تأثیر تمرینات توانبخشی ریوی بر عملکرد ریوی، اکسیژن شریانی، استرس، افسردگی و کیفیت زندگی بیماران پساکرونا

نوع مقاله : علمی - پژوهشی

نویسندگان

1 دانشکده علوم ورزشی، گروه فیزیولوژی ورزشی، دانشگاه حکیم سبزواری، سبزوار، ایران.

2 دانشکده علوم ورزشی، گروه فیزیولوژی ورزشی، دانشگاه حکیم سبزواری، سبزوار، ایران. مرکز تحقیقات بیماریهای غیر واگیر، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران

3 بخش فوق تخصصی ریه، گروه داخلی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران

چکیده

زمینه و هدف: کووید-19 یک بیماری عفونی با قدرت واگیری بسیار زیاد می­باشد که مدیریت و کنترل آن همچنان یک چالش برای دستگاه‌های بهداشتی جامعه به‌شمار می‌رود. عفونت‌های شدید تنفسی با پیامدهای بسیار گسترده از جمله هایپوکسی، لنفوپنی، تنگی نفس و آسیب حاد قلبی از جمله تظاهرات این بیماری است. خستگی، کاهش عملکرد ریوی و مشکلات روان‌شناختی از جمله افسردگی، استرس، کاهش کیفیت زندگی و اختلال حرکتی از مشکلات ماندگار پساحاد بهبودیافتگان ویروس کروناست. به‌دلیل جدید بودن ویروس کرونا یافته‌های یکپارچة فراوانی بر پایة تأثیرگذاری تمرینات توانبخشی بر بهبود وضعیت بدنی، عملکرد ریوی و ذهنی بیماران پساکرونایی در دست نیست. بنابراین پژوهش حاضر با هدف تعیین تأثیر یک دوره تمرینات توانبخشی ریوی بر عملکرد ریوی، اکسیژن شریانی، استرس، افسردگی و کیفیت زندگی بیماران پساکرونایی انجام گرفت.
مواد و روش‌ها: در تحقیق حاضر، 42 بیمار (22 مرد و 20 زن) با شدت‌های متوسط تا شدید پیامدهای بیماری کووید 19 در ردة سنی 45-70 سال، به دو گروه تمرین و کنترل تقسیم شدند. برنامة گروه مداخله شامل گروه تمرین به مدت هشت هفته تمرینات هوازی، ذهنی و تنفسی (سه روز در هفته هر جلسه 80 دقیقه) تحت نظارت و مانیتورینگ (پایش) اکسیژن شریانی EKG صورت گرفت. سنجش عملکرد ریوی (PFT) شدت استرس از راه پرسشنامة استاندارد استرس کرونا (CSS-18)، شدت افسردگی از راه پرسشنامة افسردگی بک نسخة دوم و کیفیت زندگی از طریق پرسشنامةSF-36 در آغاز و پایان تمرینات توانبخشی ریوی مورد سنجش قرار گرفت. برای مقایسة دو گروه کنترل و تمرین از آزمون تی مستقل استفاده شد.
نتایج: حمایت اکسیژن بیماران در گروه توانبخشی به شکل شایان توجه و معناداری کاهش یافت (001/0P<). تراز اشباع اکسیژن خون شریانی  SaO2(%)در گروه تمرینات توانبخشی ریوی نسبت به کنترل به شکل معناداری در شرایط استراحت، تمرین و فعالیت بدنی بهبود یافت (001/0P<). همچنین شاخص‌های عملکرد ریوی (001/0P<)، اکسیژن شریانی (001/0P<) و کیفیت زندگی (001/0P<) به‌طور معناداری بهبود یافت و میزان استرس (05/0P<) و افسردگی (01/0P<) کاهش معناداری را در مقایسه با گروه کنترل نشان داد.
نتیجه‌گیری: با توجه به درگیری چندجانبة بیماری کرونا و پیامدهای بی‌شمار آن و تأثیرات متنوع و فراگیر برنامة بازتوانی ریوی، به‌نظر می‌رسد تمرینات توانبخشی ریوی بتواند در روند بهبودی عملکرد و اکسیژن‌رسانی دستگاه ریوی، همچنین کاهش شدت استرس، افسردگی و کیفیت زندگی و به‌طور کلی بر توانایی عملکردی و روان‌شناختی بیماران پس از ابتلا به کرونا مؤثر و سودمند باشد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

