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Ortiz-Ortigosa L, Gálvez-Álvarez P, Viñolo-Gil MJ, Rodriguez-Huguet M, Góngora-Rodríguez J, Martín-Valero R. Effectiveness of pulmonary rehabilitation programmes and/or respiratory muscle training in patients with post-COVID conditions: a systematic review. Respir Res 2024; 25:248. [PMID: 38890699 PMCID: PMC11186160 DOI: 10.1186/s12931-024-02857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The term "post-COVID-19 condition" refers to the symptomatology that appears between four to twelve weeks after Covid-19 infection. These symptoms can persist for weeks or even months, significantly diminishing the quality of life for affected individuals. The primary objective of this study was to assess the effectiveness of pulmonary rehabilitation programs and/or respiratory muscle training on respiratory sequelae in patients with post-COVID condition. METHODS The literature search was conducted in the following databases: PubMed, PEDro, Embase, Cochrane, Scopus, and Web of Science. Randomized clinical trials were included in which participants were aged 18 years or older. Articles were excluded if at least one of the therapies did not involve pulmonary rehabilitation or respiratory muscle training, if the participants were COVID positive, if studies lacked results, and finally, if interventions were conducted without supervision or at home. This review only encompasses supervised non-virtual interventions. This study adheres to the PRISMA statement and has been registered in the PROSPERO database (CRD42023433843). RESULTS The outcomes obtained in the included studies are assessed across the following variables: Exercise capacity using the 6-minute walk test, Dyspnea, fatigue, Pulmonary function, Maximum inspiratory pressure, and Quality of life. CONCLUSION Despite the absence of a specific treatment at present, it was evident from this review that a well-structured pulmonary rehabilitation program that incorporates both aerobic and muscular strength exercises along with techniques and inspiratory muscle exercises was the most effective form of treatment.
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Affiliation(s)
- Lucía Ortiz-Ortigosa
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Málaga, 29071, Spain
| | - Paula Gálvez-Álvarez
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Málaga, 29071, Spain
| | | | | | | | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Málaga, 29071, Spain.
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Agustiningsih D, Wibawa T. Demystifying roles of exercise in immune response regulation against acute respiratory infections: A narrative review. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:139-153. [PMID: 38708320 PMCID: PMC11067861 DOI: 10.1016/j.smhs.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 05/07/2024] Open
Abstract
The benefits of physical activity and exercise, especially those classified as moderate-to-vigorous activity (MVPA), have been well-established in preventing non-communicable diseases and mental health problems in healthy adults. However, the relationship between physical activity and exercise and the prevention and management of acute respiratory infection (ARI), a global high-burden disease, has been inconclusive. There have been debates and disagreements among scientific publications regarding the relationship between exercise and immune response against the causative agents of ARI. This narrative review aims to explore the theory that sufficiently explains the correlation between exercise, immune response, and ARI. The potential root causes of discrepancies come from research associated with the "open window" hypothesis. The studies have several limitations, and future improvements to address them are urgently needed in the study design, data collection, exercise intervention, subject recruitment, biomarkers for infection and inflammation, nutritional and metabolism status, and in addressing confounding variables. In conclusion, data support the clinical advantages of exercise have a regulatory contribution toward improving the immune response, which in turn potentially protects humans fromARI. However, the hypothesis related to its negative effect must be adopted cautiously.
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Affiliation(s)
- Denny Agustiningsih
- Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Tri Wibawa
- Department of Microbiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Lai CY, Lin CH, Chao TC, Lin CH, Chang CC, Huang CY, Chiang SL. Effectiveness of a 12-week telerehabilitation training in people with long COVID: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101853. [PMID: 38824899 DOI: 10.1016/j.rehab.2024.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Telerehabilitation has been developed and applied for years for cardiac and pulmonary diseases with good clinical outcomes. However, its application to participants with long COVID remains limited. OBJECTIVES To investigate the effectiveness of a 12-week telerehabilitation training program in participants with long COVID. The primary outcome was cardiorespiratory fitness (CRF), and secondary outcomes were physical activity (PA) amounts, exercise self-efficacy, sleep quality, and health-related quality of life (HRQOL). METHODS A parallel-group, randomized controlled trial was conducted. Eligible participants with long COVID (n = 182) were randomly assigned in a 1:1 ratio to either the experimental group (EG) or the control group (CG). The EG received 12 weeks of telerehabilitation training with weekly remote monitoring for exercise maintenance and support. The CG received PA counseling only. CRF, PA amounts, exercise self-efficacy, sleep quality, and HRQOL were assessed at baseline and 12 weeks. Generalized estimating equations were used to analyze the intervention effects by examining the interaction between time and group. RESULTS One hundred twenty-two participants (67 %) completed the study, and 182 were included in the intention-to-treat analysis. The EG had greater walking behavior (β = -763.3, p < 0.001), total amount of PA (β= -711, p = 0.003), exercise self-efficacy (β = -1.19, p < 0.001), and better sleep quality (β = 1.69, p = 0.012) after the 12-weeks of telerehabilitation training than the CG. However, there were no significant differences in any CRF parameters or HRQOL at 12 weeks between the EG and CG. CONCLUSION Telerehabilitation training offers a personalized and convenient approach that can increase exercise willingness and PA amounts and improve sleep quality. These findings underscore the potential benefits of telerehabilitation training for promoting healthier lifestyles and improving overall health outcomes. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT05205460) on January 25, 2022.
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Affiliation(s)
- Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing & School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chueh-Ho Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
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Schröder J, Dinse H, Maria Jahre L, Skoda EM, Stettner M, Kleinschnitz C, Teufel M, Bäuerle A. Needs and Demands for e-Health Symptom Management Interventions in Patients with Post-COVID-19 Condition: A User-Centered Design Approach. Telemed J E Health 2024. [PMID: 38814744 DOI: 10.1089/tmj.2024.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Introduction: Post-COVID-19 is an increasing chronic disease for which potential treatment options require further development and examination. A well-established approach to symptom management in post-COVID-19 patients could be e-Health interventions. To enhance the implementation and utilization of e-Health interventions, the needs and demands of patients should be taken into consideration. The aim of this study was to investigate needs and demands of post-COVID-19 patients concerning e-Health symptom management interventions. Methods: A total of 556 patients participated in this cross-sectional online survey study. Recruitment was performed from January 19 to May 24, 2022. Data related to the needs and demands for e-Health interventions were analyzed, along with medical and sociodemographic information. Results: The majority of the patients preferred interventions accessible on smartphones (95.3%). The favored content formats were applications (82.7%), interactive training (69.3%), or audio and video materials (61.1%). Furthermore, the preferred session length was about 10-20 min. The most desired topics included "quality of life," "information about how intensively I may exert myself or do sports," "adjustment to new life situation," and "handling physical changes." Conclusions: This study provides a detailed framework for the content and design of e-Health interventions to support patients managing their post-COVID-19 symptoms. The findings could significantly influence the further development of tailored e-Health interventions to address this pressing global health concern.
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Affiliation(s)
- Julia Schröder
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Hannah Dinse
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Maria Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Mark Stettner
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Michalas M, Katsaras S, Spetsioti S, Spaggoulakis D, Antonoglou A, Asimakos A, Katsaounou P, Christakou A. The Effect of Physiotherapy on Dyspnea, Muscle Strength and Functional Status in Patients with Long COVID Syndrome. J Pers Med 2024; 14:515. [PMID: 38793097 PMCID: PMC11121916 DOI: 10.3390/jpm14050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Patients who were infected with COVID-19 may experience Long COVID syndrome. We examined the effectiveness of physiotherapy on dyspnea, muscle strength, and functional status in Long COVID syndrome. METHODS The exercise group underwent an 8-week supervised physiotherapeutic program consisting of interval aerobic exercise and strengthening exercises, each lasting 30 min. The control group did not engage in any exercise. Dyspnea, muscle strength, and functional status were assessed at the beginning and end of the intervention in both groups. RESULTS No significant baseline differences were found between the two groups. The exercise group demonstrated improvements compared to baseline in dyspnea, quadriceps muscle strength, and functional status. Specifically, there was a significant increase of 3.7 lifts in the 60-s sit-to-stand test (p = 0.01), an increase of 5.86 kg in right quadriceps muscle strength (p = 0.03), an increase of 8.26 kg in left quadriceps muscle strength (p = 0.01), and a decrease in dyspnea score by 0.95 points (p = 0.02). CONCLUSIONS Similar studies have reported improvements in dyspnea, muscle strength, and functional status in the exercise group. However, further research with larger sample sizes is needed to confirm these findings.
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Affiliation(s)
- Michail Michalas
- Department of Physiotherapy, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece; (M.M.); (S.K.)
| | - Stefanos Katsaras
- Department of Physiotherapy, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece; (M.M.); (S.K.)
| | - Stavroula Spetsioti
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Dimitrios Spaggoulakis
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Archontoula Antonoglou
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Andreas Asimakos
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Paraskevi Katsaounou
- First Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece; (S.S.); (D.S.); (A.A.); (A.A.); (P.K.)
| | - Anna Christakou
- Department Physiotherapy, Lab Biomechanics, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece
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Gloeckl R, Zwick RH, Fürlinger U, Schneeberger T, Leitl D, Jarosch I, Behrends U, Scheibenbogen C, Koczulla AR. Practical Recommendations for Exercise Training in Patients with Long COVID with or without Post-exertional Malaise: A Best Practice Proposal. SPORTS MEDICINE - OPEN 2024; 10:47. [PMID: 38658496 PMCID: PMC11043268 DOI: 10.1186/s40798-024-00695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 04/26/2024]
Abstract
People with long COVID may suffer from a wide range of ongoing symptoms including fatigue, exertional dyspnea, reduced exercise performance, and others. In particular, impaired exercise performance is a condition that can be recovered in many people through an individualized physical exercise training program. However, clinical experience has shown that the presence of post-exertional malaise (PEM) is a significant barrier to physical exercise training in people with long COVID. Currently, there is no guideline or consensus available on how to apply exercise training in this cohort. Therefore, we conducted a literature review in the PubMed library using the following search terms: "COVID", "post-COVID", "long COVID" and "exercise" searching for studies from January 2020 to January 2024. Data from 46 trials were included. Exercise training regimes were very heterogeneous and none of these studies reported on the management of PEM in the context of an exercise training program. Based on the feedback from an additional survey that was answered by 14 international experts in the field of exercise training in long COVID, combined with the authors´ own extensive practical experience, a best practice proposal for exercise training recommendations has been developed. This proposal differentiates exercise procedures according to the presence of no, mild/moderate or severe PEM in people with long COVID. These recommendations may guide allied healthcare professionals worldwide in initiating and adjusting exercise training programs for people with long COVID, stratified according to the presence and severity of PEM.
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Affiliation(s)
- Rainer Gloeckl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Ralf H Zwick
- Therme Wien Med, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Ulrich Fürlinger
- Therme Wien Med, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Tessa Schneeberger
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Daniela Leitl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Uta Behrends
- Childrens' Hospital, School of Medicine, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Andreas Rembert Koczulla
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany.
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.
- Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Mujovic N, Nikolic D, Markovic F, Stjepanovic M, Zekovic M, Ali HSH, Zivanovic D, Savic M, Laban M. The Effects of Six Weeks Pulmonary Rehabilitation on Functional and Psychological Outcomes in Long-COVID Patients: Preliminary Results from Serbian Single Center Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:671. [PMID: 38674318 PMCID: PMC11052156 DOI: 10.3390/medicina60040671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: In this study, we aimed to evaluate the effects of six weeks of pulmonary rehabilitation on functional and psychological outcomes in long-COVID patients. Material and Methods: The prospective clinical study included 46 patients that were diagnosed with COVID-19. A respiratory rehabilitation program was implemented for six weeks. Further valuables were tested before the beginning of the rehabilitation program (admission) and six weeks after (discharge): SpO2, heart rate, respiratory rate, Visual Analogue Scale (VAS) score, Borg score, Sit-to-Stand (StS) test number of repetition, distance of 6-Minute Walking Test (6MWT), Patient Health Questionnaire (PHQ) 9 score and Generalized anxiety disorder (GAD) anxiety score. These parameters were tested before the rehabilitation program on admission and at discharge and after the rehabilitation program on admission and at discharge. The results were presented with standard descriptive and analytical methods. Differences between the continuous variables before and after physical rehabilitation intervention were tested using the Wilcoxon test. Graphical analysis is presented with a box plot. Results: On discharge, in comparison with admission, the values of SpO2 were significantly lower (p = 0.007) before the 6MWT, and VAS scores were significantly higher (p = 0.036), while after the 6MWT, VAS scores were significantly lower (p < 0.001) as were Borg scores (p = 0.016). On discharge, in comparison with admission, the respiratory rate was significantly higher (p = 0.005) before the StS test, and Borg scores were significantly lower (p = 0.001), while after the StS test, SpO2 levels were significantly higher (p = 0.036) and VAS scores were significantly lower (p < 0.001), as were Borg scores (p = 0.008). After discharge, the values of the StS test were significantly higher (p = 0.011), PHQ9 scores were significantly lower (p < 0.001) and GAD anxiety scores were significantly lower as well (p = 0.005), while the distances measured in meters on the 6MWT were significantly increased (p < 0.001). Conclusions: A structured rehabilitation program in our study was shown to have beneficial effects on physiological, psychological and functional improvements in patients with long-COVID, and therefore it is advisable for these patients.
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Affiliation(s)
- Natasa Mujovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Center for Physical Medicine and Rehabilitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Filip Markovic
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (F.M.); (M.L.)
| | - Mihailo Stjepanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (F.M.); (M.L.)
| | - Milica Zekovic
- Laboratory for Sports Medicine and Exercise Therapy, Institute of Medical Physiology “Rihard Burijan”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | | | - Dubravka Zivanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Clinic of Dermatology and Venerology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Savic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.S.); (D.Z.); (M.S.)
