ORIGINAL PAPER
The impact of aerobic and balance exercises on anxiety and dizziness in post-COVID-19 patients: a randomised clinical trial
1
Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
2
Department of Orthopaedic, Faculty of Physical Therapy, Nahda University, Beni Sueif, Egypt
3
Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Galala University, Cairo, Egypt
4
Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Deraya University, Minia, Egypt
5
Department of Physical Therapy for Integumentary, Faculty of Physical Therapy, Egyptian Chinese University, Cairo, Egypt
6
Department of Growth and Development Disorders in Children and its Surgery, Faculty of Physical Therapy, Merit University, Sohag, Egypt
7
Department of Basic Science, Faculty of Physical Therapy, Merit University, Sohag, Egypt
These authors had equal contribution to this work
Submission date: 2024-02-26
Acceptance date: 2024-06-27
Publication date: 2025-06-18
Corresponding author
Sahar Ahmed Abdalbary
Faculty of Physical Therapy, Nahda University, University street, Beni Sueif, Egypt
Faculty of Physical Therapy, Nahda University, University street, Beni Sueif, Egypt
Physiother Quart. 2025;33(2):71-79
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Examine how aerobic exercises, relaxation techniques, and balance exercises affect patients’ anxiety and dizziness post-COVID-19 patients.
Methods:
Thirty participants post-COVID-19, complaining of anxiety and dizziness, aged 45–65 years, of both sexes, selected from the outpatient clinic of our hospital, were enrolled in the study after a COVID-19 infection. Treatment sessions were 3 times weekly for 4 weeks, and the patients were treated separately in group therapy. The 15 patients in group A were given aerobic, balancing, and relaxation techniques. The 15 patients in the control group (group B) were given only relaxation exercises. Assessments of the two groups were completed both before and after the course of treatment by the Hamilton Anxiety Scale (HAMA) and the Berg Balance Scale. Respiratory function was also assessed using maximum voluntary ventilation.
Results:
There were significant differences between the two groups after the treatment. The mean values of the HAMA after treatment were 17.2 ± 1.7 and 21.7 ± 1.4 in groups A and B, respectively. After treatment, the mean values of the Berg Balance Scale were 26.7 ± 5.7 and 22.2 ± 3.6 in groups A and B, respectively. The mean values of maximum voluntary ventilation were 117.2 ± 16.7 and 108.1 ± 16.3 in groups A and B, respectively. Both groups showed a significant decrease in anxiety and dizziness and a significant increase in maximum voluntary ventilation at the end of the 4 weeks of the training program. Participants in group A showed a significantly greater decrease in anxiety and dizziness and a significantly greater increase in maximum voluntary ventilation (p < 0.05) after the training program.
Conclusions:
Ultimately, it can be said that aerobic exercises, balance exercises, and relaxation techniques can raise maximal voluntary breathing and lessen anxiety and dizziness in post-COVID patients. Therefore, it might be regarded as a successful, secure, cost-effective, and efficient supplementary treatment method for lowering anxiety and vertigo in COVID-19 patients.
Examine how aerobic exercises, relaxation techniques, and balance exercises affect patients’ anxiety and dizziness post-COVID-19 patients.
Methods:
Thirty participants post-COVID-19, complaining of anxiety and dizziness, aged 45–65 years, of both sexes, selected from the outpatient clinic of our hospital, were enrolled in the study after a COVID-19 infection. Treatment sessions were 3 times weekly for 4 weeks, and the patients were treated separately in group therapy. The 15 patients in group A were given aerobic, balancing, and relaxation techniques. The 15 patients in the control group (group B) were given only relaxation exercises. Assessments of the two groups were completed both before and after the course of treatment by the Hamilton Anxiety Scale (HAMA) and the Berg Balance Scale. Respiratory function was also assessed using maximum voluntary ventilation.