The effect of pulmonary rehabilitation training on pulmonary function, arterial oxygen, stress, depression and quality of life in post-coronavirus patients

نویسندگان [English]

  • zahra jalili 1
  • hamid marefati 2
  • asghar kazemzadeh 3
  • amir hossein haghighi 1
1 Faculty of Sports Sciences, Department of Sports Physiology, Hakim Sabzevari University, Sabzevar, Iran.
2 Faculty of Sports Sciences, Department of Sports Physiology, Hakim Sabzevari University, Sabzevar, Iran. Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
3 Pulmonary Subspecialty Department, Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
چکیده [English]

Background and Purpose: Covid-19 is an infectious disease with a very high contagion in the society that its management and control is still considered a challenge for the health systems. Severe respiratory infections with corona various (COVID 19) complications such as hypoxia, lymphopenia, shortness of breath and heart disorders are among the manifestations of this disease. Fatigue, reduced lung function, reduced cardio-respiratory capacity, psychological problems such as depression and stress, reduced quality of life, and movement disorder are some of the permanent post-acute problems of people who have recovered from the corona virus. Due to the novelty of the corona virus, there is not much consistent evidence that rehabilitation training are effective in improving the physical condition, pulmonary and mental function in post-coronavirus patients. Therefore, the purpose of this study was to investigate the efficacy of pulmonary rehabilitation training on pulmonary function, arterial oxygen, stress, depression and quality of life in post-covid patients.
Materials and Methods: Forty two patients (22 men and 20 women) with moderate to severe consequences of the covid-19 disease in the age range of 45-70 years were admitted to comprehensive 8-week outpatient pulmonary rehabilitation programme and divided into two groups of training and control. The trining protocol included eight weeks of aerobic, mental and breathing exercises (three days a week, 80 minutes per session) under the supervision and monitoring of arterial oxygen EKG. Pulmonary function measurement (PFT), Corona Stress Standard Questionnaire (CSS-18), depression intensity (Beck Depression Questionnaire), and quality of life (SF-36 questionnaire) were assessed befor and after the pulmonary rehabilitation program. Independent t-test was used to compare the data between control and training groups.
Results: The oxygen support in patients with pulmonary rehabilitation was significantly reduced (p<0.001). In addition, the level of oxygen saturation in arterial blood (SaO2%) was significantly improved in the pulmonary rehabilitation group compared to the control both at rest, during exercise and physical activity (p<0.001). The pulmonary function indices (FVC, FEV1), and quality of life significantly (p<0.001) improved in rehabilitation group, whereas the level of stress (p<0.05) and depression (p<0.01) showed significant decreases compared to the control group.
Conclusion: Considering the multifaceted involvement of corona disease and its numerous complications, it seems that compehensive pulmonary rehabilitation training could be effective in post-covid patients through improving the performance, oxygenation of the pulmonary system, and quality of life, as well as reducing the stress and depression which total improve the functional and cognitive abilities.

کلیدواژه‌ها [English]