- Clinic for Lung Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marija Laban
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (F.M.); (M.L.)
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Gaudreau-Majeau F, Gagnon C, Djedaa SC, Bérubé B, Malo J, Iglesies-Grau J, Gayda M, Bherer L, Besnier F. Cardiopulmonary rehabilitation's influence on cognitive functions, psychological state, and sleep quality in long COVID-19 patients: A randomized controlled trial. Neuropsychol Rehabil 2024:1-17. [PMID: 38607276 DOI: 10.1080/09602011.2024.2338613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/02/2024] [Indexed: 04/13/2024]
Abstract
CLINICALTRIALS.GOV NCT05035628.Trial registration: ClinicalTrials.gov identifier: NCT05035628..
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Affiliation(s)
- Flavie Gaudreau-Majeau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Christine Gagnon
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
| | - Sarah Clavet Djedaa
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Béatrice Bérubé
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Jacques Malo
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Josep Iglesies-Grau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Mathieu Gayda
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Louis Bherer
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - Florent Besnier
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
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Tesarz J, Lange H, Kirchner M, Görlach A, Eich W, Friederich HC. Efficacy of supervised immersive virtual reality-based training for the treatment of chronic fatigue in post-COVID syndrome: study protocol for a double-blind randomized controlled trial (IFATICO Trial). Trials 2024; 25:232. [PMID: 38570805 PMCID: PMC10993519 DOI: 10.1186/s13063-024-08032-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The treatment of persistent fatigue after COVID-19 infection is complex. On the one hand, it involves maintaining a sufficient level of physical and mental activity to counteract possible degenerative processes of the body and nervous system. On the other hand, physical and mental activities can also lead to worsening of symptoms. Therefore, the challenge in treating Post-COVID fatigue is to stimulate the body and central nervous system in a way that stimulates growth and improvement, but does not overtax individual physical and mental limits. Special training programs try to take these characteristics into account, but often reach their limits. A promising approach is offered by new fitness technologies based on immersive virtual realities that stimulate both body and brain while minimizing physical and psychological stress. The aim of this study is to investigate the efficacy of supervised immersive Virtual Reality (VR)-based activity training compared to conventional activity training for patients with Post-COVID-associated fatigue. METHODS In a single centre, individually randomised, prospective, double-blind two-arm exploratory superiority trial with parallel group design, N = 100 patients with persistent fatigue after COVID-19 infection will be recruited. The intervention includes a supervised immersive neuromuscular training (12 sessions of 30 min over 6 weeks) based on a novel VR-exercise device. We will systematically compare the effects of this intervention on Post-COVID-associated fatigue with a supervised conventional activation program of comparable scope without an immersive environment. The primary outcome is the difference between groups in absolute change in the mean fatigue symptom severity measured on the Fatigue Severity Scale (FSS) from baseline to posttreatment assessment. Posttreatment assessment in both groups will be conducted by blinded outcome assessors. At three and six months afterwards, patients are sent self-report questionnaires for follow up. The main analysis will be based on the intention-to-treat principle. DISCUSSION To the best of our knowledge, this is the first exploratory study on a supervised immersive neuromuscular training for the treatment of persistent fatigue after COVID-19 infection. TRIAL REGISTRATION German register for clinical studies (ID: DRKS00032059) Prospectively registered on June 16th 2023. URL of trial registration.
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Affiliation(s)
- Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany.
- DZPG (German Centre for Mental Health), Partner Site Heidelberg/ Mannheim/ Ulm, Heidelberg, Germany.
| | - Hannah Lange
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Axel Görlach
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, Germany
- DZPG (German Centre for Mental Health), Partner Site Heidelberg/ Mannheim/ Ulm, Heidelberg, Germany
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10
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Martínez-Pozas O, Meléndez-Oliva E, Rolando LM, Rico JAQ, Corbellini C, Sánchez Romero EA. The pulmonary rehabilitation effect on long covid-19 syndrome: A systematic review and meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2077. [PMID: 38389299 DOI: 10.1002/pri.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis aims to evaluate the efficacy of pulmonary rehabilitation (PR) in improving dyspnea, fatigue, physical activity, quality of life, anxiety and depression in patients with Long COVID-19 (LC). The impact of PR on LC and a comparison of face-to-face and telerehabilitation approaches was explored. METHODS This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. A literature search included PubMed, Web of Science, and Cochrane Library until January 2023. No language filters were applied. Randomized controlled trials, non-randomized controlled trials, and observational studies were included. The risk of bias was assessed using appropriate tools. Descriptive analysis and meta-analysis were performed. Forest plots presented results. Statistical analyses were conducted using the Metafor Package in R v.3.4.2. RESULTS/FINDINGS This systematic review and meta-analysis included 16 studies on PR in LC patients. A total of 1027 adults were included. The studies varied in design, with seven observational studies, three quasi-experimental studies, and six randomized controlled trials. Dyspnea, physical function, quality of life, psychological state, and fatigue were assessed as outcomes. The review found that pulmonary rehabilitation had a significant positive effect on dyspnea, physical function, quality of life (both global and physical domain), anxiety, and depression. However, the effect on fatigue was not significant. Heterogeneity was observed in some analyses, and publication bias was found in certain outcomes. Age and study design were identified as potential moderators. Both face-to-face and telerehabilitation interventions improved the studied outcomes, with only differences in the physical domain of quality of life favoring the face-to-face group. IMPLICATIONS ON PHYSIOTHERAPY PRACTICE PR improved dyspnea, physical function, quality of life, and psychological state in LC patients, but not fatigue. Face-to-face and telerehabilitation have similar effects, except for physical quality of life.
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Affiliation(s)
- Oliver Martínez-Pozas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
| | - Erika Meléndez-Oliva
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Valencia, Valencia, Spain
| | | | - José Antonio Quesada Rico
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Camilo Corbellini
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.S.B.L., Differdange, Luxembourg
| | - Eleuterio A Sánchez Romero
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
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11
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Poon ETC, Sun F, Tse ACY, Tsang JH, Chung AYH, Lai YYY, Wong SWS. Effectiveness of tele-exercise training on physical fitness, functional capacity, and health-related quality of life in non-hospitalized individuals with COVID-19: The COFIT-HK study. J Exerc Sci Fit 2024; 22:134-139. [PMID: 38347889 PMCID: PMC10859274 DOI: 10.1016/j.jesf.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/04/2024] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
Background The use of tele-exercise programs as an option for post-COVID-19 rehabilitation has been suggested, but its effectiveness in non-hospitalized individuals is not well understood. Objective This study aimed to determine the effectiveness of an 8-week tele-exercise training program (COFIT-HK) on physical fitness, functional capacity, and health-related quality of life (HRQoL) in non-hospitalized post-COVID-19 individuals. Methods Forty-one non-hospitalized individuals (age:47.4 ± 7.8 yrs) who had COVID-19 history were divided into two groups: the tele-exercise training group (TELE; n = 21) and the non-intervention control group (CON; n = 20). TELE engaged in online supervised multicomponent low-to-moderate intensity exercise training (including respiratory muscle, aerobic, and resistance training) three times per week, whereas CON received standardized educational leaflets based on World Health Organization (WHO) guidelines for post-COVID-19-related illness rehabilitation only. Various components of physical fitness, functional capacity, and HRQoL were assessed at baseline and after the 8-week intervention. Results TELE showed significant improvements in handgrip strength, arm flexibility, functional lower extremity endurance, and HRQoL after the 8-week intervention (all p < 0.05, ES = 0.50-1.10). When comparing the groups, TELE demonstrated significantly greater improvements in both the physical and mental component summary scores of HRQoL compared to CON (both p < 0.05). Other outcomes did not reveal significant group differences. Conclusion Our tele-exercise intervention was effective in improving physical fitness, functional capacity and HRQoL among non-hospitalized post-COVID-19 individuals. Further research is needed to explore the utility and limitations of tele-exercise programs for post-COVID-19 rehabilitation and beyond.
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Affiliation(s)
- Eric Tsz-Chun Poon
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Taipo, Hong Kong
| | - Andy Choi-Yeung Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Taipo, Hong Kong
| | | | - Aaron Yiu-Huen Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Taipo, Hong Kong
| | - Yannis Yuet-Yan Lai
- Department of Health and Physical Education, The Education University of Hong Kong, Taipo, Hong Kong
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12
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Estebanez‐Pérez M, Martín‐Valero R, Pastora‐Estebanez P, Pastora‐Bernal J. Experiences of people with Long Covid with a digital physiotherapy intervention: A qualitative study. Health Expect 2024; 27:e13993. [PMID: 38590093 PMCID: PMC11002316 DOI: 10.1111/hex.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/10/2024] Open
Abstract
PURPOSE Long Covid syndrome is a multiorgan condition with multiple sequelae affecting quality of life, capacity to work and daily activities. The advantages that new technologies can offer are presented as an opportunity in the current healthcare framework. OBJECTIVE This research aimed to explore people with Long Covid's experiences with a digital physiotherapy practice intervention, during four weeks. METHODS Qualitative semistructured interviews were conducted by video call. Thirty-two Long Covid participants were invited to join an in-depth interview once the intervention was completed. Participants were queried on their intervention experiences and perceptions, as well as any lifestyle changes made, as a result of receiving digital physiotherapy practice. The interviews were transcribed and analysed using inductive qualitative content analysis. RESULTS In-depth qualitative analysis has revealed four themes that reflect participants' perceptions of digital physiotherapy intervention. The helpfulness of the exercises, interaction with the physiotherapist, the domestic use of technology and the future of digital health practice were the topics highlighted by Long Covid participants. Some improvements have been suggested including video sounds and the need to introduce face-to-face sessions. Participants stated that interventions were helpful and superior to printed exercise sheets, mobile phone apps and usual care received. This intervention did not present major barriers, highlighting the importance of personalized care and continuity in the provision of health services. CONCLUSION The digital physiotherapy practice is perceived by people with Long Covid as an appropriate method for the care of their health needs. Participants stated the need for this type of intervention in the public health system, where it would eliminate waiting lists, facilitate accessibility and improve existing care. PATIENT AND PUBLIC CONTRIBUTION Participants contributed to the interpretation of the data acquired in the interview. CLINICAL TRIAL REGISTRATION Trial registration NCT04742946.
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Affiliation(s)
- María‐José Estebanez‐Pérez
- Department of Physiotherapy, Faculty of Health ScienceUniversity of MalagaMálagaSpain
- Department of PhysiotherapyFaculty of Health Science, University of GranadaMelillaSpain
| | - Rocío Martín‐Valero
- Department of Physiotherapy, Faculty of Health ScienceUniversity of MalagaMálagaSpain
| | - Pablo Pastora‐Estebanez
- Department of Economy, Faculty of Economic and Business SciencesUniversity of MálagaMálagaSpain
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13
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Schmachtenberg T, Königs G, Roder S, Müller F, Müllenmeister C, Schröder D, El-Sayed I. How do people with long COVID utilize COVID-19 vaccination and rehabilitation services and what are their experiences with these services? results of a qualitative study with 48 participants from Germany. BMC Public Health 2024; 24:915. [PMID: 38549052 PMCID: PMC10976759 DOI: 10.1186/s12889-024-18380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Studies estimate that at least 7.5% of adults are affected by long-term symptoms such as fatigue or cognitive impairment after the acute phase of COVID-19. COVID-19 vaccination may reduce the risk of long COVID. Rehabilitation can have a positive impact on recovery. This study aims to present the experiences of people with long COVID with COVID-19 vaccination and rehabilitation. Such research is important because perceptions of these measures can impact healthcare utilization and health status. METHODS 48 adults with long COVID participated in this qualitative study, 25 of them in one-on-one interviews and 23 in focus groups. Participants were recruited via calls for participation on the websites and social media channels of two university hospitals and with the help of respondents' networks. The conversations were audio-recorded, transcribed, and analyzed using qualitative content analysis. Subsequently, the results were compared, interpreted, and discussed by scientific literature. RESULTS 35 study participants reported that they had received a COVID-19 vaccination and 16 of them stated that they had utilized a rehabilitation service. These participants had varying experiences with COVID-19 vaccination and rehabilitation. Nine of them stated that they developed long COVID despite vaccination before COVID-19. Ten participants reported vaccine reactions, and two participants reported severe side effects. Two participants reported persistent deterioration of their long COVID symptoms after vaccination. This led to uncertainty about the safety, benefits, and handling of COVID-19 vaccination. However, most participants perceived the vaccine as effective regarding milder COVID-19 sequelae. Four participants felt their rehabilitation was helpful and four participants felt it was unhelpful. Two persons found the combination of inpatient rehabilitation and rehabilitation sport helpful. CONCLUSIONS Several implications can be derived from this study: (1) researchers should explore the effects of COVID-19 vaccination on long COVID symptoms; (2) vaccination campaigns should be more responsive to the perspectives of people with long COVID on vaccination; (3) care planners should build rehabilitation facilities specialized in long COVID; (4) rehabilitation providers should train their professionals regarding long COVID and develop rehabilitation programs tailored to different clinical pictures. TRIAL REGISTRATION German register for clinical trials DRKS00026007, 09 September 2021.