Results:
There were significant differences between the two groups after the treatment. The mean values of the HAMA after treatment were 17.2 ± 1.7 and 21.7 ± 1.4 in groups A and B, respectively. After treatment, the mean values of the Berg Balance Scale were 26.7 ± 5.7 and 22.2 ± 3.6 in groups A and B, respectively. The mean values of maximum voluntary ventilation were 117.2 ± 16.7 and 108.1 ± 16.3 in groups A and B, respectively. Both groups showed a significant decrease in anxiety and dizziness and a significant increase in maximum voluntary ventilation at the end of the 4 weeks of the training program. Participants in group A showed a significantly greater decrease in anxiety and dizziness and a significantly greater increase in maximum voluntary ventilation (p < 0.05) after the training program.
Conclusions:
Ultimately, it can be said that aerobic exercises, balance exercises, and relaxation techniques can raise maximal voluntary breathing and lessen anxiety and dizziness in post-COVID patients. Therefore, it might be regarded as a successful, secure, cost-effective, and efficient supplementary treatment method for lowering anxiety and vertigo in COVID-19 patients.
REFERENCES (40)
1.
Perlman S, Netland J. Coronaviruses post-SARS: update on replication and pathogenesis. Nat Rev Microbiol. 2009;7(6):439–50; doi:10.1038/nrmicro2147.
2.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China medical treatment expert group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;30;382(18):1708–20; doi: 10.1056/NEJMoa2002032.
3.
Iqbal S, Alanazi RF, Alahmed AH, Alnakhli AF, Alghanim MH, Alghamdi MAA, Ahmad S. Prevalence of sleep disturbance and anxiety due to the COVID-19 pandemic in Saudi Arabia. Sleep Sci. 2021;14(Spec 1):56–62; doi: 10.5935/1984-0063.20200079.
4.
Korres G, Kitsos DK, Kaski D, Tsogka A, Giannopoulos S, Giannopapas V, Sideris G, Tyrellis G, Voumvourakis K. The prevalence of dizziness and vertigo in COVID-19 patients: a systematic review. Brain Sci. 2022;12(7):948; doi: 10.3390/brainsci12070948.
5.
Angulo AE, Martínez JME, Iñigo Huarte V, Máñez Añón I, Tenías Burillo JM, Peydro de Moya F. Severe SARS-CoV-2 infection: clinical assessment and biomechanical functional evaluation one month after hospital discharge. Rehabilitacion. 2022;56(2):142–9; doi: 10.1016/j.rh.2021.07.003.
6.
Marsico E, D’Isanto T, Raiola G, Cassese FP. The effects of physical exercise on state and trait anxiety. Acta Kinesiol. 2019;13(2):64–73.
7.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–5; doi: 10.1111/j.2044-8341.1959.tb00467.x.
8.
Taheri M, Irandoust K, Reynoso-Sánchez LF, Muñoz-Helú H, Cruz-Morales KN, Torres-Ramírez R, Mirmoezzi M, Youzbashi L, Mirakhori F, Dergaa I, Vancini RL, Mataruna-Dos-Santos LJ, Zazueta-Beltrán DK, Zouhal H, Morales-Beltrán RA, Soylu Y, Molgado-Sifuentes A, González-Hernández J, Hernández-Cruz G, Castro LBB, Kurt C, Trabelsi K, Chtourou H, Seghatoleslami A, López-Camacho MO, Mendoza-Baldenebro RE, Torabi F, Saad HB, Washif JA, Strahler J, Guimarães-Mataruna AF, Lebaron TW, Ezdini ES, Rezaei MS, Moshtagh M, Yagin FH, Gülü M, Esmaeili A, Müller P, Ammar A, Scoditti E, Garbarino S, Puce L, Bragazzi NL, Nobari H. Effects of home confinement on physical activity, nutrition, and sleep quality during the COVID-19 outbreak in amateur and elite athletes. Front Nutr. 2023;10:1143340; doi: 10.3389/fnut.2023.1143340.
9.
Balaban CD, Thayer JF. Neurological bases for balance – anxiety links. J Anxiety Disord. 2001;15(1–2):53–79; doi: 10.1016/S0887-6185(00)00042-6.
10.
Taheri M, Esmaeili A, Irandoust K, Mirmoezzi M, Souissi A, Laher I, Dergaa I, Zouhal H. Mental health, eating habits and physical activity levels of elite Iranian athletes during the COVID-19 pandemic. Sci Sports. 2023;38(5–6):527–33; doi:10.1016/j.scispo.2023.01.002.