  • Covid-19
  • Rehabilitation training
  • Depression
  • Stress
  • Spirometry index
  1.  Chen X, Jiang S, Li Z, Lo B. A Pervasive Respiratory Monitoring Sensor for COVID-19 Pandemic [Internet]. Vol. 2, IEEE Open Journal of Engineering in Medicine and Biology. Institute of Electrical and Electronics Engineers (IEEE); 2021. p. 11–6.
  2. Zhu F, Zhang M, Gao M, Zeng C, Wang D, Hong Q, et al. Effects of respiratory rehabilitation on patients with novel coronavirus (COVID-19) pneumonia in the rehabilitation phase: protocol for a systematic review and meta-analysis [Internet]. Vol. 10, BMJ Open. BMJ; 2020. p. e039771.
  3. Shahrabadi, Hadi; Haghigi, Amir Hossein; Talebi, Shahrabano. (2019). The effects of exercise training on the improvement of the immune system of the elderly during the period of covid-19 disease: a systematic review, Journal of Veteran Medicine, 12 (4), 259-265. [In Persian]
  4. Ahmadi Hekmatikar, Amir Hossein; Melanuri Shamsi, Mahdia (2019). The effects of sports activity following health protocols on immunological indicators during the outbreak of covid-19 disease: a narrative review. Journal of Arak University of Medical Sciences, 23(5), 584-602. [In Persian]
  5. Jalalund, Mina; Akhtari, Maryam; Farhadi, Elham; Mahmoudi, Mahdi (2019). Immunopathogenesis, diagnosis and treatment of COVID-19, Iranian Journal of Biology, 4(7), 255-263. [In Persian]
  6. Kurtaiş Aytür Y, Füsun Köseoglu B, Özyemişci Taşkıran Ö, Kutay Ordu Gökkaya N, Ünsal Delialioğlu S, Sonel Tur B, et al. Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation [Internet]. Vol. 67, Turkish Journal of Physical Medicine and Rehabilitation. Baycinar Tibbi Yayincilik; 2021. p. 129–45.
  7. Samra Fakhri, Mitra; Poursalehi, Hamidreza; Mandadi, Ali; ... Lashkarizadeh, Mohammadreza (2014). Effect of methanol extract of fennel on bleomycin-induced pulmonary fibrosis in rats, Journal of Kerman University of Medical Sciences, 22 (5), 483-470. [In Persian]
  8. Wynn TA. Integrating mechanisms of pulmonary fibrosis [Internet]. Vol. 208, Journal of Experimental Medicine. Rockefeller University Press; 2011. p. 1339–50.
  9. Mashhadhi, Mohammad; Sahib al-Zamani, Mansour; Student, Abdul Hamid; Adeli, Seyed Hasan (1401). 19- A systematic review of the methods of post-acute therapeutic exercises for those who have recovered from Covid-19, Mashhad Journal of Paramedical Sciences and Rehabilitation, 11 (1), 108-94. [In Persian]
  10. De Biase S, Cook L, Skelton DA, Witham M, ten Hove R. The COVID-19 rehabilitation pandemic [Internet]. Vol. 49, Age and Ageing. Oxford University Press (OUP); 2020. p. 696–700
  11. Carfì A, Bernabei R, Landi F. Persistent Symptoms in Patients After Acute COVID-19 [Internet]. Vol. 324, JAMA. American Medical Association (AMA); 2020. p. 603.
  12. Wong AW, Shah AS, Johnston JC, Carlsten C, Ryerson CJ. Patient-reported outcome measures after COVID-19: a prospective cohort study [Internet]. Vol. 56, European Respiratory Journal. European Respiratory Society (ERS); 2020. p. 2003276.
  13. Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Avanzi GC, et al. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge [Internet]. Vol. 4, JAMA Network Open. American Medical Association (AMA); 2021. p. e2036142.
  14. Hall VJ, Foulkes S, Saei A, Andrews N, Oguti B, Charlett A, et al. COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study [Internet]. Vol. 397, The Lancet. Elsevier BV; 2021. p. 1725–35.
  15. Zhao Y miao, Shang Y min, Song W bin, Li Q quan, Xie H, Xu Q fu, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery [Internet]. Vol. 25, EClinicalMedicine. Elsevier BV; 2020. p. 100463.
  16. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19) [Internet]. Vol. 5, JAMA Cardiology. American Medical Association (AMA); 2020. p. 1265.
  17. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China [Internet]. Vol. 287, Psychiatry Research. Elsevier BV; 2020. p. 112934.
  18. Gloeckl R, Leitl D, Jarosch I, Schneeberger T, Nell C, Stenzel N, et al. Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study [Internet]. Vol. 7, ERJ Open Research. European Respiratory Society (ERS); 2021. p. 00108–2021.
  19. Tozato, C., Ferreira, B. F. C., Dalavina, J. P., Molinari, C. V., & Alves, V. L. D. S. (2021). Cardiopulmonary rehabilitation in post-COVID-19 patients: case series. Revista Brasileira de terapia intensive Vol. 33, 167-171.