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Affiliation(s)
- Tim Schmachtenberg
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Gloria Königs
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Sascha Roder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Social Work, University of Applied Sciences and Arts Bielefeld, Interaktion 1, 33619, Bielefeld, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, 49503, East Lansing, MI, USA
| | - Christina Müllenmeister
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Iman El-Sayed
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
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Seo JW, Kim SE, Kim Y, Kim EJ, Kim T, Kim T, Lee SH, Lee E, Lee J, Seo YB, Jeong YH, Jung YH, Choi YJ, Song JY. Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID. Infect Chemother 2024; 56:122-157. [PMID: 38527781 PMCID: PMC10990882 DOI: 10.3947/ic.2024.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/27/2024] Open
Abstract
"Long COVID" is a term used to describe a condition when the symptoms and signs associated with coronavirus disease 2019 (COVID-19) persist for more than three months among patients infected with COVID-19; this condition has been reported globally and poses a serious public health issue. Long COVID can manifest in various forms, highlighting the need for appropriate evaluation and management by experts from various fields. However, due to the lack of clear clinical definitions, knowledge of pathophysiology, diagnostic methods, and treatment protocols, it is necessary to develop the best standard clinical guidelines based on the scientific evidence reported to date. We developed this clinical guideline for diagnosing and treating long COVID by analyzing the latest research data collected from the start of the COVID-19 pandemic until June 2023, along with the consensus of expert opinions. This guideline provides recommendations for diagnosis and treatment that can be applied in clinical practice, based on a total of 32 key questions related to patients with long COVID. The evaluation of patients with long COVID should be comprehensive, including medical history, physical examination, blood tests, imaging studies, and functional tests. To reduce the risk of developing long COVID, vaccination and antiviral treatment during the acute phase are recommended. This guideline will be revised when there is a reasonable need for updates based on the availability of new knowledge on the diagnosis and treatment of long COVID.
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Affiliation(s)
- Jun-Won Seo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Seong Eun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Jung Kim
- Health, Welfare, Family and Gender Equality Team, National Assembly Research Service, Seoul, Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, and Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Yu Jung Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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15
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Faghy MA, Duncan R, Hume E, Gough L, Roscoe C, Laddu D, Arena R, Asthon REM, Dalton C. Developing effective strategies to optimize physical activity and cardiorespiratory fitness in the long Covid population- The need for caution and objective assessment. Prog Cardiovasc Dis 2024; 83:62-70. [PMID: 38460898 DOI: 10.1016/j.pcad.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
The Post Covid-19 Condition (commonly known as Long Covid) has been defined by the World Health Organisation as occurring in individuals with a history of probable or confirmed SARS CoV 2 infection, usually within 3 months from the onset of acute Covid-19 infection with symptoms that last for at least two months which cannot be explained by an alternative diagnosis. Long Covid is associated with over two hundred recognised symptoms and affects tens of millions of people worldwide. Widely reported reductions in quality of life(QoL) and functional status are caused by extremely sensitive and cyclical symptom profiles that are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli. This manifestation prevents millions of people from engaging in routine activities of daily living (ADLs) and has important health and well-being, social and economic impacts. Post-exertional symptom exacerbation (PESE) (also known as post-exertional malaise) is an exacerbation in the severity of fatigue and other symptoms following physical, emotional, orthostatic and cognitive tasks. Typically, this will occur 24-72 h after "over-exertion" and can persist for several days and even weeks. It is a hallmark symptom of Long Covid with a reported prevalence of 86%. The debilitating nature of PESE prevents patients from engaging in physical activity which impacts functional status and QoL. In this review, the authors present an update to the literature relating to PESE in Long Covid and make the case for evidence-based guidelines that support the design and implementation of safe rehabilitation approaches for people with Long Covid. This review also considers the role of objective monitoring to quantify a patient's response to external stimuli which can be used to support the safe management of Long Covid and inform decisions relating to engagement with any stimuli that could prompt an exacerbation of symptoms.
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Affiliation(s)
- Mark A Faghy
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection Network (HL-Pivot), Illinois, Chicago, USA.
| | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Emily Hume
- Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Lewis Gough
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Clare Roscoe
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK
| | - Deepika Laddu
- Healthy Living for Pandemic Event Protection Network (HL-Pivot), Illinois, Chicago, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, USA
| | - Ross Arena
- Healthy Living for Pandemic Event Protection Network (HL-Pivot), Illinois, Chicago, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, USA
| | - Ruth E M Asthon
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection Network (HL-Pivot), Illinois, Chicago, USA
| | - Caroline Dalton
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
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16
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Ghosh S, Kumar A, Pandey SK, Kumar S. Association of Sleep Quality With Fatigue in Post-COVID-19 Patients in an Indian Population. Am J Phys Med Rehabil 2024; 103:188-193. [PMID: 37602544 DOI: 10.1097/phm.0000000000002332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVE The aims of the study are to assess the quality of sleep in recently recovered COVID-19 and long-COVID cases and to determine its associations with fatigue and pain. METHODS Post-COVID-19 cases ( n = 201) and controls ( n = 206) were assessed using the Pittsburgh Sleep Quality Index questionnaire for sleep quality, Fatigue Severity Scale for fatigue, and Numeric Pain Rating Scale for pain in this observational study. RESULTS Global Pittsburgh Sleep Quality Index score was higher ( P ≤ 0.001) among cases (5.7 ± 5.1; 95% confidence interval, 5.0-6.4) than controls (2.1 ± 2.0; 95% confidence interval, 1.8-2.4). Normal sleep latency was observed in 56 (27.9%) patients and 164 (79.6%) controls ( P < 0.001). Fatigue Severity Scale score was higher ( P ≤ 0.001) among cases (16.8 ± 10.2; 95% confidence interval, 15.4, 18.2) against controls (10.9 ± 4.1; 95% confidence interval, 10.3-11.4). The Fatigue Severity Scale scores in mild, moderate, and severe COVID-19 were 14.3 ± 8.1, 22.1 ± 10.8, and 22.8 ± 13, respectively ( P < 0.001) and higher in the older (20.7 ± 12.1) and middle-aged (19.6 ± 10.3) than in younger (13.9 ± 8.3) ( P ≤ 0.001) cases. The global Pittsburgh Sleep Quality Index score was positively correlated with the Fatigue Severity Scale ( r = 0.755, P < 0.001) and Numeric Pain Rating Scale scores ( r = 0.657, P < 0.001). Numeric Pain Rating Scale score correlated with Fatigue Severity Scale score ( r = 0.710, P < 0.001). Fatigue Severity Scale and global Pittsburgh Sleep Quality Index scores were higher in the long-COVID group ( P < 0.001). CONCLUSIONS Significantly poor sleep quality was observed in post-COVID-19 individuals including long COVID being positively associated with fatigue and pain.
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Affiliation(s)
- Srutarshi Ghosh
- From the Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, India (SG, AK, SKP); and ESIMCH, Bihta, Patna, India (SK)
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17
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Ribeiro J, Caldeira D, Dores H. Long-term manifestations of COVID-19 in athletes: a narrative review. PHYSICIAN SPORTSMED 2024:1-8. [PMID: 38375735 DOI: 10.1080/00913847.2024.2321629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/18/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Long COVID is a condition where symptoms or complications persist beyond 3 months after COVID-19 infection. Although most athletes experience mild symptoms, those involved in sports with higher cardiovascular demands can develop long COVID, which can negatively impact sports performance. This narrative review aimed to analyze the long COVID in athletes, especially cardiovascular effects; to alert medical and sporting community for the clinical aftermaths of COVID-19, focusing on physical activity; and to discuss the potential return-to-play strategies for these athletes. METHODS An electronic search in PubMed database for articles published between January/2020 and February/2023 was performed including athletic populations with COVID-19, emphasizing long-term complications, especially the cardiovascular effects. RESULTS AND CONCLUSIONS While severe cardiac complications are rare, athletes with long COVID often experience symptoms such as fatigue, dyspnea, palpitations, and exercise intolerance. To manage athletes with long COVID, individualized and structured return-to-play programs with the involvement of multidisciplinary teams are crucial. This underscores the importance of recognizing long COVID in athletes, raising awareness of its potential impacts, and implementing strategies to ensure a safe return to play.
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Affiliation(s)
- João Ribeiro
- Faculdade de Medicina da, Universidade de Lisboa, Lisbon, Portugal
| | - Daniel Caldeira
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Lisbon, Portugal
- Cardiovascular Pharmacology and Therapeutics Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), CEMBE, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da, Universidade de Lisboa, Lisbon, Portugal
| | - Hélder Dores
- Hospital da Luz Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Lisbon, Portugal
- Pathophysiology Department, NOVA Medical School, Lisbon, Portugal
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18
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Bileviciute-Ljungar I, Norrefalk JR, Borg K. Improved Functioning and Activity According to the International Classification of Functioning and Disability after Multidisciplinary Telerehabilitation for Post-COVID-19 Condition-A Randomized Control Study. J Clin Med 2024; 13:970. [PMID: 38398284 PMCID: PMC10889504 DOI: 10.3390/jcm13040970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
This study investigates the outcomes and feasibility concerning the functioning and activity of multidisciplinary group telerehabilitation for a post-COVID-19 condition. Recruitment for the group rehabilitation was announced three times during 2021 and 2022 through the COVID-19 patient organization in Sweden. The key inclusion criteria were remaining symptoms and functional impairments beyond 12 weeks after SARS-CoV-2 infection; medical assessment and treatment regarding comorbidities or new postinfection symptoms; the ability to use the Internet. Participants were randomized into a rehabilitation group or onto a waiting list using an Internet program. Multiple outcomes included self-scored questionnaires and physical tests before and after eight weeks, and at six months follow-up. Here, we present the self-scored outcomes on the International Classification of Functioning and Disability questionnaire (ICF, 22 body functions and 16 activity/participation categories) and breathing scales. Of the 164 participants who registered for the study, 67 (mean age 43, 78% women) participated in an eight-week group rehabilitation compared to 42 who served as waiting list controls (mean age 47, 88% women). At six months follow-up, 60 participants from the rehabilitation group and 21 from the waiting list completed the data. The results indicate that a larger number of ICF body functions and activity/participation categories had improved in the rehabilitation group after eight weeks and six months. Overall credibility, as assessed by the Credibility Expectancy Questionnaire, was high, and the attrition rate in rehabilitation was low. The results indicate beneficial outcomes for multidisciplinary telerehabilitation in people suffering from a post-COVID-19 condition. Therefore, rehabilitation interventions should be further developed and implemented in clinical practice.
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Affiliation(s)
- Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, 18288 Stockholm, Sweden; (J.-R.N.); (K.B.)
- Multidisciplinary Pain Clinic, Capio St. Göran Hospital, 11219 Stockholm, Sweden
- Department of Physical and Rehabilitation Medicine, Danderyd University Hospital, 18288 Stockholm, Sweden
| | - Jan-Rickard Norrefalk
- Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, 18288 Stockholm, Sweden; (J.-R.N.); (K.B.)
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, 18288 Stockholm, Sweden; (J.-R.N.); (K.B.)
- Multidisciplinary Pain Clinic, Capio St. Göran Hospital, 11219 Stockholm, Sweden
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Rzepka-Cholasińska A, Ratajczak J, Michalski P, Kasprzak M, Kosobucka-Ozdoba A, Pietrzykowski Ł, Grzelakowska K, Kubica J, Kryś J, Kubica A. Gender-Related Effectiveness of Personalized Post-COVID-19 Rehabilitation. J Clin Med 2024; 13:938. [PMID: 38398252 PMCID: PMC10889393 DOI: 10.3390/jcm13040938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Post-COVID-19 syndrome (PCS) may affect a substantial proportion of patients who have had COVID-19. The rehabilitation program might improve the physical capacity, functioning of the cardiopulmonary system, and mental conditions of these patients. This study aimed to investigate the effectiveness of personalized rehabilitation in patients with PCS according to gender. Methods: Adults who underwent a 6-week personalized PCS rehabilitation program were enrolled in a prospective post-COVID-19 Rehabilitation (PCR-SIRIO 8) study. The initial visit and the final visit included the hand-grip strength test, the bioimpedance analysis of body composition, and the following scales: modified Borg's scale, Modified Fatigue Impact Scale (MFIS), Functioning in Chronic Illness Scale (FCIS), modified Medical Research Council (mMRC) dyspnea scale, and tests: 30 s chair stand test (30 CST), Six-Minute Walk Test (6MWT), Short Physical Performance Battery test (SPPB)e. Results: A total of 90 patients (54% female) underwent the rehabilitation program. Rehabilitation was associated with an increase in skeletal muscle mass (24.11 kg vs. 24.37 kg, p = 0.001) and phase angle (4.89° vs. 5.01°, p = 0.001) and with a reduction in abdominal fat tissue volume (3.03 L vs. 2.85 L, p = 0.01), waist circumference (0.96 m vs. 0.95 m, p = 0.001), and hydration level (83.54% vs. 82.72%, p = 0.001). A decrease in fat tissue volume and an increase in skeletal muscle mass were observed only in females, while an increase in grip strength was noticed selectively in males. Patients' fatigue (modified Borg's scale, MFIS), physical capacity (30 CST, 6MWT), balance (SPPB), dyspnea (mMRC), and functioning (FICS) were significantly improved after the rehabilitation regardless of gender. Conclusions: Personalized rehabilitation improved the body composition, muscle strength, and functioning of patients diagnosed with PCS. The beneficial effect of rehabilitation on body composition, hydration, and phase angle was observed regardless of gender.
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Affiliation(s)
- Alicja Rzepka-Cholasińska
- Department of Cardiac Rehabilitation and Health Promotion, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (J.R.); (P.M.); (A.K.-O.); (Ł.P.); (A.K.)
| | - Jakub Ratajczak
- Department of Cardiac Rehabilitation and Health Promotion, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (J.R.); (P.M.); (A.K.-O.); (Ł.P.); (A.K.)
| | - Piotr Michalski
- Department of Cardiac Rehabilitation and Health Promotion, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (J.R.); (P.M.); (A.K.-O.); (Ł.P.); (A.K.)