11.
Da Costa TS, Seffrin A, de Castro Filho J, Togni G, Castardeli E, Barbosa de Lira CA, Vancini RL, Knechtle B, Rosemann T, Andrade MS. Effects of aerobic and strength training on depression, anxiety, and health self-perception levels during the COVID-19 pandemic. Eur Rev Med Pharmacol Sci. 2022;26(15):5601–10; doi:10.26355/eurrev_202208_29433.
12.
Guzik A, Wolan-Nieroda A, Kochman M, Perenc L, Drużbicki M. Impact of mild COVID-19 on balance function in young adults, a prospective observational study. Sci Rep. 2022;12:12181; doi:10.1038/s41598-022-16397-8.
13.
Scaramuzzo G, Ronzoni L, Campo G, Campo G, Priani P, Arena C, La Rosa R, Turrini C, Volta CA, Papi A, Spadaro S, Contoli M. Long-term dyspnea, regional ventilation distribution and peripheral lung function in COVID-19 survivors: a 1-year follow-up study. BMC Pulm Med. 2022;22(1):408; doi: 10.1186/s12890-022-02214-5.
14.
Fyfe JJ, Hamilton DL, Daly RM. Minimal-dose resistance training for improving muscle mass, strength, and function: a narrative review of current evidence and practical considerations. Sports Med. 2022;52(3):463–79; doi: 10.1007/s40279-021-01605-8.
15.
Ahmed I, Bin Inam A, Belli S, Ahmad J, Khalil W, Jafar M. Effectiveness of aerobic exercise training program on cardio-respiratory fitness and quality of life in patients recovered from COVID-19. Eur J Physiother. 2021;24(6):358–63; doi.org/10.1080/21679169.2021.1909649.
16.
Mansur AJ, Nunes RAB. Heart rate response and chronotropic incompetence in exercise stress testing of asymptomatic women. Womens Health. 2010.
17.
Dehnavi Z, Jafarnejad F, Kamali Z. The effect of aerobic exercise on primary dysmenorrhea: a clinical trial study. J Educ Health Promot. 2018;7:3; doi: 10.4103/jehp.jehp_79_17.
18.
Imenez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: special focus in older people. Prog Cardiovasc Dis. 2020;63(3):386–88; doi: 10.1016/j.pcad.2020.03.009.
19.
Polero P, Rebollo-Seco C, Adsuar JC, Pérez-Gómez J, Rojo-Ramos J, Manzano-Redondo F, Garcia-Gordillo MA. Physical activity recommendations during COVID-19: narrative review. Int J Environ Res Public Health. 2020;18:65; doi: 10.3390/ijerph18010065.
20.
Perri MG, Anton SD, Durning PE, Ketterson TU, Sydeman SJ, Berlant NE, Kanasky Jr WF, Newton Jr RL, Limacher MC, Martin AD. Adherence to exercise prescriptions: effects of prescribing moderate versus higher levels of intensity and frequency. Health Psychol. 2002;21(5):452–8; doi: 10.1037/0278-6133.21.5.452.
21.
Bickton FM, Chisati E, Rylance J, Morton B. An improvised pulmonary tele-rehabilitation programme for post-acute COVID-19 patients would be feasible and acceptable in a low-resource setting: a case report. Am J Phys Med Rehabil. 2021; 100(3):209–12; doi: 10.1097/phm.00000 00000001666. 116.
22.
Cattadori G, Di Marco S, Baravelli M, Picozzi A, Ambrosio G. Exercise training in Post-COVID-19 patients: The need for a multifactorial protocol for a multifactorial pathophysiology. J Clin Med. 2022;11(8):2228; doi: 10.3390/jcm11082228.
23.
Gaudlitz K, Plag J, Dimeo F, Ströhle A. Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depress Anxiety. 2015;32(3):221–8; doi: 10.1002/da.22337.
24.
Ströhle A, Graetz B, Scheel M, Scheel M, Wittmann A, Feller C, Heinz A. The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. J Psychiatr Res. 2009;43(12):1013–7; doi: 10.1016/j.jpsychires.2009.02.004.
