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The effect of exercise using incentive spirometry on heart rate variability in patients after COVID-19 infection

  • Hilman Harisuddin ,
  • Imam Subadi ,
  • Nuniek Nugraheni Sulistiawati ,
  • Andriati ,
  • Soenarnatalina Melaniani ,


Background: COVID-19 infection causes various sequelae and complications after recovery. Changes in heart rate variability (HRV) were found in patients with COVID-19 infection, suggesting a disturbance in the autonomic system. Breathing exercises with diaphragmatic breathing and incentive spirometry have been shown to increase HRV by increasing lung capacity, respiratory muscle strength, and pulmonary O2 pressure, which can affect baroreflex signals. Incentive spirometry is one of the easy-to-use, safe, inexpensive pulmonary rehabilitation exercises that can be done at home without supervision and are accompanied by a visual display as a guide to the patient. The purpose of the study was to determine the effect of giving breathing exercises using Incentive Spirometry for four weeks on Heart Rate Variability in patients post COVID-19 infection

Method: This research is an experimental study with a pre-post-test control group design. The treatment group was given breathing exercises using Incentive Spirometry, while the control group used diaphragmatic breathing five times a day, seven times per week, for four weeks in each group. HRV measurement was performed before and after four weeks of intervention, using the parameter Root Mean Square of Successive Differences between normal heartbeats (RMSSD), Standard Deviation of N-N intervals (SDNN), and LF/HF ratio of Heart Rate Variability (HRV).

Result: There subject of this study was 20 post-COVID-19 patients divided into a treatment group (n=10) and a control group (n=10). There was no significant increase in RMSSD, SDNN, and LF/HF ratio pre and post-intervention in both groups, suggesting no significant increase in HRV.

Conclusion: Exercise with Incentive Spirometry and Diaphragmatic Breathing for four weeks did not increase the Heart Rate Variability value in post-COVID-19 patients.


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How to Cite

Harisuddin, H., Subadi, I. ., Sulistiawati, N. N. ., Andriati, & Melaniani, S. (2023). The effect of exercise using incentive spirometry on heart rate variability in patients after COVID-19 infection. Bali Medical Journal, 12(1), 483–489.




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Hilman Harisuddin
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Imam Subadi
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Nuniek Nugraheni Sulistiawati
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Soenarnatalina Melaniani
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