  20. Ahmadizad, Sajjad. Basami, Mino (2019). The role of exercise in improving the immune and physical system during the pandemic, report and related exercise guidelines. Shahid Beheshti University of Tehran Journal of Sport and Exercise Physiology, 13 (1), 1-14. [In Persian]
  21. Wang TJ, Chau B, Lui M, Lam GT, Lin N, Humbert S. Physical Medicine and Rehabilitation and Pulmonary Rehabilitation for COVID-19 [Internet]. Vol. 99, American Journal of Physical Medicine & Rehabilitation. Ovid Technologies (Wolters Kluwer Health); 2020. p. 769–74.
  22. Jalili, Zahra; Marefati, Hamid; Kazemzadeh, Asghar; Haghigi, Amir Hossein; Jalili, Zakia (1401). The effect of a course of multidisciplinary rehabilitation exercises on the stress and quality of life of post-chronic patients, the second international conference on new findings in medical and health sciences with a health promotion approach.
  23. Chen X, Jiang S, Li Z, Lo B. A Pervasive Respiratory Monitoring Sensor for COVID-19 Pandemic [Internet]. Vol. 2, IEEE Open Journal of Engineering in Medicine and Biology. Institute of Electrical and Electronics Engineers (IEEE); 2021. p. 11–6.
  24. Narici M, Vito GD, Franchi M, Paoli A, Moro T, Marcolin G, et al. Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures [Internet]. Vol. 21, European Journal of Sport Science. Informa UK Limited; 2020. p. 614–35.
  25. Mohammadi Mirzaei, Ruholah; Mirdar, Shadmehr (2015). The effect of respiratory muscle training at altitude on inspiratory energy consumption, blood oxygen saturation and 1500 meters performance of national team endurance runners, Tehran Shahid Beheshti University Physiology Journal, 18, 1435-1446.
  26. Soleimanifar, Manijeh; Hazrati, Ebrahim (2019), Pulmonary rehabilitation and physiotherapy treatment of respiratory complications in patients infected with the covid-19 virus: a comparative study, Journal of Military Care Sciences, 7 (1), 71-80. [In Persian]
  27. Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge [Internet]. Vol. 55, European Respiratory Journal. European Respiratory Society (ERS); 2020. p. 2001217.
  28. Jung NJ, Na SS, Kim SK, Hwangbo G. The effect of the inspiratory muscle training on functional ability in stroke patients [Internet]. Vol. 29, Journal of Physical Therapy Science. Society of Physical Therapy Science; 2017. p. 1954–6.
  29. Piquet V, Luczak C, Seiler F, Monaury J, Martini A, Ward AB, et al. Do Patients With COVID-19 Benefit from Rehabilitation? Functional Outcomes of the First 100 Patients in a COVID-19 Rehabilitation Unit [Internet]. Vol. 102, Archives of Physical Medicine and Rehabilitation. Elsevier BV; 2021. p. 1067–74.
  30. Demeco A, Marotta N, Barletta M, Pino I, Marinaro C, Petraroli A, et al. Rehabilitation of patients post-COVID-19 infection: a literature review [Internet]. Vol. 48, Journal of International Medical Research. SAGE Publications; 2020. p. 030006052094838.
  31. Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L , Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep med. 2010;11(9):934-40.
  32. ghorbanian, Bahlul; Feridnia, Samia (1401). The effect of an aerobic exercise course on some metabolic indicators, quality of life and general health of women recovered from corona disease, Journal of Wind and Biokinetic Sciences, 1 (21), 1-11.
  33. St-Pierre M, Sinclair I, Elgbeili G, Bernard P, Dancause KN. Relationships between psychological distress and health behaviors among Canadian adults: Differences based on gender, income, education, immigrant status, and ethnicity [Internet]. Vol. 7, SSM - Population Health. Elsevier BV; 2019. p. 100385.
  34. Fallahzade H, Dehghani Tafti A, Dehghani Tafti M, Hoseini F, Hoseini H. Factors affecting quality of life after menopause in women. JSSU. 2011; 18: 552-558 [in Persian]
  35. Atkinson G, Davenne D. Relationships between sleep, physical activity and human health [Internet]. Vol. 90, Physiology & Behavior. Elsevier BV; 2007. p. 229–35.
  1. Hosseini M, & Daryabor A. (2021). Psychological Effects Resulting From COVID-19 and Rehabilitation Intervention: A Review of Literature. The Scientific Journal of Rehabilitation Medicine, 10(4), 618-629.
  2. Connerney I, Shapiro P A, McLaughlin J S, Bagiella E, & Sloan R P. (2001). Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. In The Lancet, 358( 9295), 1766–1771.
  • تاریخ دریافت: 21 خرداد 1402
  • تاریخ بازنگری: 15 مهر 1402
  • تاریخ پذیرش: 23 مهر 1402
  • تاریخ اولین انتشار: 08 آذر 1402
  • تاریخ انتشار: 01 بهمن 1402