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (M.K.); (K.G.); (J.K.)
| | - Agata Kosobucka-Ozdoba
- Department of Cardiac Rehabilitation and Health Promotion, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (J.R.); (P.M.); (A.K.-O.); (Ł.P.); (A.K.)
| | - Łukasz Pietrzykowski
- Department of Cardiac Rehabilitation and Health Promotion, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (J.R.); (P.M.); (A.K.-O.); (Ł.P.); (A.K.)
| | - Klaudyna Grzelakowska
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (M.K.); (K.G.); (J.K.)
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (M.K.); (K.G.); (J.K.)
| | - Jacek Kryś
- Department of Health Economics, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland;
| | - Aldona Kubica
- Department of Cardiac Rehabilitation and Health Promotion, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (J.R.); (P.M.); (A.K.-O.); (Ł.P.); (A.K.)
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20
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Oliveira MR, Hoffman M, Jones AW, Holland AE, Borghi-Silva A. Effect of Pulmonary Rehabilitation on Exercise Capacity, Dyspnea, Fatigue, and Peripheral Muscle Strength in Patients With Post-COVID-19 Syndrome: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00049-2. [PMID: 38311096 DOI: 10.1016/j.apmr.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To establish the effects of pulmonary rehabilitation (PR) in patients with persistent symptoms after COVID-19 infection. In addition, to compare the modalities of PR services (face-to-face and telerehabilitation) and the duration of PR in weeks (4-8 weeks and >8 weeks). DATA SOURCES PubMed/MEDLINE, Embase (Elsevier), Central/Cochrane Library, SciELO Citation Index (Web of Science), and CINAHL. STUDY SELECTION Studies determining the effects of PR in patients with post-COVID-19 syndrome were included and grouped according to PR delivery modality. DATA EXTRACTION Data extraction and quality assessment were independently performed by 2 reviewers. The methodological quality was assessed using the Cochrane Risk of Bias Tool 1 (RoB-1). DATA SYNTHESIS The literature search retrieved 1406 articles, of which 7 studies explored the effects of PR on patients with post-COVID-19 syndrome, with 188 patients randomized to PR. The mean age of participants was 50 years and 49% were women. Meta-analysis showed an increase in exercise capacity with PR compared with control (6-minute walking test: mean difference: 60.56 m, 95% confidence interval: 40.75-80.36), a reduction in fatigue (Fatigue Severity Scale: -0.90, -1.49 to -0.31) but no change in dyspnea (-0.57, -1.32 to 0.17) and muscle strength (3.03, -1.89 to 7.96). There were no differences between telerehabilitation and face-to-face PR regarding effects on peripheral muscle strength (P=.42), dyspnea (P=.83), and fatigue (P=.34). There were no differences between programs 4-8 weeks and >8 weeks regarding exercise capacity (P=.83), peripheral muscle strength (P=.42), and dyspnea (P=.76). CONCLUSIONS PR improves exercise capacity and reduces fatigue in patients with post-COVID-19 syndrome. Duration of PR (4-8 weeks vs > 8 weeks) or PR modality (telerehabilitation vs face-to-face) did not affect outcomes but data were limited and based on subgroup analysis. Further evidence is required to determine the optimal delivery mode and duration of PR for post-COVID-19 syndrome.
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Affiliation(s)
- Murilo Rezende Oliveira
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, Brazil; Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil.
| | - Mariana Hoffman
- Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil
| | - Arwel W Jones
- Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil
| | - Anne E Holland
- Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil; Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, Brazil; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL
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21
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Kerling A, Beyer S, Dirks M, Scharbau M, Hennemann AK, Dopfer-Jablonka A, Lampe V, Salzmann JHW, Tegtbur U, Drick N, Pink I, Haufe S. Effects of a randomized-controlled and online-supported physical activity intervention on exercise capacity, fatigue and health related quality of life in patients with post-COVID-19 syndrome. BMC Sports Sci Med Rehabil 2024; 16:33. [PMID: 38308307 PMCID: PMC10835885 DOI: 10.1186/s13102-024-00817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The Post-COVID-19 syndrome (PCS), which can occur after acute respiratory syndrome coronavirus 2 infection, leads to restrictions in everyday activity. Our study assessed the impact of an online-guided intervention which intended to facilitate physical activity on the mental and physical capability of PCS patients. METHODS We randomized 62 patients with PCS (20 male/ 42 female; age: 46 ± 12 years; body mass index: 28.7 ± 6.7 kg/m2) with a score ≥ 22 in the fatigue assessment scale (FAS) to a 3-month exercise-focused intervention (IG n = 30) or control period (CG n = 32). We assessed changes in exercise capacity (bicycle exercise test with measurements of gas exchange), fatigue, markers of health-related quality of life (HrQoL) and mental health. RESULTS The FAS score decreased significantly in both study groups (IG: 35.1 ± 7.4 to 31.8 ± 8.5 points; CG: 35.6 ± 7.4 to 32.6 ± 7.5 points, both p < 0.01). Exercise capacity did not increase in the CG or IG (within-group changes for IG: peak oxygen uptake: 0.9 ± 2.6 ml/min/kg, p = 0.098; peak power output: 6.1 ± 17.8 W, p = 0.076) with no significant changes in HrQoL and work ability. Patients with a FAS score at baseline ≥ 35 (severe fatigue) showed no change in exercise capacity with the 3-month intervention whereas the sub-group of patients with FAS < 35 points (moderate fatigue) showed improvements, independent of the study group. CONCLUSIONS Our 3-month intervention seems appropriate for patients with moderate fatigue, whereas those with more severe fatigue appear to be too restricted with respect to their mental or physical health status to perform exercise at a level which is sufficient to improve markers of physical performance. TRIAL REGISTRATION German Clinical Trials Register (registration trial number: DRKS00026245) on September 2 2021.
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Affiliation(s)
- Arno Kerling
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sebastian Beyer
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Meike Dirks
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Michèle Scharbau
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | | | - Viktoria Lampe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Uwe Tegtbur
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Isabell Pink
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Sven Haufe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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22
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Calvache-Mateo A, López-López L, Heredia-Ciuró A, Martín-Núñez J, Valenza-Peña G, Cabrera-Martos I, Valenza MC. Early Effects of a Pain-Informed Movement Program in Patients with Post-COVID-19 Condition Experiencing Persistent Pain: Protocol for a Randomized Controlled Trial. J Clin Med 2024; 13:597. [PMID: 38276103 PMCID: PMC10816970 DOI: 10.3390/jcm13020597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: The COVID-19 pandemic has generated 771 million confirmed cases. Of these patients, 60% have developed persistent symptoms including pain. This pain is a complex symptom that needs comprehensive therapeutic strategies to address it holistically. The main objective of this study will be to evaluate the early impact of the Pain Informed Movement (PIM) program in patients with post-COVID-19 conditions experiencing new-onset persistent pain. (2) Methods: A randomized, single-blind clinical trial will be performed. Patients will be randomly assigned (1:1) to the experimental or control group. The experimental group will undergo a PIM program consisting of low-intensity functional exercises, pain neuroscience education, and relaxation techniques. The control group will receive no intervention. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: This study will provide a basis for future research to support the implementation of comprehensive therapeutic approaches in the care of patients with post-COVID-19 persistent pain.
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Affiliation(s)
| | | | | | | | | | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (L.L.-L.); (A.H.-C.); (J.M.-N.); (G.V.-P.); (M.C.V.)
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23
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Daynes E, Mills G, Hull JH, Bishop NC, Bakali M, Burtin C, McAuley HJC, Singh SJ, Greening NJ. Pulmonary Rehabilitation for People With Persistent Symptoms After COVID-19. Chest 2024:S0012-3692(24)00040-0. [PMID: 38246521 DOI: 10.1016/j.chest.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
TOPIC IMPORTANCE COVID-19 can cause ongoing and persistent symptoms (such as breathlessness and fatigue) that lead to reduced functional capacity. There are parallels in symptoms and functional limitations in adults with post-COVID symptoms and adults with chronic respiratory diseases. Pulmonary rehabilitation is a key treatment for adults with chronic respiratory diseases, with the aims to improve symptom management and increase functional capacity. Given the similarities in presentation and aims, a pulmonary rehabilitation program may be optimal to meet the needs of those with ongoing symptoms after COVID-19. REVIEW FINDINGS Aerobic and strength training has shown benefit for adults living with long COVID, although there is little evidence on structured education in this population. Breathing pattern disorder is common in adults with long COVID, and considerations on treatment before rehabilitation, or alongside rehabilitation, are necessary. Considerations on postexertional malaise are important in this population, and evidence from the chronic fatigue syndrome literature supports the need for individualization of exercise programs, and considerations for those who have an adverse reaction to activity and/or exercise. SUMMARY This narrative review summarizes the current evidence on pulmonary rehabilitation programs in a long-COVID population. Where the evidence is lacking in long COVID the supporting evidence of these programs in chronic respiratory diseases has highlighted the importance of aerobic and strength training, considerations for fatigue, potential mechanisms for immunology improvement, and management of breathing pattern disorders in these programs.
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Affiliation(s)
- Enya Daynes
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England.
| | - George Mills
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
| | - James H Hull
- Respiratory Medicine, Royal Brompton Hospital, London, England; Institute of Sport, Exercise and Health, University College London, London, England
| | - Nicolette C Bishop
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, England
| | - Majda Bakali
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, England
| | - Chris Burtin
- REVAL Rehabilitation Center, BIOMED Biomedical Research Institute, Hasselt University, Belgium
| | - Hamish J C McAuley
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
| | - Sally J Singh
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
| | - Neil J Greening
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
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24
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Zheng C, Chen XK, Sit CHP, Liang X, Li MH, Ma ACH, Wong SHS. Effect of Physical Exercise-Based Rehabilitation on Long COVID: A Systematic Review and Meta-analysis. Med Sci Sports Exerc 2024; 56:143-154. [PMID: 37586104 DOI: 10.1249/mss.0000000000003280] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
PURPOSE The number of persons living with post-coronavirus disease 2019 (COVID-19) conditions or long COVID continues to rise worldwide; however, the etiology and the treatment of long COVID remain nebulous. Therefore, efficient, feasible, and cost-effective therapeutic strategies for a large population with long COVID remain warranted. Physical exercise-based rehabilitation is a promising strategy for long COVID, although its therapeutic effects remain to be determined. This systematic review and meta-analysis aimed to examine the effects of physical exercise-based rehabilitation on long COVID. METHODS The electronic databases Medline, Embase, Global Health (Ovid), CINAHL (EBSCO), Web of Science, WHO Global Research Database on COVID-19, LitCovid, and Google Scholar were searched from their inception to November 2022. The identified articles were independently screened by three reviewers, and a random-effects model was used to determine the mean differences in the meta-analysis. RESULTS Twenty-three studies involving 1579 individuals who had COVID-19 (752 women) were included. Physical exercise-based rehabilitation showed beneficial effects on long COVID-related symptoms characterized by dyspnea, fatigue, and depression, as well as on the 6-min walk test, forced expiratory volume in 1 s/forced vital capacity, and quality of life in people who had COVID-19. CONCLUSIONS Physical exercise-based rehabilitation is a potential therapeutic strategy against long COVID and can be applied as a routine clinical practice in people who have recovered from COVID-19. However, customized physical exercise-based rehabilitation programs and their effects on specific types of long COVID require future large-scale studies.
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Affiliation(s)
| | | | - Cindy Hui-Ping Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
| | - Xiao Liang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
| | - Ming-Hui Li
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
| | - Alvin Chun-Hang Ma
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, CHINA
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, CHINA
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25
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Chuang HJ, Lin CW, Hsiao MY, Wang TG, Liang HW. Long COVID and rehabilitation. J Formos Med Assoc 2024; 123 Suppl 1:S61-S69. [PMID: 37061399 PMCID: PMC10101546 DOI: 10.1016/j.jfma.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused tremendous morbidity and mortality worldwide. The large number of post-COVID survivors has drawn attention to the management of post-COVID condition, known as long COVID. This review examines current knowledge of long COVID, regarding its epidemiology, mechanism, and clinical presentations in both adults and children. We also review the rehabilitation principles, modules, and effects, and share Taiwan's efforts to provide a top-down, nationwide care framework for long COVID patients. Dyspnea, chronic cough, and fatigue are the most commonly reported symptoms in the first 6 months after infection, but cognitive impairment and psychological symptoms may persist beyond this time. Several possible mechanisms behind these symptoms were proposed, but remained unconfirmed. These symptoms negatively impact individuals' function, activities, participation and quality of life. Rehabilitation is a key element of management to achieve functional improvement. Early management should start with comprehensive evaluation and identification of red flags. Exercise-based therapy, an essential part of management of long COVID, can be conducted with different modules, including telerehabilitation. Post-exertional symptom exacerbation and orthostatic hypotension should be carefully monitored during exercise. Randomized control trials with a large sample size are needed to determine the optimal timing, dosage, and modules.
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Affiliation(s)
- Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan, ROC.
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26
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Horlick S, Krysa JA, Brehon K, Pohar Manhas K, Kovacs Burns K, Russell K, Papathanassoglou E, Gross DP, Ho C. Exploring Rehabilitation Provider Experiences of Providing Health Services for People Living with Long COVID in Alberta. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7176. [PMID: 38131727 PMCID: PMC10743286 DOI: 10.3390/ijerph20247176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/10/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND COVID-19 infection can result in persistent symptoms, known as long COVID. Understanding the provider experience of service provision for people with long COVID symptoms is crucial for improving care quality and addressing potential challenges. Currently, there is limited knowledge about the provider experience of long COVID service delivery. AIM To explore the provider experience of delivering health services to people living with long COVID at select primary, rehabilitation, and specialty care sites. DESIGN AND SETTING This study employed qualitative description methodology. Semi-structured interviews were conducted with frontline providers at primary care, rehabilitation, and specialty care sites across Alberta. Participants were interviewed between June and September 2022. METHOD Interviews were conducted virtually over zoom, audio-recorded, and transcribed with consent. Iterative inductive qualitative content analysis of transcripts was employed. Relationships between emergent themes were examined for causality or reciprocity, then clustered into content areas and further abstracted into a priori categories through their interpretive joint meaning. PARTICIPANTS A total of 15 participants across Alberta representing diverse health care disciplines were interviewed. RESULTS Main themes include: the importance of education for long COVID recognition; the role of symptom acknowledgement in patient-centred long COVID service delivery; the need to develop recovery expectations; and opportunities for improvement of navigation and wayfinding to long COVID services. CONCLUSIONS Provider experience of delivering long COVID care can be used to inform patient-centred service delivery for persons with long COVID symptoms.
