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/ Clinical Trial: The Best Option for Post COVID 19 Condition |Concurrent Training, Respiratory Muscle Training, or Self Management Recommendations by WHO?|

Clinical Trial: The Best Option for Post-COVID-19 Condition |Concurrent Training, Respiratory Muscle Training, or Self-Management Recommendations by WHO?|

Recently Reviewed: April 5, 2025 Uploaded on:
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Dr. Noman Elahi

Medical Researcher and Writer

Dr. Noman is a medical researcher and expert writer dedicated to bridging the gap between science and public understanding by translating complex medical studies into explicit, engaging, and informative content.
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Nina Bausek, PhD

Chief Scientist

With 10 years of experience in respiratory health research, Dr. Nina provides expert review and validation to ensure accuracy, clarity, and scientific integrity in medical content.
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Clinical Context and Key Findings
  • Post-COVID-19 is associated with symptoms persisting at least 3 months after disease and impacts on the quality of life of the affected persons.
  • World Health Organization (WHO) has proposed management guidelines for recovery from post-COVID-19 condition.
  • Here we show that a clinical study including respiratory muscle training (RMT) adjunct to concurrent training improved cardiorespiratory fitness, breathlessness, fatigue, depression and lower body muscle strength, along with a reduction in the severity of symptoms in post-COVID-19.

Post-COVID-19 condition, often termed as Long COVID, significantly impacts quality of life in patients due to long-lasting symptoms. Currently, there is no medicinal treatment for recovery from post-COVID-19 condition; the WHO recommends only self-management guidelines and peer support from non-hospitalized patients. However, recent studies suggest that RMT and concurrent training (CT) could play significant roles during recovery from post-COVID-19 condition.

This article reviews the evidence comparing the effects of RMT, CT, or self-management guidelines on post-COVID condition based on a clinical trial [1].

What is Long COVID? 

Long COVID is characterized by headaches, fatigue, dyspnea (breathlessness), sleep disturbances, cardiac abnormalities, muscle pain, and cognitive impairment  [2]. These symptoms can last for months even after a person has become negative for COVID-19, significantly deteriorating the quality of life.

According to the WHO, the post-COVID condition occurs in COVID-19 patients after three months of the initial diagnosis and can last for up to two months [3]. Usually, no pharmacological therapy is recommended for patients experiencing long COVID-19 symptoms; instead, the management guidelines provided by WHO are limited to peer support and self-management strategies.

Role of RMT in Long COVID Recovery

In the absence of pharmacological treatments for long-term COVID, exercise-based rehabilitation programs have gained attention as an effective approach to recovery. RMT and CT have been shown to improve cardiopulmonary fitness, muscle strength, and symptom severity. These interventions offer greater benefits than WHO self-management strategies by targeting both respiratory and musculoskeletal systems.

One of the most effective tools for performing RMT is THE BREATHER, a clinically tested respiratory muscle training device that strengthens both inspiratory and expiratory muscles.

Clinical Trial: Evaluating the Best Option for Post-COVID-19 Condition

Seven researchers from Spain conducted a clinical trial (RECOVO trial) to compare the effect of CT, RMT, and self-management guidelines on the treatment of post-COVID-19 condition. They recruited 80 non-hospitalized Long COVID patients and divided them into four groups, with 20 patients in each group, and provided training as follows:

  1. CT group: Performing only concurrent training 

  2. RM group: Performing only respiratory muscle training 

  3. CTRM  group: Performing both respiratory muscle training and concurrent training

  4. CON group: Control group only following the WHO self-management guidelines for rehabilitation

These interventions were implemented for 8 weeks, and then the researchers evaluated their effects on cardiopulmonary fitness, muscle strength, and the severity of post-COVID symptoms.

Results

This 8-week trial showed promising results; let’s go through these in detail.

Improvement in muscle strength

In this trial, lower body muscles were significantly improved in CT and CTRM groups compared to the participants in RM and CON groups.

Reduction in Dyspnea and Fatigue

 In the CT and CTRM groups, dyspnea and fatigue significantly reduced at the end of the training completion period compared to the start of the trial.

Reduction in depression

In CT and CTRM groups, depression was significantly decreased as compared to participants in RM and CON groups. 

Conclusions

This clinical study demonstrated that RMT alone or in combination with concurrent training can be used to rehab post-COVID-19 conditions. These two types of training are better than RMT alone and the WHO's self-management guidelines for post-COVID-19 condition.

References

[1]. Jimeno-Almazán A, Buendía-Romero Á, Martínez-Cava A, Franco-López F, Sánchez-Alcaraz BJ, Courel-Ibáñez J, et al. Effects of a concurrent training, respiratory muscle exercise, and self-management recommendations on recovery from post-COVID-19 conditions: the RECOVE trial. J Appl Physiol. 2023;134: 95–104.

[2]. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management. BMJ. 2021;374: n1648.

[3]. Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV, WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22: e102–e107.

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