Progressive muscle relaxation exercises in patients with COVID-19: Systematic review and meta-analysis

Patients with COVID-19 will experience high levels of anxiety and depression and poor levels of sleep and quality of life (QoL) due to isolation treatment and uncertain outcomes. Progressive muscle relaxation (PMR) exercises show promising treatment effects on mental health and sleep problems and overall QoL in COVID-19 patients. This study aimed to evaluate the efficacy and safety of PMR exercises in patients with COVID-19. METHODS: Both experimental and non-experimental studies related to PMR and COVID-19 were systematically searched in the PubMed, Cochrane Library, PEDro and HINARI databases for studies published from the occurrence of the pandemic to December 2022. Study selection, methodological quality assessment and data extraction were carried out by 2 independent authors. Efficacy outcomes were evaluated for sleep quality, anxiety, depression, and QoL. The safety outcomes were evaluated based on adverse events reported. Review manager (RevMan 5.4, Cochrane collaboration) was used for the data analysis. RESULTS: Four studies with 227 subjects were included in this systematic review. The pooled results indicated that PMR interventions improved the sleep quality score standardized mean difference (SMD): −0.23; 95% confidence interval (CI): −0.54, 0.07; P = .13, level of anxiety SMD: −1.35; 95% CI −2.38, −0.32; P = .01 compared to the usual care. Depression level, disease severity and QoL were also improved following PMR interventions. Only 1 study reported worsening of 1 patient clinical status while all other studies did not report any adverse events during the interventions. CONCLUSIONS: PMR interventions can improve the sleep quality, anxiety, depression, disease severity and QoL in patients with mild to moderate COVID-19 in a short-term period compared to the usual care. However, there was indecision about the safety and long-term effects of PMR.