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Affiliation(s)
- Sidney Horlick
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Jacqueline A. Krysa
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Katelyn Brehon
- Rehabilitation Research Centre, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (K.B.); (D.P.G.)
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Kristine Russell
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Douglas P. Gross
- Rehabilitation Research Centre, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (K.B.); (D.P.G.)
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
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27
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Arienti C, Lazzarini SG, Andrenelli E, Cordani C, Negrini F, Pollini E, Ceravolo MG. Rehabilitation and COVID-19: systematic review by Cochrane Rehabilitation. Eur J Phys Rehabil Med 2023; 59:800-818. [PMID: 38214047 DOI: 10.23736/s1973-9087.23.08331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Until the last update in February 2022, the Cochrane Rehabilitation COVID-19 Evidence-based Response (REH-COVER) action identified an increasing volume of evidence for the rehabilitation management of COVID-19. Therefore, our aim was to identify the best available evidence on the effectiveness of interventions for rehabilitation for COVID-19-related limitations of functioning of rehabilitation interest in adults with COVID-19 or post COVID-19 condition (PCC). EVIDENCE ACQUISITION We ran the searches on February 17th, 2023, in the following databases: PubMed, EMBASE, CENTRAL, CINHAL, and the Cochrane COVID-19 Study Register, applying a publication date restriction to retrieve only papers published in 2022. To retrieve papers published before 2022, we screened the reference lists of previous publications included in the REH-COVER action, covering papers from early 2020 to the end of 2022. This current review includes only randomised controlled trials and concludes the rapid living systematic reviews of the Cochrane Rehabilitation REH-COVER action. The risk of bias and certainty of evidence were evaluated in all studies using the Cochrane Risk of Bias tool and GRADE, respectively. We conducted a narrative synthesis of the evidence. PROSPERO registration number: CRD42022374244. EVIDENCE SYNTHESIS After duplicate removal, we identified 18,950 individual records and 53 RCTs met the inclusion criteria. Our findings suggest that the effect of breathing and strengthening exercise programs on dyspnea and physical exercise capacity compared to no treatment in non-severe COVID-19 patients is uncertain. Multicomponent telerehabilitation may slightly increase physical exercise capacity compared to educational intervention in adults with PCC. There is, however, uncertainty about its effect on lung function and physical exercise capacity when compared to no treatment. Finally, the effect of inspiratory muscle training on maximal inspiratory pressure compared to no treatment in adults with PCC is uncertain. CONCLUSIONS Interventions that are part of comprehensive pulmonary rehabilitation approaches may benefit dyspnea and exercise tolerance in adults with COVID-19 and PCC. The available evidence has several methodological limitations that limit the certainty of evidence and the clinical relevance of findings. Therefore, we cannot provide robust suggestions for practice. While high-quality RCTs are being conducted, clinicians should consider using high-quality evidence from other pulmonary conditions to rehabilitate patients with COVID-19 or PCC using context-specific interventions.
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Affiliation(s)
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesco Negrini
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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Fontana JM, Alito A, Piterà P, Verme F, Cattaldo S, Cornacchia M, Mai S, Brunani A, Capodaglio P. Whole-Body Cryostimulation in Post-COVID Rehabilitation for Patients with Obesity: A Multidisciplinary Feasibility Study. Biomedicines 2023; 11:3092. [PMID: 38002092 PMCID: PMC10669700 DOI: 10.3390/biomedicines11113092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND A post-COVID condition can reduce activity and quality of life, resulting in a significant socioeconomic and health burden. Understanding its impact on patients' health is important for the development of personalized rehabilitation interventions. An independent association between obesity and post-COVID condition was found because of complications and comorbidities. METHODS Sixteen patients with obesity and post-COVID symptoms (i.e., dyspnea, pain, poor sleep quality, muscle fatigue), admitted to the Istituto Auxologico Italiano, Piancavallo (VB), Italy, were recruited for a four-week rehabilitation program including conventional exercise therapy, nutritional intervention, psychological support and whole-body cryostimulation (WBC). RESULTS All participants attended all sessions of the program. Anthropometric data showed statistically significant changes in weight, waist circumference and body mass index. Biochemical analyses showed significant reductions in lipid and inflammatory profiles. There was a significant improvement in physical performance, reduction in pain and improvement in psychological well-being. CONCLUSION A multidisciplinary rehabilitation protocol including WBC, designed for patients with obesity and a post-COVID condition, is safe and feasible. The overall improvements demonstrate that multidisciplinary rehabilitation was effective on post COVID patients and suggest that the use of WBC is safe and could play a role as a booster in rehabilitation programs.
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Affiliation(s)
- Jacopo Maria Fontana
- Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy; (P.P.); (F.V.); (A.B.); (P.C.)
| | - Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy;
| | - Paolo Piterà
- Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy; (P.P.); (F.V.); (A.B.); (P.C.)
| | - Federica Verme
- Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy; (P.P.); (F.V.); (A.B.); (P.C.)
| | - Stefania Cattaldo
- Laboratory of Clinical Neurobiology, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy;
| | - Mauro Cornacchia
- Pulmonary Rehabilitation Department, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy;
| | - Stefania Mai
- Laboratory of Metabolic Research, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy;
| | - Amelia Brunani
- Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy; (P.P.); (F.V.); (A.B.); (P.C.)
| | - Paolo Capodaglio
- Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy; (P.P.); (F.V.); (A.B.); (P.C.)
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Torino, 10121 Torino, Italy
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Sánchez-García JC, Reinoso-Cobo A, Piqueras-Sola B, Cortés-Martín J, Menor-Rodríguez MJ, Alabau-Dasi R, Rodríguez-Blanque R. Long COVID and Physical Therapy: A Systematic Review. Diseases 2023; 11:163. [PMID: 37987274 PMCID: PMC10660729 DOI: 10.3390/diseases11040163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
Prolonged COVID is a persistent condition following the initial COVID-19 infection, which is characterized by a variety of symptoms that may include fatigue, muscle pain, sleep disturbances, "brain fog", respiratory, cardiovascular, digestive, neurological and dermatological symptoms. Physical therapy has been identified as a crucial aspect of the management of patients with long COVID, as it can help improve symptoms and overall physical function. The investigation of long COVID poses significant challenges due to the diversity and variability of symptoms, lack of clear diagnostic criteria, and limited understanding of the underlying mechanisms. The aim of this study is to conduct a systematic review of studies conducted in patients with long COVID in conjunction with interventions targeting respiratory function, particularly involving physical activity. To this end, we conducted a systematic review to analyze studies conducted on treatment programs for long COVID based on some form of physical activity. The protocol of the review was registered in the PROSPERO website, and the databases PubMed, Scopus, CINAHL and WOS were searched. Of the 62 initial articles, six were included in the review. The results obtained have positive implications for the advancement of physical activity as a therapeutic intervention for individuals with long COVID-19 and the conceptualization of evidence-based treatment protocols. Statistically significant results have been observed in studies of at least 6 weeks duration, in which inspiratory muscle training exercises are proposed. Further research is needed to better understand long COVID and develop effective treatment strategies.
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Affiliation(s)
- Juan Carlos Sánchez-García
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Ampliación de Campus de Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (A.R.-C.); (R.A.-D.)
| | - Beatriz Piqueras-Sola
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - María José Menor-Rodríguez
- Área Sanitaria Santiago de Compostela-Barbanza, Subdirección de Humanización y Atención a la Ciudadanía, 15706 Santiago de Compostela, Spain;
| | - Raquel Alabau-Dasi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Ampliación de Campus de Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (A.R.-C.); (R.A.-D.)
| | - Raquel Rodríguez-Blanque
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- San Cecilio University Hospital, 18071 Granada, Spain
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Fedorowski A, Olsén MF, Nikesjö F, Janson C, Bruchfeld J, Lerm M, Hedman K. Cardiorespiratory dysautonomia in post-COVID-19 condition: Manifestations, mechanisms and management. J Intern Med 2023; 294:548-562. [PMID: 37183186 DOI: 10.1111/joim.13652] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A significant proportion of COVID-19 patients experience debilitating symptoms for months after the acute infection. According to recent estimates, approximately 1 out of 10 COVID-19 convalescents reports persistent health issues more than 3 months after initial recovery. This 'post-COVID-19 condition' may include a large variety of symptoms from almost all domains and organs, and for some patients it may mean prolonged sick-leave, homestay and strongly limited activities of daily life. In this narrative review, we focus on the symptoms and signs of post-COVID-19 condition in adults - particularly those associated with cardiovascular and respiratory systems, such as postural orthostatic tachycardia syndrome or airway disorders - and explore the evidence for chronic autonomic dysfunction as a potential underlying mechanism. The most plausible hypotheses regarding cellular and molecular mechanisms behind the wide spectrum of observed symptoms - such as lingering viruses, persistent inflammation, impairment in oxygen sensing systems and circulating antibodies directed to blood pressure regulatory components - are discussed. In addition, an overview of currently available pharmacological and non-pharmacological treatment options is presented.
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Affiliation(s)
- Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Solna, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Monika Fagevik Olsén
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Nikesjö
- Department of Respiratory Medicine in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
| | - Maria Lerm
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lewthwaite H, Byrne A, Brew B, Gibson PG. Treatable traits for long COVID. Respirology 2023; 28:1005-1022. [PMID: 37715729 DOI: 10.1111/resp.14596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Abstract
Long COVID, or post-acute COVID-19 sequelae, is experienced by an estimated one in eight adults following acute COVID-19. Long COVID is a new and complex chronic health condition that typically includes multiple symptoms that cross organ systems and fluctuate over time; a one-size-fits-all approach is, therefore, not likely to be appropriate nor relevant for long COVID treatment. 'Treatable Traits' is a personalized medicine approach, purpose-built to address the complexity and heterogeneity of complex chronic conditions. This comprehensive review aimed to understand how a treatable traits approach could be applied to long COVID, by first identifying the most prevalent long COVID treatable traits and then the available evidence for strategies to target these traits. An umbrella review of 22 systematic reviews identified 34 symptoms and complications common with long COVID, grouped into eight long COVID treatable trait clusters: neurological, chest, psychological, pain, fatigue, sleep impairment, functional impairment and other. A systematic review of randomized control trials identified 18 studies that explored different intervention approaches for long COVID prevention (k = 4) or management (k = 14). While a single study reported metformin as effective for long COVID prevention, the findings need to be replicated and consensus is required around how to define long COVID as a clinical trial endpoint. For long COVID management, current evidence supports exercise training or respiratory muscle training for long COVID treatable traits in the chest and functional limitation clusters. While there are studies exploring interventions targeting other long COVID treatable traits, further high-quality RCTs are needed, particularly targeting treatable traits in the clusters of fatigue, psychological, pain and sleep impairment.
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Affiliation(s)
- Hayley Lewthwaite
- Centre of Research Excellence Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Anthony Byrne
- Heart Lung Clinic, Department of Thoracic Medicine St Vincent's Hospital and Clinical School University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Bruce Brew
- Peter Duncan Neuroscience Research Unit, St. Vincent's Centre for Applied Medical Research, Darlinghurst, New South Wales, Australia
- Department of Neurology and Immunology, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Peter G Gibson
- Centre of Research Excellence Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Edward JA, Peruri A, Rudofker E, Shamapant N, Parker H, Cotter R, Sabin K, Lawley J, Cornwell WK. Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID. J Cardiopulm Rehabil Prev 2023; 43:400-406. [PMID: 37646620 DOI: 10.1097/hcr.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The post-acute sequalae of SARS-CoV-2, also known as "Long COVID," is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
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Affiliation(s)
- Justin A Edward
- Department of Medicine-Cardiology (Drs Edward, Rudofker, Shamapant, Parker, Cotter, and Cornwell and Ms Sabin) and Clinical Translational Research Center (Dr Cornwell), University of Colorado Anschutz Medical Campus, Aurora; Department of Medicine, Division of Cardiology, Parkview Medical Center, Pueblo, Colorado (Dr Peruri); and Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria (Dr Lawley)
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Kogel A, Machatschek M, Scharschmidt R, Wollny C, Lordick F, Ghanem M, Laufs U, Fikenzer S. Physical exercise as a treatment for persisting symptoms post-COVID infection: review of ongoing studies and prospective randomized controlled training study. Clin Res Cardiol 2023; 112:1699-1709. [PMID: 37698618 PMCID: PMC10584711 DOI: 10.1007/s00392-023-02300-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND PURPOSE No evidence-based treatment is available for patients with persisting symptoms post-COVID-19 infection. We hypothesized that physical exercise may represent a safe and effective treatment option for post-COVID. METHODS We performed a systematic search of the literature that revealed a lack of randomized training studies in patients post-COVID. Based on these findings, a prospective randomized controlled study with open-label and blinded endpoint evaluation was designed. 272 patients with symptoms of fatigue persisting over 6 weeks post-COVID infection were screened. Patients with pathological cardiovascular findings were excluded. 57 patients consented and were randomized to 4 weeks of supervised personalized strength and endurance training or usual care. The follow-up period was 3 and 6 months. RESULTS There were no adverse events related to the training. Spiroergometry of the training group showed a significantly higher increase in VO2peak (10.0 ± 12.7% vs. 0.1 ± 8.9%, p < 0.01, respectively) and oxygen pulse (9.8 ± 10.8% vs. 0.0 ± 13.9%, p < 0.05, respectively). Parameters of the Multidimensional Fatigue Inventory-20, McGill Quality of Life Questionnaire, and Post-COVID-19 Functional Status were improved after 4 weeks in both groups. In the follow-up period, the total physical activity per week was significantly greater in the exercise group than in controls (1280 ± 1192 min vs. 644 ± 554 min, p < 0.05, respectively). The improvements in fatigue and quality of life were not statistically different between the training and usual care groups. CONCLUSION Exercise is safe and improves maximal exercise capacity in post-COVID patients. Fatigue and quality of life improve over time in individuals that are willing to participate in a training study irrespective of their allocation. REGISTRATION German Clinical Trials Register: DRKS00026686. Date of registration: 27.09.2021.
