MR-spectroscopy in Post-covid Condition Prior to and Following a Yoga Breathing Intervention

Inclusion Criteria:

• Inclusion criteria for participants with Post COVID condition

1. Eligible patients will be recruited at the Respiratory Outpatient Clinic (MedicalUniversity Innsbruck, Internal Medicine II) from the PRECISE registry or fromother participating clinics at Medical University Innsbruck and via localadvertisement.
2. Persistent respiratory symptoms for 3 months after infection (mMRC dyspnea score ≥ 1).
3. Absence of obstructive or restrictive lung disease or unilateral diaphragmaticparesis.
4. Medical history with symptoms compatible with DB as assessed by the physician ANDNijmegen cut-off score of >23 or reduced MIP. The last two conditions were chosento provide a readily accessible and objectifiable entry criterion at theinclusion visit.
5. Age >= 18 years, < 50 years.
6. Sufficient knowledge of German language for interaction during Yoga andcompletion of questionnaires. Inclusion criteria for participants with COPD
7. Eligible patients will be recruited at the Respiratory Outpatient Clinic (MedicalUniversity Innsbruck).
8. A postbronchodilator FEV1/FVC ratio less than 0,7 obtained in functional pulmonarytesting is required fo diagnosis of COPD (Global Initiative for Chronic ObstructiveLung Disease (GOLD) Science Committee, 2022).
9. Persistent respiratory symptoms for 3 months (mMRC≥ 1).
10. Absence of unilateral diaphragmatic paresis.
11. Medical history with symptoms compatible with DB as assessed by the physician ANDNijmegen cut-off score of >23 or reduced MIP. The last two conditions were chosen toprovide a readily accessible and objectifiable entry criterion at the inclusion visit.
12. Age >= 18 years, < 50 years
13. Sufficient knowledge of German language for interaction during Yoga and completion ofquestionnaires Inclusion criteria for participants with somatic symptom disorder
14. Eligible patients will be recruited at University Hospital for Psychiatry I and II,Medical University Innsbruck) and via local advertisement.
15. Screening positive for somatic symptoms disorder with the following scores: SSD-12 ≥ 23, SSS-8 ≥ 9.
16. Persistent respiratory symptoms for 3 months after infection (mMRC≥ 1).
17. Absence of obstructive or restrictive lung disease or unilateral diaphragmaticparesis.
18. Absence of medical history with symptoms compatible with DB as assessed by thephysician AND Nijmegen cut-off score of >23 or reduced MIP. The last two conditionswere chosen to provide a readily accessible and objectifiable entry criterion at theinclusion visit.
19. Age >= 18 years, < 50 years.
20. Sufficient knowledge of German language for interaction during Yoga and completion ofquestionnaires. Inclusion criteria for healthy participants
21. Eligible participants will be recruited via local advertisement.
22. Absence of significant active mental or somatic disorders
23. Absence of persistent respiratory symptoms (mMRC< 1).
24. Absence of obstructive or restrictive lung disease or unilateral diaphragmaticparesis.
25. Absence of medical history with symptoms compatible with DB as assessed by thephysician AND Nijmegen questionnaire and MIP within normal limits..
26. Age >= 18 years, < 50 years.
27. Sufficient knowledge of German language for interaction during Yoga and completion ofquestionnaires.

Exclusion Criteria:

• Exclusion criteria for participants with post COVID condition

1. Conditions precluding magnetic resonance imaging (MRI) such as metal implants inthe body (e.g., pacemakers, surgical devices), phobic anxiety, claustrophobia, orpregnancy.
2. Active psychiatric conditions interfering with study participation such aspsychosis or acute suicidality.
3. Severe fatigue interfering with study participation.
4. Previous evidence of structural brain abnormality on the structural MRI scan.
5. Significant previous meditation or Yoga experience.
6. Patients with known carotid stenosis >70% or cardiopulmonary contraindicationsfor tilt table and other cardiovascular autonomic function tests (e.g. Valsalvamaneuver, deep breathing, standing test). Exclusion criteria for participants with COPD
7. Conditions precluding magnetic resonance imaging (MRI) such as metal implants in thebody (e.g., pacemakers, surgical devices), phobic anxiety, claustrophobia, orpregnancy.
8. Active psychiatric conditions interfering with study participation such as psychosisor acute suicidality.
9. Severe fatigue interfering with study participation.
10. Previous evidence of structural brain abnormality on the structural MRI scan.
11. Medical history of post COVID condition.
12. Significant previous meditation or Yoga experience.
13. Patients with known carotid stenosis >70% or cardiopulmonary contraindications fortilt table and other cardiovascular autonomic function tests (e.g. Valsalva maneuver,deep breathing, standing test).
14. Patients dependent on a long-term oxygen therapy (LTOT ) Exclusion criteria for participants with somatic symptom disorder
15. Conditions precluding magnetic resonance imaging (MRI) such as metal implants in thebody (e.g., pacemakers, surgical devices), phobic anxiety, claustrophobia, orpregnancy.
16. Other active psychiatric conditions interfering with study participation such aspsychosis or acute suicidality.
17. Severe fatigue interfering with study participation.
18. Previous evidence of structural brain abnormality on the structural MRI scan.
19. Medical history of post COVID condition.
20. Significant previous meditation or Yoga experience.
21. Patients with known carotid stenosis >70% or cardiopulmonary contraindications fortilt table and other cardiovascular autonomic function tests (e.g. Valsalva maneuver,deep breathing, standing test). Exclusion criteria for healthy participants
22. Conditions precluding magnetic resonance imaging (MRI) such as metal implants in thebody (e.g., pacemakers, surgical devices), phobic anxiety, claustrophobia, orpregnancy.
23. Active psychiatric conditions interfering with study participation such as psychosisor acute suicidality.
24. Previous evidence of structural brain abnormality on the structural MRI scan.
25. Medical history of post COVID condition.
26. Significant previous meditation or Yoga experience.
27. Patients with known carotid stenosis >70% or cardiopulmonary contraindications fortilt table and other cardiovascular autonomic function tests (e.g. Valsalva maneuver,deep breathing, standing test). legend: PRECISE = a study conducted with participants with post-COVID-19 condition at theMedical University of Innsbruck; mMRC score = modified medical research council score; DB =dysfunctional breathing; MIP = maximal inspiratory pressure; COPD = chronic obstructivepulmonary disease; FEV1/FVC = forced expiratory volume in one second/ forced vitalcapacity; SSD-12 = Somatic Symptom Disorder - B Criteria Scale; SSS-8 = Somatic SymptomScale - 8;