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Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome

Richard Metcalfe Orcid Logo, PAUL A. SWINTON, Kelly Mackintosh Orcid Logo, RONAN M. G. BERG, James Shelley, ZOE L. SAYNOR, Joanne Hudson Orcid Logo, JAMIE DUCKERS, Keir Lewis Orcid Logo, Gwyneth Davies Orcid Logo, Melitta McNarry Orcid Logo

Medicine and Science in Sports and Exercise, Volume: 55, Issue: 10, Pages: 1761 - 1769

Swansea University Authors: Richard Metcalfe Orcid Logo, Kelly Mackintosh Orcid Logo, James Shelley, Joanne Hudson Orcid Logo, Keir Lewis Orcid Logo, Gwyneth Davies Orcid Logo, Melitta McNarry Orcid Logo

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DOI (Published version): 10.1249/mss.0000000000003207

Abstract

Purpose: To investigate whether heterogeneous treatment effects occur for changes in inspiratory muscle strength, perceived dyspnoea, and health-related quality of life (QoL), following eight-weeks unsupervised home-based inspiratory muscle training (IMT) in adults with post-acute COVID-19 syndrome....

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Published in: Medicine and Science in Sports and Exercise
ISSN: 0195-9131 1530-0315
Published: Ovid Technologies (Wolters Kluwer Health) 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa63295
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Conversely, there were minimal differences in the SDs between the IMT and the control group for changes in perceived dyspnoea and health-related QoL, providing no evidence of heterogeneous treatment effects. Higher cumulative power during the IMT intervention was related to changes in MIP (ß=10.9 [95% CrI: 5.3-16.8] cmH2O per 1SD) and SMIP (ß=63.7 [32.2-95.3] PTUs per 1SD), clearly indicating an IMT dose response for changes in inspiratory muscle strength. Older age (&gt;50 years), a longer time post-acute COVID-19 (&gt;3 months), and greater severity of dyspnoea at baseline were also associated with smaller improvements in inspiratory muscle strength.Conclusion: Heterogenous individual responses occurred following an eight-week home-based IMT programme in people with post-acute COVID-19 syndrome. Consistent with standard exercise theory, larger improvements in inspiratory muscle strength are strongly related to a greater cumulative dose of IMT.</abstract><type>Journal Article</type><journal>Medicine and Science in Sports and Exercise</journal><volume>55</volume><journalNumber>10</journalNumber><paginationStart>1761</paginationStart><paginationEnd>1769</paginationEnd><publisher>Ovid Technologies (Wolters Kluwer Health)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0195-9131</issnPrint><issnElectronic>1530-0315</issnElectronic><keywords>Post-acute COVID-19 syndrome, long COVID, rehabilitation, treatment,breathlessness, breathing</keywords><publishedDay>31</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-10-31</publishedDate><doi>10.1249/mss.0000000000003207</doi><url>http://dx.doi.org/10.1249/mss.0000000000003207</url><notes/><college>COLLEGE NANME</college><department>Engineering and Applied Sciences School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>EAAS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This research was funded by the Welsh Government Sêr Cymru III Tackling COVID-19 grant scheme (Reference MA/KW/1457/20) and The Higher Education Funding Council for Wales Research Wales Innovation Fund (Collaboration Booster Faculty Fund), grant number FF4. The Centre for Physical Activity Research is supported by TrygFonden grants (ID 101390, ID 20045 and ID 125132).</funders><projectreference/><lastEdited>2024-05-13T19:26:53.8301960</lastEdited><Created>2023-05-02T11:54:48.7203093</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Engineering and Applied Sciences - Sport and Exercise Sciences</level></path><authors><author><firstname>Richard</firstname><surname>Metcalfe</surname><orcid>0000-0003-0980-2977</orcid><order>1</order></author><author><firstname>PAUL A.</firstname><surname>SWINTON</surname><order>2</order></author><author><firstname>Kelly</firstname><surname>Mackintosh</surname><orcid>0000-0003-0355-6357</orcid><order>3</order></author><author><firstname>RONAN M. 