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Affiliation(s)
- Alexander Kogel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Moritz Machatschek
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Ronja Scharschmidt
- Zentrale Einrichtung für Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Carolin Wollny
- Zentrale Einrichtung für Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Florian Lordick
- Medizinische Klinik und Poliklinik 2-Onkologie, Gastroenterologie, Hepatologie, Pneumologie, Infektiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mohamed Ghanem
- Zentrale Einrichtung für Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Germany
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Sven Fikenzer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Aljazeeri J, Almusally R, Wert Y, Abdelhalim M, Klinger C, Ramesh N, Rahman T. Pulmonary Rehabilitation for Post-COVID-19. J Cardiopulm Rehabil Prev 2023; 43:438-443. [PMID: 37535550 DOI: 10.1097/hcr.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
PURPOSE Patients with COVID-19 often report persistent respiratory symptoms. Limited data exist on how to mitigate long-term sequelae of exercise intolerance and dyspnea. We aimed to study the role of pulmonary rehabilitation (PR) in patients with post-COVID-19. METHODS This was an observational study. Consecutive patients with post-COVID-19, admitted to three separate outpatient PR programs, were enrolled. The program consisted of 8-12 wk of PR sessions (3 times/wk). Data were gathered at the initial visit and discharge. The primary outcome was the change in the 6-min walk test (6MWT) distance. Secondary outcomes included the Shortness of Breath Questionnaire (SOBQ), modified Borg dyspnea scale, Patient Health Questionnaire-9 (PHQ-9), and Lung Information Needs Questionnaire (LINQ). RESULTS A total of 56 patients completed the PR program (age 62.8 ± 14.7 yr, 57% were men). At baseline, the mean 6MWT was 313.3 ± 193.8 m. On average, the 6MWT improved by 84.3 m after PR ( P < .0001). Apart from the modified Borg dyspnea scale, there was improvement across secondary outcomes: SOBQ (-16.9 points), PHQ-9 (-2.6 points), and LINQ (-4.2 points); all P < .05. CONCLUSION Pulmonary rehabilitation showed a promising positive effect on patients with with post-COVID-19. It improved exercise capacity, perception of dyspnea, depressive symptoms, and patient knowledge needed to manage their lung disease. Pulmonary rehabilitation should be considered for post-COVID-19 patients.
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Affiliation(s)
- Jafar Aljazeeri
- University of Pittsburgh Medical Center, Central Pennsylvania the United States (Drs Aljazeeri, Ramesh, and Rahman and Mss Wert and Klinger); Drexel University College of Medicine, Philadelphia, Pennsylvania, the United States (Drs Aljazeeri, Abdelhalim, and Ramesh); and Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia (Dr Almusally)
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Schmachtenberg T, Königs G, Dragaqina A, Roder S, Müller F, Müllenmeister C, Schröder D, Dopfer-Jablonka A, Vieth K, El-Sayed I. "There is no one who helps you with it": experiences of people with long COVID regarding medical care, therapeutic measures, and barriers in the German healthcare system: results of a qualitative study with four focus groups. BMC Health Serv Res 2023; 23:1160. [PMID: 37884993 PMCID: PMC10601213 DOI: 10.1186/s12913-023-10170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Many people experience long-term symptoms such as fatigue, cognitive problems, or shortness of breath after an acute infection with COVID-19. This emerging syndrome, known as long COVID, is new and complex in many aspects. This study aims to collect the experiences of people with long COVID with ambulatory healthcare structures. METHODS Four focus groups were conducted with a total of 23 adults with long COVID in June and July 2022. These discussions were audio-recorded, subsequently transcribed, and analyzed using the qualitative content analysis of Mayring and Kuckartz. RESULTS Fourteen out of 19 participants who had a primary care encounter regarding their long COVID symptoms did not perceive it as helpful. Many respondents reported that their general practitioners did not take their long COVID symptoms seriously and did not refer them to specialists or made therapeutic recommendations. However, some participants reported that they were prescribed non-pharmaceutical therapies (e.g., group meetings supported by psychotherapists, occupational therapy, etc.) that improved their condition. 14 of 23 respondents perceived care barriers such as providers' lack of awareness of long COVID, poor access to specialists, a lack of specialized care (e.g., long COVID clinics), or high bureaucratic hurdles for specific healthcare services. To improve medical care, participants suggested campaigns to raise awareness of long COVID among healthcare providers and the general population, increase research and government investments regarding the development of treatment structures for long COVID, expanding existing therapeutic services, and establishing one-stop shops for integrated specialist healthcare for people with long COVID. CONCLUSIONS Several implications for healthcare professionals and policymakers can be derived from this study: (1) general practitioners should take the symptoms of long COVID seriously, assume a care coordinating role, make referrals, and establish contact with long COVID clinics; (2) care planners should focus on developing interprofessional evidence-based care and treatment approaches for long COVID; (3) existing care structures such as long COVID outpatient clinics should be expanded. The overarching goal must be to develop consistent guidelines for long COVID diagnosis, care, and treatment. TRIAL REGISTRATION The study is registered in the German register for clinical trials (DRKS00026007, first registration on 09/09/2021).
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Affiliation(s)
- Tim Schmachtenberg
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Gloria Königs
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Anita Dragaqina
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Sascha Roder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Christina Müllenmeister
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Feodor-Lynen- Str. 26, 30625, Hannover, Germany
| | - Katharina Vieth
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Iman El-Sayed
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
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Mooren JM, Garbsch R, Schäfer H, Kotewitsch M, Waranski M, Teschler M, Schmitz B, Mooren FC. Medical Rehabilitation of Patients with Post-COVID-19 Syndrome-A Comparison of Aerobic Interval and Continuous Training. J Clin Med 2023; 12:6739. [PMID: 37959205 PMCID: PMC10649998 DOI: 10.3390/jcm12216739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Post-COVID-19 syndrome (PCS) is a multisystemic disorder marked by impaired physical performance as one lead symptom. Since it has been suggested that endurance training as part of medical rehabilitation may be effective in improving physical performance capacity in PCS, this study aimed to compare different modes of aerobic endurance training. METHODS A total of 110 PCS patients (49.3 ± 11.8 years; 38% women; time after infection = 260.2 ± 127.5 days) underwent detailed clinical screening including symptom-limited cardiopulmonary exercise testing at admission and after 4-6 weeks of inpatient medical rehabilitation. Questionnaires were used to assess disease perception. Patients performed controlled isocaloric cycle ergometer training (3-5 sessions/week; 18 min) as either continuous training (CT) at 50% of maximal workload or as interval training (IT; load = 60%, relief = 30%). Outcomes of PCS patients were compared to coronary artery disease patients (CAD; n = 96) to evaluate overall training effectiveness. RESULTS Training participation was comparable between the groups, with no indication of training-specific exercise-induced fatigue. Overall, PCS patients improved significantly by a mean of 6.8 ± 12.1% for W at VT1; 3.1 ± 10.0% for VO2 at VT1; 5.5 ± 14.7% for O2 pulse at VT1; 7.5 ± 15.0% for W at VO2peak; 2.7 ± 11.0% for VO2peak and 4.6 ± 12.4% for O2 pulse at VO2peak (all p < 0.05) with no significant differences between groups (p > 0.05). Both groups showed reduced levels of fatigue, anxiety, and depression as well as improved quality of life and wellbeing (all p < 0.05). Compared to guideline-based cardiac rehabilitation, PCS patients showed a similar improvement in workload and oxygen uptake compared to CAD patients. CONCLUSION PCS patients benefit from aerobic endurance training performed as moderate continuous or interval training as part of a medical rehabilitation program in terms of improved physical exercise capacity and disease perception. The results for PCS patients are comparable to the guideline-based rehabilitation of CAD patients.
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Affiliation(s)
- Johanna M. Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
| | - René Garbsch
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
| | - Hendrik Schäfer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
| | - Mona Kotewitsch
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
| | - Melina Waranski
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
| | - Marc Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
| | - Boris Schmitz
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
| | - Frank C. Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany (B.S.)
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany
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Sanhueza S, Vidal MA, Hernandez MA, Henriquez-Beltran ME, Cabrera C, Quiroga R, Antilef BE, Aguilar KP, Castillo DA, Llerena FJ, Fraga Figueroa M, Nazal M, Castro E, Lagos P, Moreno A, Lastra JJ, Gajardo J, Garcés P, Riffo B, Buchert J, Sanhueza R, Ormazába V, Saldivia P, Vargas C, Nourdin G, Koch E, Zuñiga FA, Lamperti L, Bustos P, Guzmán-Gutiérrez E, Tapia CA, Ferrada L, Cerda G, Woehlbier U, Riquelme E, Yuseff MI, Muñoz Ramirez BA, Lombardi G, De Gonzalo-Calvo D, Salomon C, Verdugo RA, Quiñones LA, Colombo A, Barría MI, Labarca G, Nova-Lamperti E. Clinical and pulmonary function analysis in long-COVID revealed that long-term pulmonary dysfunction is associated with vascular inflammation pathways and metabolic syndrome. Front Med (Lausanne) 2023; 10:1271863. [PMID: 37869162 PMCID: PMC10590130 DOI: 10.3389/fmed.2023.1271863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Long-term pulmonary dysfunction (L-TPD) is one of the most critical manifestations of long-COVID. This lung affection has been associated with disease severity during the acute phase and the presence of previous comorbidities, however, the clinical manifestations, the concomitant consequences and the molecular pathways supporting this clinical condition remain unknown. The aim of this study was to identify and characterize L-TPD in patients with long-COVID and elucidate the main pathways and long-term consequences attributed to this condition by analyzing clinical parameters and functional tests supported by machine learning and serum proteome profiling. Methods Patients with L-TPD were classified according to the results of their computer-tomography (CT) scan and diffusing capacity of the lungs for carbon monoxide adjusted for hemoglobin (DLCOc) tests at 4 and 12-months post-infection. Results Regarding the acute phase, our data showed that L-TPD was favored in elderly patients with hypertension or insulin resistance, supported by pathways associated with vascular inflammation and chemotaxis of phagocytes, according to computer proteomics. Then, at 4-months post-infection, clinical and functional tests revealed that L-TPD patients exhibited a restrictive lung condition, impaired aerobic capacity and reduced muscular strength. At this time point, high circulating levels of platelets and CXCL9, and an inhibited FCgamma-receptor-mediated-phagocytosis due to reduced FcγRIII (CD16) expression in CD14+ monocytes was observed in patients with L-TPD. Finally, 1-year post infection, patients with L-TPD worsened metabolic syndrome and augmented body mass index in comparison with other patient groups. Discussion Overall, our data demonstrated that CT scan and DLCOc identified patients with L-TPD after COVID-19. This condition was associated with vascular inflammation and impair phagocytosis of virus-antibody immune complexes by reduced FcγRIII expression. In addition, we conclude that COVID-19 survivors required a personalized follow-up and adequate intervention to reduce long-term sequelae and the appearance of further metabolic diseases.
