Influence of Manual Diaphragm Release Technique Combined with Inspiratory Muscle Training on Selected Persistent Symptoms in Men with Post-Covid-19 Syndrome: A Randomized Controlled Trial

J Rehabil Med. 2022 Oct 20:54:jrm00330. doi: 10.2340/jrm.v54.3972.


Objective: To determine whether the addition of manual diaphragm release to an inspiratory muscle training programme is more effective than inspiratory muscle training alone in reducing blood pressure, dyspnoea, fatigue, and aerobic performance capacity in men with post-COVID-19 syndrome.

Design: A prospective, randomized-controlled trial.

Setting: Chest Disease Department, Outpatient Clinic, Cairo University, Egypt.

Participants: Fifty-two men with post-COVID-19 syndrome were allocated randomly to the study and control groups.

Intervention: The study group underwent diaphragm release plus inspiratory muscle training, whereas the control group received inspiratory muscle training only.

Outcome measures: All patients were assessed with the following measures at baseline and 6 weeks postintervention: maximum static inspiratory pressure for inspiratory muscle strength, peripheral arterial blood pressure, Modified Medical Research Council scale for dyspnoea, Fatigue Severity Scale, serum lactate level, and 6-min walk test distance for aerobic performance.

Results: All outcome measures showed a significant improvement in favour of the study group (p < 0.001) over the control group. However, maximum static inspiratory pressure increased significantly, by 48.17% (p < 0.001) in the study group with no significant change in the control group.

Conclusion: Addition of manual diaphragm release to an inspiratory muscle training programme potentiates the role of inspiratory muscle training in the management of men with symptomatic post-COVID-19 syndrome.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Breathing Exercises* / methods
  • COVID-19*
  • Diaphragm
  • Dyspnea
  • Humans
  • Lactates
  • Male
  • Muscle Fatigue
  • Muscle Strength / physiology
  • Post-Acute COVID-19 Syndrome
  • Prospective Studies
  • Respiratory Muscles*


  • Lactates