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spelling v2 63295 2023-05-02 Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome 9bb783273dd9d54a2f3f66f75c43abdf 0000-0003-0980-2977 Richard Metcalfe Richard Metcalfe true false bdb20e3f31bcccf95c7bc116070c4214 0000-0003-0355-6357 Kelly Mackintosh Kelly Mackintosh true false 120b09997c79f9494ca91b8a7706efe4 James Shelley James Shelley true false 304341cf2cd1bdb99d7d6ccf0f030d99 0000-0003-4732-8356 Joanne Hudson Joanne Hudson true false bc53c343c975d6e0ad88c1d8b9ddd70c 0000-0002-8248-6774 Keir Lewis Keir Lewis true false 92d69cf8519a334ced3f55142c811d95 0000-0003-1218-1008 Gwyneth Davies Gwyneth Davies true false 062f5697ff59f004bc8c713955988398 0000-0003-0813-7477 Melitta McNarry Melitta McNarry true false 2023-05-02 EAAS Purpose: To investigate whether heterogeneous treatment effects occur for changes in inspiratory muscle strength, perceived dyspnoea, and health-related quality of life (QoL), following eight-weeks unsupervised home-based inspiratory muscle training (IMT) in adults with post-acute COVID-19 syndrome.Methods: In total, 147 adults with self-reported prior COVID-19 either completed an eight-week home-based IMT intervention (n=111; 92 females; 48±11 years; 9.3±3.6 months post-acute COVID-19 infection) or acted as “usual care” wait list controls (n=36; 34 females; 49±12 years; 9.4±3.2 months post-acute COVID-19 infection).Results: Applying a Bayesian framework, we found clear evidence of heterogeneity of treatment response for inspiratory muscle strength: the estimated difference between standard deviations (SDs) of the IMT and control groups was 22.8 cmH2O (75% Credible Interval (CrI): 4.7-37.7) for changes in maximal inspiratory pressure (MIP), and 86.8 pressure time-units (PTUs; 75% CrI: 55.7-116.7) for sustained MIP (SMIP). Conversely, there were minimal differences in the SDs between the IMT and the control group for changes in perceived dyspnoea and health-related QoL, providing no evidence of heterogeneous treatment effects. Higher cumulative power during the IMT intervention was related to changes in MIP (ß=10.9 [95% CrI: 5.3-16.8] cmH2O per 1SD) and SMIP (ß=63.7 [32.2-95.3] PTUs per 1SD), clearly indicating an IMT dose response for changes in inspiratory muscle strength. Older age (>50 years), a longer time post-acute COVID-19 (>3 months), and greater severity of dyspnoea at baseline were also associated with smaller improvements in inspiratory muscle strength.Conclusion: Heterogenous individual responses occurred following an eight-week home-based IMT programme in people with post-acute COVID-19 syndrome. Consistent with standard exercise theory, larger improvements in inspiratory muscle strength are strongly related to a greater cumulative dose of IMT. Journal Article Medicine and Science in Sports and Exercise 55 10 1761 1769 Ovid Technologies (Wolters Kluwer Health) 0195-9131 1530-0315 Post-acute COVID-19 syndrome, long COVID, rehabilitation, treatment,breathlessness, breathing 31 10 2023 2023-10-31 10.1249/mss.0000000000003207 http://dx.doi.org/10.1249/mss.0000000000003207 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University This research was funded by the Welsh Government Sêr Cymru III Tackling COVID-19 grant scheme (Reference MA/KW/1457/20) and The Higher Education Funding Council for Wales Research Wales Innovation Fund (Collaboration Booster Faculty Fund), grant number FF4. The Centre for Physical Activity Research is supported by TrygFonden grants (ID 101390, ID 20045 and ID 125132). 2024-05-13T19:26:53.8301960 2023-05-02T11:54:48.7203093 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Richard Metcalfe 0000-0003-0980-2977 1 PAUL A. SWINTON 2 Kelly Mackintosh 0000-0003-0355-6357 3 RONAN M. G. BERG 4 James Shelley 5 ZOE L. SAYNOR 6 Joanne Hudson 0000-0003-4732-8356 7 JAMIE DUCKERS 8 Keir Lewis 0000-0002-8248-6774 9 Gwyneth Davies 0000-0003-1218-1008 10 Melitta McNarry 0000-0003-0813-7477 11 63295__27291__0f93e04560b844c8904874919af318c3.pdf 63295.pdf 2023-05-02T12:00:52.7136863 Output 647062 application/pdf Accepted Manuscript true 2024-05-12T00:00:00.0000000 true eng
title Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome
spellingShingle Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome
Richard Metcalfe
Kelly Mackintosh
James Shelley
Joanne Hudson
Keir Lewis
Gwyneth Davies
Melitta McNarry
title_short Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome
title_full Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome
title_fullStr Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome
title_full_unstemmed Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome
title_sort Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome
author_id_str_mv 9bb783273dd9d54a2f3f66f75c43abdf
bdb20e3f31bcccf95c7bc116070c4214
120b09997c79f9494ca91b8a7706efe4
304341cf2cd1bdb99d7d6ccf0f030d99
bc53c343c975d6e0ad88c1d8b9ddd70c
92d69cf8519a334ced3f55142c811d95
062f5697ff59f004bc8c713955988398
author_id_fullname_str_mv 9bb783273dd9d54a2f3f66f75c43abdf_***_Richard Metcalfe
bdb20e3f31bcccf95c7bc116070c4214_***_Kelly Mackintosh
120b09997c79f9494ca91b8a7706efe4_***_James Shelley
304341cf2cd1bdb99d7d6ccf0f030d99_***_Joanne Hudson
bc53c343c975d6e0ad88c1d8b9ddd70c_***_Keir Lewis
92d69cf8519a334ced3f55142c811d95_***_Gwyneth Davies
062f5697ff59f004bc8c713955988398_***_Melitta McNarry
author Richard Metcalfe
Kelly Mackintosh
James Shelley
Joanne Hudson
Keir Lewis
Gwyneth Davies
Melitta McNarry
author2 Richard Metcalfe
PAUL A. SWINTON
Kelly Mackintosh
RONAN M. G. BERG
James Shelley
ZOE L. SAYNOR
Joanne Hudson
JAMIE DUCKERS
Keir Lewis
Gwyneth Davies
Melitta McNarry
format Journal article
container_title Medicine and Science in Sports and Exercise
container_volume 55
container_issue 10
container_start_page 1761
publishDate 2023
institution Swansea University
issn 0195-9131
1530-0315
doi_str_mv 10.1249/mss.0000000000003207
publisher Ovid Technologies (Wolters Kluwer Health)
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
url http://dx.doi.org/10.1249/mss.0000000000003207
document_store_str 1
active_str 0
description Purpose: To investigate whether heterogeneous treatment effects occur for changes in inspiratory muscle strength, perceived dyspnoea, and health-related quality of life (QoL), following eight-weeks unsupervised home-based inspiratory muscle training (IMT) in adults with post-acute COVID-19 syndrome.Methods: In total, 147 adults with self-reported prior COVID-19 either completed an eight-week home-based IMT intervention (n=111; 92 females; 48±11 years; 9.3±3.6 months post-acute COVID-19 infection) or acted as “usual care” wait list controls (n=36; 34 females; 49±12 years; 9.4±3.2 months post-acute COVID-19 infection).Results: Applying a Bayesian framework, we found clear evidence of heterogeneity of treatment response for inspiratory muscle strength: the estimated difference between standard deviations (SDs) of the IMT and control groups was 22.8 cmH2O (75% Credible Interval (CrI): 4.7-37.7) for changes in maximal inspiratory pressure (MIP), and 86.8 pressure time-units (PTUs; 75% CrI: 55.7-116.7) for sustained MIP (SMIP). Conversely, there were minimal differences in the SDs between the IMT and the control group for changes in perceived dyspnoea and health-related QoL, providing no evidence of heterogeneous treatment effects. Higher cumulative power during the IMT intervention was related to changes in MIP (ß=10.9 [95% CrI: 5.3-16.8] cmH2O per 1SD) and SMIP (ß=63.7 [32.2-95.3] PTUs per 1SD), clearly indicating an IMT dose response for changes in inspiratory muscle strength. Older age (>50 years), a longer time post-acute COVID-19 (>3 months), and greater severity of dyspnoea at baseline were also associated with smaller improvements in inspiratory muscle strength.Conclusion: Heterogenous individual responses occurred following an eight-week home-based IMT programme in people with post-acute COVID-19 syndrome. Consistent with standard exercise theory, larger improvements in inspiratory muscle strength are strongly related to a greater cumulative dose of IMT.
published_date 2023-10-31T19:26:52Z
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score 11.037581

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