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Affiliation(s)
- Sergio Sanhueza
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Mabel A. Vidal
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
- Facultad de Ingeniería, Diseño y Arquitectura, Universidad San Sebastián, Concepción, Chile
| | | | - Mario E. Henriquez-Beltran
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
- Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán, Chile
- Kinesiology School, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles, Chile
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Camilo Cabrera
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Romina Quiroga
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Bárbara E. Antilef
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Kevin P. Aguilar
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Daniela A. Castillo
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Faryd J. Llerena
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Marco Fraga Figueroa
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Mauricio Nazal
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Eritson Castro
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Paola Lagos
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Alexa Moreno
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Jaime J. Lastra
- Internal Medicine Department, Hospital Guillermo Grant Benavente and Medicine Faculty, University of Concepción, Concepción, Chile
| | - Jorge Gajardo
- Internal Medicine Department, Hospital Guillermo Grant Benavente and Medicine Faculty, University of Concepción, Concepción, Chile
| | - Pamela Garcés
- Internal Medicine Department, Hospital Guillermo Grant Benavente and Medicine Faculty, University of Concepción, Concepción, Chile
| | | | | | - Rocío Sanhueza
- Kinesiology School, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles, Chile
| | - Valeska Ormazába
- Department of Pharmacology, Faculty of Biological Sciences, University of Concepción, Concepción, Chile
| | - Pablo Saldivia
- Division of Biotechnology, MELISA Institute, San Pedro de la Paz, Chile
| | - Cristian Vargas
- Division of Biotechnology, MELISA Institute, San Pedro de la Paz, Chile
| | - Guillermo Nourdin
- Division of Biotechnology, MELISA Institute, San Pedro de la Paz, Chile
| | - Elard Koch
- Division of Biotechnology, MELISA Institute, San Pedro de la Paz, Chile
| | - Felipe A. Zuñiga
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Liliana Lamperti
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Paula Bustos
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Enrique Guzmán-Gutiérrez
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Claudio A. Tapia
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
| | - Luciano Ferrada
- CMA Bío-Bío - Advanced Microscopy Center, University of Concepción, Concepción, Chile
| | - Gustavo Cerda
- CMA Bío-Bío - Advanced Microscopy Center, University of Concepción, Concepción, Chile
| | - Ute Woehlbier
- Center for Integrative Biology, Faculty of Sciences, Universidad Mayor, Santiago, Chile
| | - Erick Riquelme
- Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Maria-Isabel Yuseff
- Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Braulio A. Muñoz Ramirez
- Department of Pharmacology and Toxicology, School of Medicine, Indiana University Bloomington, Bloomington, IN, United States
| | - Giovanna Lombardi
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - David De Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Carlos Salomon
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Medicine and Biomedical Science Faculty, The University of Queensland, Brisbane, QLD, Australia
| | - Ricardo A. Verdugo
- Instituto de Investigación Interdisciplinaria y Escuela de Medicina, Universidad de Talca, Talca, Chile
| | - Luis A. Quiñones
- Department of Basic-Clinical Oncology, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Pharmaceutical Sciences and Technology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
- Latin American Network for Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
| | - Alicia Colombo
- Department of Basic-Clinical Oncology, Faculty of Medicine, University of Chile, Santiago, Chile
- Servicio de Anatomía Patológica, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Maria I. Barría
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Puerto Montt, Chile
| | - Gonzalo Labarca
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
- Internal Medicine, Complejo Asistencial Dr. Víctor Ríos Ruiz, Los Ángeles, Chile
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Estefania Nova-Lamperti
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Pharmacy Faculty, University of Concepción, Concepción, Chile
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Kuut TA, Müller F, Nieuwkerk P, Rovers CP, Knoop H. Reply to Crawford and Biere-Rafi et al. Clin Infect Dis 2023; 77:1075-1077. [PMID: 37387679 DOI: 10.1093/cid/ciad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Chantal P Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
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Torres G, Gradidge P. The quality and pattern of rehabilitation interventions prescribed for post-COVID-19 infection patients: A systematic review and meta-analysis. Prev Med Rep 2023; 35:102395. [PMID: 37705882 PMCID: PMC10495653 DOI: 10.1016/j.pmedr.2023.102395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Patients with prior COVID-19 infection may present with lasting multisystem symptoms that require intervention and includes exercise rehabilitation. The aim of this systematic review was to investigate the quality of articles, with emphasis on exercise rehabilitation, and conduct a meta-analysis on experimental and observational rehabilitation intervention studies on cardiorespiratory fitness and pulmonary function in post-COVID-19 infection patients. This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for evaluating rehabilitation interventions in clinical practice. A methodical search of cohort and experimental studies occurred from January 2019 up to March 2023. Thirty-two studies were included for complete analysis. The quality of the eligible studies for complete review was fair overall. The studies did not provide a detailed account of key descriptors of exercise such as volume, progression, motivational strategies, adherence and replication. There was a significant difference in the 6-minute walk test (Mean difference (MD) = 51.69 m; confidence intervals (CIs) = 36.99 to 66.38; p < 0.001, level of heterogeneity (I2) = 0), percent of predicted forced expiratory volume in one second (MD = 7.95%; CIs = 3.46 to 12.44; p = 0.0005, I2 = 65%) and percent of predicted forced vital capacity (MD = 3.49%; 95% CI = 1.25 to 5.73; p = 0.002; I2 = 37%) between the experiment and control groups. The current evidence suggests that rehabilitation interventions significantly improve cardiorespiratory fitness and pulmonary function in post-COVID-19 infection patients; however, there is a need for conceptualising high-quality and long-term rehabilitation interventions, especially exercise interventions.
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Affiliation(s)
- G. Torres
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - P.J. Gradidge
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
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Sembera M, Busch A, Kobesova A, Hanychova B, Sulc J, Kolar P. The effect of abdominal bracing on respiration during a lifting task: a cross-sectional study. BMC Sports Sci Med Rehabil 2023; 15:112. [PMID: 37715283 PMCID: PMC10504786 DOI: 10.1186/s13102-023-00729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Abdominal bracing is a maneuver widely used by rehabilitation specialists and sports trainers to improve spinal stability. This study aimed to investigate how lifting tasks with and without abdominal bracing affect the respiratory function of the diaphragm. METHODS M-mode ultrasonographic assessment of diaphragmatic motion combined with spirometry was performed on 31 healthy adults. Participants were asked to breathe continuously whilst lifting a load with spontaneous abdominal muscle contraction (natural loaded breathing) and abdominal bracing (AB loaded breathing). RESULTS Pearson's correlations revealed strong correlations between ultrasonography and spirometry measures (p < 0.001) for all types of breathing: tidal breathing (r = 0.709, r2 = 0.503), natural loaded breathing (r = 0.731, r2 = 0.534) and AB loaded breathing (r = 0.795, r2 = 0.632). Using paired-samples t-tests, the natural loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p < 0.001) but not during expiration (p = .101). Spirometry demonstrated lower lung volumes (L) at the end of inspiration and expiration (p < 0.001), with no changes in total lung volume (p = 0.06). The AB loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p = 0.002) but not during expiration (p = 0.05). Spirometry demonstrated lower lung volumes at the end of inspiration (p < 0.001), expiration (p = 0.002), and total lung volumes (p = 0.019). CONCLUSION This study demonstrated that abdominal bracing performed during a lifting task reduces lung volume despite an increase in diaphragmatic motion. Diaphragm excursions strongly correlate with lung volumes even under postural loading. TRIAL REGISTRATION The study was prospectively registered on 8 April 2021 at ClinicalTrials.gov with identification number NCT04841109.
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Affiliation(s)
- Martin Sembera
- Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Andrew Busch
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, USA
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Barbora Hanychova
- Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Sulc
- Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Pavel Kolar
- Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic
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Kuut TA, Müller F, Csorba I, Braamse A, Aldenkamp A, Appelman B, Assmann-Schuilwerve E, Geerlings SE, Gibney KB, Kanaan RAA, Mooij-Kalverda K, Olde Hartman TC, Pauëlsen D, Prins M, Slieker K, van Vugt M, Keijmel SP, Nieuwkerk P, Rovers CP, Knoop H. Efficacy of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following Coronavirus Disease 2019: Results of a Randomized Controlled Trial. Clin Infect Dis 2023; 77:687-695. [PMID: 37155736 PMCID: PMC10495128 DOI: 10.1093/cid/ciad257] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Severe fatigue following coronavirus disease 2019 (COVID-19) is prevalent and debilitating. This study investigated the efficacy of cognitive-behavioral therapy (CBT) for severe fatigue following COVID-19. METHODS A multicenter, 2-arm randomized controlled trial was conducted in the Netherlands with patients being severely fatigued 3-12 months following COVID-19. Patients (N = 114) were randomly assigned (1:1) to CBT or care as usual (CAU). CBT, targeting perpetuating factors of fatigue, was provided for 17 weeks. The primary outcome was the overall mean difference between CBT and CAU on the fatigue severity subscale of the Checklist Individual Strength, directly post-CBT or CAU (T1), and after 6 months (T2). Secondary outcomes were differences in proportions of patients meeting criteria for severe and/or chronic fatigue, differences in physical and social functioning, somatic symptoms, and problems concentrating between CBT and CAU. RESULTS Patients were mainly nonhospitalized and self-referred. Patients who received CBT were significantly less severely fatigued across follow-up assessments than patients receiving CAU (-8.8 [95% confidence interval {CI}, -11.9 to -5.8]); P < .001), representing a medium Cohen's d effect size (0.69). The between-group difference in fatigue severity was present at T1 (-9.3 [95% CI, -13.3 to -5.3]) and T2 (-8.4 [95% CI, -13.1 to -3.7]). All secondary outcomes favored CBT. Eight adverse events were recorded during CBT, and 20 during CAU. No serious adverse events were recorded. CONCLUSIONS Among patients, who were mainly nonhospitalized and self-referred, CBT was effective in reducing fatigue. The positive effect was sustained at 6-month follow-up. CLINICAL TRIALS REGISTRATION Netherlands Trial Register NL8947.
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Affiliation(s)
- Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Irene Csorba
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Arnoud Aldenkamp
- Department of Lung Medicine, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | | | - Suzanne E Geerlings
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Katherine B Gibney
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, 3000 Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, 3084 Victoria, Australia
| | - Kirsten Mooij-Kalverda
- Department of Pulmonology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands
| | - Dominique Pauëlsen
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Maria Prins
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands
| | - Kitty Slieker
- Department of Internal Medicine, Bernhoven Hospital, 5406 PT Uden, The Netherlands
| | - Michele van Vugt
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Stephan P Keijmel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Chantal P Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Yang G, Li Z, Li Z, Huang L, Liang P, Liu L, Li D. Meta-analysis of the impact of physical activity on the recovery of physical function in COVID-19 patients. Heliyon 2023; 9:e19339. [PMID: 37662802 PMCID: PMC10469390 DOI: 10.1016/j.heliyon.2023.e19339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Background The decrease in physical function resulting from COVID-19 infection exerts a substantial negative influence on the quality of life of individuals. Physical activity plays a crucial and irreplaceable role in hastening the elimination of adverse effects on the body caused by acute and chronic diseases. Nevertheless, there have been reports of unfavorable events following physical activity post-COVID-19 infection, sparking debate regarding the efficacy of physical activity as a rehabilitation method to enhance the physical function of COVID-19 patients. Objective The aim of this study is to investigate the impact of physical activity on promoting the restoration of physical function among individuals with COVID-19, and to offer guidance for the advancement and consideration of physical activity in the rehabilitation treatment of COVID-19 patients. Methods A search was conducted on the PubMed and Web of Science core collection databases, with the search period set from January 1, 2020, to February 6, 2023. The included literature was assessed for risk of bias and methodological quality according to the Cochrane Handbook for Systematic Reviews of Interventions, utilizing Review Manager 5.1 software. The outcome measures from the included studies were analyzed, and the quality of evidence for the outcome measures was graded using the GRADE classification criteria. Results The effect of physical activity intervention on improving the 6-Minute Walk Test score in COVID-19 patients was better than that of conventional treatment [WMD = 69.19(95%CI = 39.38, 98.99), I2 = 57%(p = 0.03)]. The effect of physical activity on improving the 30-Second Sit-to-Stand Test score was better than that of conventional treatment [WMD = 2.98(95%CI = 1.91, 4.04), I2 = 0%(p = 0.56)]. There was no significant difference between physical activity and conventional treatment in improving Grip strength in COVID-19 patients [WMD = 2.35(95%CI = -0.49, 5.20), I2 = 0%(p = 0.80)]. The effect of physical activity on improving the Timed Up and Go test score in COVID-19 patients was better than that of conventional treatment [WMD = -1.16(95%CI = -1.98, -0.34), I2 = 4%(p = 0.35)]. The effect of physical activity on improving Forced Vital Capacity in COVID-19 patients was better than that of conventional treatment [WMD = 0.14(95%CI = 0.08, 0.21), I2 = 0%(p = 0.45)]. The effect of physical activity on improving Forced Expiratory Volume in the first second in COVID-19 patients was better than that of conventional treatment [WMD = 0.08(95%CI = 0.02, 0.15), I2 = 52%(p = 0.10)]. Conclusions Physical activity plays a crucial role in facilitating the recovery of exercise capacity and pulmonary function in COVID-19 patients, helping to expedite the restoration of overall physical health. It is crucial for COVID-19 patients to undergo an accurate assessment of their physical condition before engaging in any physical activity.
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Affiliation(s)
- Geng Yang
- Graduate School, Guangzhou Sport University, Guangzhou, 510500, Guangdong, China
| | - Zhigan Li
- School of Sports and Health, Guangzhou Sport University, Guangzhou, 510500, Guangdong, China
| | - Zhenpeng Li
- Sports Group, Zhongshan Yangxianyi Middle School, Zhongshan, 528403, Guangdong, China
| | - Linjie Huang
- Graduate School, Guangzhou Sport University, Guangzhou, 510500, Guangdong, China
| | - Peiyi Liang
- Graduate School, Guangzhou Sport University, Guangzhou, 510500, Guangdong, China
| | - Lining Liu
- Graduate School, Guangzhou Sport University, Guangzhou, 510500, Guangdong, China
| | - Dingge Li
- Graduate School, Guangzhou Sport University, Guangzhou, 510500, Guangdong, China
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Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med 2023; 11:20503121231194400. [PMID: 37655303 PMCID: PMC10467233 DOI: 10.1177/20503121231194400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - April Elliott
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Sick J, König D. Exercise Training in Non-Hospitalized Patients with Post-COVID-19 Syndrome-A Narrative Review. Healthcare (Basel) 2023; 11:2277. [PMID: 37628475 PMCID: PMC10454172 DOI: 10.3390/healthcare11162277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Post COVID-19 Syndrome (PCS) is the persistence of symptoms after an infection with SARS-CoV-2 in both hospitalized and non-hospitalized COVID-19 survivors. Exercise was proposed as a rehabilitation measure for PCS and early studies focused on patients post-hospital discharge. The objective of this review is to summarize the results of trials investigating exercise interventions in non-hospitalized subjects with PCS and propose practical recommendations concerning safe exercise programming. A literature search in the databases MEDLINE and Scopus was conducted until 26 July 2023 and resulted in seven studies that met the criteria. In total, 935 subjects with PCS were investigated. Exercise enhanced aerobic fitness and physical function and relieved symptoms of dyspnea, fatigue and depression. Participants reported lower Post COVID-19 Functional Status scores post-intervention. The exercise programs were well tolerated with no adverse events. To ensure safety, medical examinations should take place in advance and there should be a regular evaluation of the individual responses to the training. Caution is advised when working with patients suffering from post-exertional malaise or diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome. There is a growing need for additional randomized controlled trials to investigate the effectiveness and safety of exercise in individuals with PCS.