25.
Wedekind D, Broocks A, Weiss N, Engel K, Neubert K, Bandelow B. A randomized, controlled trial of aerobic exercise in combination with paroxetine in the treatment of panic disorder. World J Biol Psychiatry. 2010;11(7):904–13; doi: 10.3109/15622975.2010.489620.
26.
Bartley CA, Hay M, Bloch MH. Meta-analysis: aerobic exercise for the treatment of anxiety disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2013;45:34–9; doi:10.1016/j. pnpbp.2013.04.016.
27.
DeBoer LB, Powers MB, Utschig AC, Otto MW, Smits JA. Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Rev Neurother. 2012;12(8):1011–22; doi:10.1586/ern.12.73.
28.
Meyer T, Broocks A, Bandelow B, Hillmer-Vogel U, Rüther E. Endurance training in panic patients: Spiroergometric and clinical effects. Int J Sports Med. 1998;19(7):496–502; doi: 10.1055/s-2007-971951.
29.
Stahlmann R, Lode H. Medication for COVID-19 – an overview of approaches currently under study. Dtsch Arztebl Int. 2020;117:213–9; doi: 10.3238/arztebl.2020.0213.
30.
Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205–30; doi: 10.1016/S0005-7894(04)80036-4.
31.
Goldin P, Ziv M, Jazaieri H, Hahn K, Gross JJ. MBSR vs aerobic exercise in social anxiety: fMRI of emotion regulation of negative self-beliefs. Soc Cogn Affect Neurosci. 2013;8(1):65–72; doi: 10.1093/scan/nss054.
32.
Asmundson GJ, Fetzner MG, Deboer LB, Powers MB, Otto MW, Smits JA. Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depress Anxiety. 2013;30(4):362–73; doi: 10.1002/da.22043.
33.
Tantimonaco M, Ceci R, Sabatini S, Catani MV, Rossi A, Gasperi V, Maccarrone M. Physical activity and the endocannabinoid system: an overview. Cell Mol Life Sci. 2014;71(14):2681–98; doi: 10.1007/s00018-014-1575-6.
34.
McNarry MA, Berg RMG, Shelley J, Hudson J, Saynor Z, Duckers J, Lewis K, Davies GA, Mackintosh KA. Inspiratory muscle training enhances recovery post-COVID-19: a randomised controlled trial. Eur Respir J. 2022;60(4):2103101; doi: 10.1183/13993003.03101-2021.
35.
Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner GS. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–30; doi: 10.1249/MSS.0b013e3181a0c95c.
36.
Schuch FB, Bulzing RA, Meyer J, Vancampfort D, Firth J, Stubbs B, Grabovac I, Willeit P, Tavares VDO, Calegaro VC, Deenik J, López-Sánchez GF, Veronese N, Caperchione CM, Sadarangani KP, Abufaraj M, Tully MA, Smith L. Associations of moderate to vigorous physical activity and sedentary behavior with depressive and anxiety symptoms in self-isolating people during the COVID-19 pandemic: a cross-sectional survey in Brazil. Psychiatry Res. 2020;292:113339; doi: 10.1016/j.psychres.2020.113339.
37.
Meyer J, McDowell C, Lansing J, Brower C, Smith L, Tully M. Changes in physical activity and sedentary behavior in response to COVID-19 and their associations with mental health in 3052 US adults. Int J Environ Res Public Health. 2020;17:6469; doi: 10.3390/ijerph17186469.
38.
Lakhan R, Agrawal A, Sharma M. Prevalence of depression, anxiety, and stress during COVID-19 pandemic. J Neurosci Rural Pract. 2020;11(4):519–25; doi: 10.1055/s-0040-1716442.
39.
Wang TJ, Chau B, Lui M, Lam G-T, Lin N, Humbert S. Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020;99(9):769–74; doi: 10.1097/PHM.0000000000001505.
40.
Abdullahi A. Safety and efficacy of chest physiotherapy in patients with COVID-19: a critical review. Front Med. 2020;7:454; doi: 10.3389/fmed.2020.00454.
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