/10.20473/jr.v8-I.1.2022.15-25
  8. Yong MS, Lee HY, Lee YS. Effects of diaphragm breathing exercise and feedback breathing exercise on pulmonary function in healthy adults. J Phys Ther Sci. 2017;29(1):85-87. doi:10.1589/jpts.29.85.
  9. Suharti A. Hidayati ERN, Yusviani HA. Comparative Effect of Incentive Spirometry and Diaphragm Breathing to Functional Capacity in COVID-19 Patient in An Isolated Ward. Bali Medical Journal. 2022;11(3). p1415-1419. doi:10.15562/bmj.v11i3.3579.
  10. Hopper SI, Murray SL, Ferrara LR, Singleton JK. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database System Rev Implement Rep. 2019;17(9):1855-1876. doi:10.11124/JBISRIR-2017-003848.
  11. Restrepo RD, Wettstein R, Wittnebel L, Tracy M. Incentive spirometry: 2011. Respir Care. 2011;56(10):1600-1604. doi:10.4187/respcare.01471.
  12. Kader M, Hossain MA, Reddy V, Perera NKP, Rashid M. Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study. BMC Sports Sci Med Rehabil. 2022;14(1):60. Published 2022 Apr 5. doi:10.1186/s13102-022-00451-z.
  13. Cox NS, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021;1(1):CD013040. Published 2021 Jan 29. doi:10.1002/14651858.CD013040.pub2.
  14. Prabawa IMY, Silakarma D, and Widnyana M. Telerehabilitation as a physical therapy solution for the post-stroke patient in COVID-19 pandemic situations: A review. ISM. 2021;12(1). p1–5. https://doi.org/10.15562/ism.v12i1.873.
  15. Galea MD. Telemedicine in Rehabilitation. Phys Med Rehabil Clin N Am. 2019;30(2):473-483. doi:10.1016/j.pmr.2018.12.002.
  16. Vieira AGDS, Pinto ACPN, Garcia BMSP, Eid RAC, Mól CG, Nawa RK. Telerehabilitation improves physical function and reduces dyspnoea in people with COVID-19 and post-COVID-19 conditions: a systematic review. J Physiother. 2022;68(2):90-98. doi:10.1016/j.jphys.2022.03.011.
  17. Franczuk M, Przybyłowski T, Czajkowska-Malinowska M, et al. Spirometry during the SARS-CoV-2 pandemic. Guidelines and practical advice from the expert panel of Respiratory Physiopathology Assembly of Polish Respiratory Society. Adv Respir Med. 2020;88(6):640-650. doi:10.5603/ARM.a2020.0186.
  18. Aydın YY, Sönmez BM, Yurtseven A, Ensarioglu K, Kurt B. Effect of respiratory exerciser on pulmonary functions of COVID-19 patients: A prospective, observational study. Indian J Respir Care. 2022;11:234-9. DOI: 10.4103/ijrc.ijrc_29_22.
  19. Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863. Published 2013 Nov 26. doi:10.3389/fpsyg.2013.00863.
  20. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. Preprint. medRxiv. 2021;2021.01.27.21250617. Published 2021 Jan 30. doi:10.1101/2021.01.27.21250617.
  21. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management [published correction appears in BMJ. 2021 Aug 3;374:n1944]. BMJ. 2021;374:n1648. Published 2021 Jul 26. doi:10.1136/bmj.n1648.
  22. Wei J, Yang H, Lei P, et al. Analysis of thin-section CT in patients with coronavirus disease (COVID-19) after hospital discharge. J Xray Sci Technol. 2020;28(3):383-389. doi:10.3233/XST-200685.
  23. Nugraha B, Wahyuni LK, Laswati H, Kusumastuti P, Tulaar AB, Gutenbrunner C. COVID-19 pandemic in Indonesia: Situation and challenges of rehabilitation medicine in Indonesia. Acta Med Indones. 2020;52(3):299-305.
  24. Wade DT. Rehabilitation after COVID-19: an evidence-based approach. Clin Med (Lond). 2020;20(4):359-365. doi:10.7861/clinmed.2020-0353.
  25. Liao X, Wang Y, He Z, et al. Three-Month Pulmonary Function and Radiological Outcomes in COVID-19 Survivors: A Longitudinal Patient Cohort Study. Open Forum Infect Dis. 2020;8(9):ofaa540. Published 2020 Nov 14. doi:10.1093/ofid/ofaa540.
  26. Zhao HM, Xie YX, Wang C; Chinese Association of Rehabilitation Medicine; Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine; Cardiopulmonary Rehabilitation Group of Chinese Society of Physical Medicine and Rehabilitation. Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019. Chin Med J (Engl). 2020;133(13):1595-1602. doi:10.1097/CM9.0000000000000848.
  27. Prabawa IMY, Silakarma D, Manuaba I, Widnyana M, and Jeviana A. Chest therapy and breathing exercise in COVID-19 patient: a case report. Bali Medical Journal. 2021;10(2). p495-498. DOI:10.15562/bmj.v10i2.2403.
  28. DeVrieze BW, Modi P, Giwa AO. Peak Flow Rate Measurement. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 1, 2022.
  29. Motta LP, Silva PPFD, Borguezan BM, et al. An emergency system for monitoring pulse oximetry, peak expiratory flow, and body temperature of patients with COVID-19 at home: Development and preliminary application. PLoS One. 2021;16(3):e0247635. Published 2021 Mar 26. doi:10.1371/journal.pone.0247635.
  30. Hamasaki H. Effects of Diaphragmatic Breathing on Health: A Narrative Review. Medicines (Basel). 2020;7(10):65. Published 2020 Oct 15. doi:10.3390/medicines7100065.
  31. Kaur H. Variations in the Peak Expiratory Flow Rate with Various Factors in a Population of Healthy Women of the Malwa Region of Punjab, India. JCDR. 2013;7(6). p1000-1003. http://dx.doi.org/10.7860/JCDR/2013/5217.3049.
  32. Bhardwaj P, Poonam K, Jha K, Bano M. Effects of age and body mass index on peak-expiratory flow rate in Indian population. Indian J Physiol Pharmacol. 2014;58(2):166-169.
  33. Kumar AS. Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial. JCDR. 2016;10(1). p1-6. http://dx.doi.org/10.7860/JCDR/2016/16164.7064.
  34. Aliasgharpour M, Arazi T, Mohammadi S, Mohammadi N, Kazemnejad A. Effect of Incentive Spirometry on Pulmonary Function Tests in Patients Undergoing Hemodialysis: A Randomized Clinical Trials. Iranian Rehabilitation Journal. 2018;16(3). p265–70. http://dx.doi.org/10.32598/irj.16.3.265.
  35. Sum SK, Peng YC, Yin SY, et al. Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial. Trials. 2019;20(1):797. Published 2019 Dec 30. doi:10.1186/s13063-019-3943-x.
  36. Shetty N, Samuel SR, Alaparthi GK, Amaravadi SK, Joshua AM, Pai S. Comparison of Diaphragmatic Breathing Exercises, Volume, and Flow-Oriented Incentive Spirometry on Respiratory Function in Stroke Subjects: A Non-randomized Study. Ann Neurosci. 2020;27(3-4):232-241. doi:10.1177/0972753121990193.
  37. Alaparthi GK, Augustine AJ, Anand R, Mahale A. Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial. Minim Invasive Surg. 2016;2016:1967532. doi:10.1155/2016/1967532.
  38. Seyller H, Gottlieb M, Colla J. A breath of fresh air: The role of incentive spirometry in the treatment of COVID-19. Am J Emerg Med. 2021;48:369. doi:10.1016/j.ajem.2021.01.084.

How to Cite

Kusumawardani, R. I., Tinduh, D., Andriati, Poerwandari, D., Marhana, I. A., & Melaniani, S. (2023). The effectiveness of incentive spirometry exercise on pulmonary function in COVID-19 survivors: a randomized controlled trial study. Bali Medical Journal, 12(1), 539–544. https://doi.org/10.15562/bmj.v12i1.3956
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
11

Total
5

Share

Search Panel

Rosa Indah Kusumawardani
Google Scholar
Pubmed
BMJ Journal

Damayanti Tinduh
Google Scholar
Pubmed
BMJ Journal

Andriati
Google Scholar
Pubmed
BMJ Journal

Dewi Poerwandari
Google Scholar
Pubmed
BMJ Journal

Isnin Anang Marhana
Google Scholar
Pubmed
BMJ Journal

Soenarnatalina Melaniani
Google Scholar
Pubmed
BMJ Journal