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Affiliation(s)
- Johanna Sick
- Department of Sport Science, Centre for Sports Science and University Sports, University of Vienna, 1150 Vienna, Austria;
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, 1090 Vienna, Austria
| | - Daniel König
- Department of Sport Science, Centre for Sports Science and University Sports, University of Vienna, 1150 Vienna, Austria;
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, 1090 Vienna, Austria
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Sánchez-García JC, Rentero Moreno M, Piqueras-Sola B, Cortés-Martín J, Liñán-González A, Mellado-García E, Rodriguez-Blanque R. Physical Therapies in the Treatment of Post-COVID Syndrome: A Systematic Review. Biomedicines 2023; 11:2253. [PMID: 37626749 PMCID: PMC10452406 DOI: 10.3390/biomedicines11082253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Several days to months after diagnosis of SARS-CoV-2, 35% of patients have persistent symptoms in high incidence. This is referred to as post-COVID-19 Syndrome. There is a pressing need to find a way to help patients with the manifested symptoms. OBJECTIVE To show the different therapies that exist for post-COVID Syndrome and their efficacy. METHODOLOGY A systematic review of the scientific literature was carried out. The data search was carried out in Scopus, PubMed, Cinahl, and Web of Science. Of the 106 articles found, 12 articles were obtained after applying the following eligibility criteria. RESULTS Interventions related to respiratory musculature and moderate intensity exercise both in supervised face-to-face sessions and in supervised home sessions led patients to a significant improvement in the symptoms presented. CONCLUSION Physical therapies significantly reduce fatigue and dyspnea as well as other symptoms related to quality of life.
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Affiliation(s)
- Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - María Rentero Moreno
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Beatriz Piqueras-Sola
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- University Hospital Virgen de las Nieves, 18014 Granada, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Antonio Liñán-González
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, 52005 Melilla, Spain
| | - Elena Mellado-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- Costa del Sol Health District, 29640 Fuengirola, Spain
| | - Raquel Rodriguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
- University Hospital San Cecilio, 18071 Granada, Spain
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Meléndez-Oliva E, Martínez-Pozas O, Cuenca-Zaldívar JN, Villafañe JH, Jiménez-Ortega L, Sánchez-Romero EA. Efficacy of Pulmonary Rehabilitation in Post-COVID-19: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:2213. [PMID: 37626710 PMCID: PMC10452542 DOI: 10.3390/biomedicines11082213] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis examines how pulmonary rehabilitation impacts in patients suffering from subacute and long COVID-19 infections, gauging enhancements in of dyspnea, physical function, quality of life, psychological state (anxiety and depression), and fatigue. METHODS Three electronic databases (PubMed, Web of Science, Cochrane Library) were systematically searched for full-text articles published from inception to January 2023. Randomized, quasi-experimental, and observational studies were included, with adults diagnosed with subacute or long COVID-19 who received pulmonary rehabilitation as intervention. Outcomes related to dyspnea, physical function, quality of life, fatigue, and psychological status were included. Risk of bias was assessed with Cochrane Risk of Bias Tool for Randomized Controlled Trials and Risk of bias in non-randomized studies of intervention. The review was registered before starting in PROSPERO (CRD: 42022373075). RESULTS Thirty-four studies were included, involving 1970 patients with subacute and long COVID-19. The meta-analysis demonstrated moderate to large effects on dyspnea, physical function, quality of life, and depressive symptoms compared to usual care intervention. No significant differences were found in fatigue compared to usual care, nor in anxiety levels after pulmonary rehabilitation intervention. CONCLUSIONS Pulmonary rehabilitation has the potential to improve health outcomes in patients with subacute and long COVID-19. However, due to the high risk of bias of included studies, conclusions should be taken with caution.
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Affiliation(s)
- Erika Meléndez-Oliva
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Valencia, Pg. de l’Albereda, 7, 46010 Valencia, Spain;
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
| | - Oliver Martínez-Pozas
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Juan Nicolás Cuenca-Zaldívar
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Grupo de Investigación en Fisioterapia y Dolor, Departamento de Enfermería y Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain
- Physical Therapy Unit, Primary Health Care Center “El Abajón”, 28231 Madrid, Spain
| | | | - Laura Jiménez-Ortega
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain;
- Center of Human Evolution and Behavior, Carlos III Health Institute, Complutense University of Madrid, 28040 Madrid, Spain
| | - Eleuterio A. Sánchez-Romero
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
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Wang R, Jia Y, Sun T, Ruan B, Zhou H, Yu L, Hou X. Does Physical Activity Affect Clinical Symptoms and the Quality of Life of Mild-Infected Individuals with COVID-19 in China? A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2163. [PMID: 37570403 PMCID: PMC10418943 DOI: 10.3390/healthcare11152163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Few studies have identified the links between physical activity (PA), clinical symptoms, and the quality of life (QoL) among mildly infected individuals with COVID-19. This cross-sectional study aims to evaluate how PA levels before infections affect the infectious symptoms and the QoL in mildly infected patients with COVID-19. METHODS An online questionnaire link including participants' sociodemographic and anthropometric characteristics, clinical symptoms during the COVID-19 infectious period, the QoL of the worst symptomatic day, and PA in the last seven days before COVID-19 infections was disclosed. Logistic regression and multiple linear regression analyses were applied to assess the relationships between PA levels in the last seven days before infections and COVID-19-related outcomes. The level of statistical significance was set at p < 0.05. RESULTS Compared to the low-PA-level group, the moderate-PA-level group presented a higher risk of headaches (OR = 1.34, 95% CI = 1.03 to 1.75, and p = 0.03) and the high-PA-level group presented a higher risk of muscle/body aches (OR = 1.42, 95% CI = 1.04 to 1.93, and p = 0.03). The adjusted linear regression analysis showed that no associations were found between PA levels in the last seven days before infections and the QoL index value on the worst symptomatic day (moderate-PA-level group: β = -0.04, and p = 0.08; high-PA-level group: β = -0.04, and p = 0.17). However, for the mobility and usual activities dimensions of EQ-5D-5L, the lower-PA-level group had a lower burden of QoL than the higher-PA-level group did on the worst-symptomatic day. CONCLUSIONS Among mildly infected patients with COVID-19, a higher PA level is associated with a higher risk of experiencing clinical symptoms and a lower QoL.
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Affiliation(s)
- Rong Wang
- School of Sport Science, Beijing Sport University, Beijing 100084, China; (R.W.)
- Key Laboratory of Sports and Physical Health Ministry of Education, Beijing Sport University, Beijing 100084, China
| | - Yuanyuan Jia
- School of Sport Science, Beijing Sport University, Beijing 100084, China; (R.W.)
- Key Laboratory of Sports and Physical Health Ministry of Education, Beijing Sport University, Beijing 100084, China
| | - Tingting Sun
- Key Laboratory of Sports and Physical Health Ministry of Education, Beijing Sport University, Beijing 100084, China
| | - Bing Ruan
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Huixuan Zhou
- School of Sport Science, Beijing Sport University, Beijing 100084, China; (R.W.)
| | - Laikang Yu
- Department of Sports Performance, Beijing Sport University, Beijing 100084, China
| | - Xiao Hou
- School of Sport Science, Beijing Sport University, Beijing 100084, China; (R.W.)
- Key Laboratory of Sports and Physical Health Ministry of Education, Beijing Sport University, Beijing 100084, China
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Dillen H, Bekkering G, Gijsbers S, Vande Weygaerde Y, Van Herck M, Haesevoets S, Bos DAG, Li A, Janssens W, Gosselink R, Troosters T, Verbakel JY. Clinical effectiveness of rehabilitation in ambulatory care for patients with persisting symptoms after COVID-19: a systematic review. BMC Infect Dis 2023; 23:419. [PMID: 37344767 DOI: 10.1186/s12879-023-08374-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Lingering symptoms after acute COVID-19 present a major challenge to ambulatory care services. Since there are reservations regarding their optimal management, we aimed to collate all available evidence on the effects of rehabilitation treatments applicable in ambulatory care for these patients. METHODS On 9 May 2022, we systematically searched articles in COVID-19 collections, Embase, MEDLINE, Cochrane Library, Web of Science, CINAHL, PsycArticles, PEDro, and EuropePMC. References were eligible if they reported on the clinical effectiveness of a rehabilitation therapy applicable in ambulatory care for adult patients with persisting symptoms continuing 4 weeks after the onset of COVID-19. The quality of the studies was evaluated using the CASP cohort study checklist and the Cochrane Risk of Bias Assessment Tool. Summary of Findings tables were constructed and the certainty of evidence was assessed using the GRADE framework. RESULTS We included 38 studies comprising 2,790 participants. Physical training and breathing exercises may reduce fatigue, dyspnoea, and chest pain and may improve physical capacity and quality of life, but the evidence is very weak (based on 6 RCTs and 12 cohort studies). The evidence underpinning the effect of nutritional supplements on fatigue, dyspnoea, muscle pain, sensory function, psychological well-being, quality of life, and functional capacity is very poor (based on 4 RCTs). Also, the evidence-base is very weak about the effect of olfactory training on sensory function and quality of life (based on 4 RCTs and 3 cohort studies). Multidisciplinary treatment may have beneficial effects on fatigue, dyspnoea, physical capacity, pulmonary function, quality of life, return to daily life activities, and functional capacity, but the evidence is very weak (based on 5 cohort studies). The certainty of evidence is very low due to study limitations, inconsistency, indirectness, and imprecision. CONCLUSIONS Physical training, breathing exercises, olfactory training and multidisciplinary treatment can be effective rehabilitation therapies for patients with persisting symptoms after COVID-19, still with high uncertainty regarding these effects. These findings can guide ambulatory care practitioners to treat these patients and should be incorporated in clinical practice guidelines. High-quality studies are needed to confirm our hypotheses and should report on adverse events.
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Affiliation(s)
- Hannelore Dillen
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium.
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium.
| | - Geertruida Bekkering
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Centre for Evidence-Based Medicine, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Cochrane Belgium, 7 Kapucijnenvoer, 3000, Leuven, Belgium
| | | | - Yannick Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, 10 Corneel Heymanslaan, 9000, Ghent, Belgium
| | - Maarten Van Herck
- REVAL-Rehabilitation Research Center, Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research and Development, Ciro, 1 Hornerheide, Horn, 6085 NM, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 25 P. Debyelaan, Maastricht, 6229 HX, The Netherlands
| | - Sarah Haesevoets
- REVAL-Rehabilitation Research Center, Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - David A G Bos
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
| | - Ann Li
- , post-COVID community, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven University Hospitals Leuven, 49 Herestraat, 3000, Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 101 Tervuursevest, 3001, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 101 Tervuursevest, 3001, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
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Gloeckl R, Leitl D, Schneeberger T, Jarosch I, Koczulla AR. Rehabilitative interventions in patients with persistent post COVID-19 symptoms-a review of recent advances and future perspectives. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01631-9. [PMID: 37326700 DOI: 10.1007/s00406-023-01631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
The SARS-CoV-2 pandemic has not only caused millions of deaths but left also millions of people with persistent symptoms behind. These long-term COVID-19 sequelae cause a considerable burden on individuals´ health, healthcare systems, and economies worldwide given the high rate of SARS-CoV-2 infections. Therefore, rehabilitative interventions and strategies are needed to counteract the post COVID-19 sequelae. The importance of rehabilitation for patients with persistent COVID-19 symptoms has been recently also highlighted in a Call for Action by the World Health Organisation. Based on previously published research, but also in line with clinical experience, COVID-19 is not one specific disease but rather presents in different phenotypes that vary in their pathophysiological mechanisms, symptomatic manifestations, and potential interventional approaches. This review provides a proposal for differentiating post COVID-19 patients in non-organ-specific phenotypes that may help clinicians to evaluate patients and to plan therapeutic options. Furthermore, we present current unmet needs and suggest a potential pathway for a specific rehabilitation approach in people with persistent post-COVID symptoms.
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Affiliation(s)
- Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany.
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany.
| | - Daniela Leitl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
- Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
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Tan C, Wang J, Cao G, He Y, Yin J, Chu Y, Geng Z, Li L, Qiu J. Psychological changes in athletes infected with Omicron after return to training: fatigue, sleep, and mood. PeerJ 2023; 11:e15580. [PMID: 37337583 PMCID: PMC10276985 DOI: 10.7717/peerj.15580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
Background This study aims to analyze the changes of approximately 1 month in fatigue, sleep, and mood in athletes after returning to training following infection with the COVID-19 Omicron strain and provide recommendations for returning to training after infection. Methods Two hundred and thirty professional athletes who had returned to training after being infected with COVID-19 in December 2022 were recruited to participate in three tests conducted from early January 2023. The second test was completed approximately 1 week after the first, and the third was completed about 2 weeks after the second. Each test consisted of completing scales and the exercise-induced fatigue measure. The scales included a visual analog scale, the Athens Insomnia Scale for non-clinical application, and the Depression-Anxiety-Stress scale. The exercise task was a six-minute stair climb test, and athletes evaluated subjective fatigue levels before and after exercise using another Visual Analog Scale and the Karolinska Sleepiness Scale. Results After returning to training, athletes' physical fatigue decreased initially but increased as training progressed. Cognitive fatigue did not change significantly. The exercise task led to elevated levels of physical fatigue after a longer duration of training. Sleep quality problems decreased rapidly after the start of training but remained stable with prolonged training. Depression levels continued to decline, while anxiety levels only reduced after a longer duration of training. Stress levels decreased rapidly after the start of training but did not change with prolonged training. Conclusion Athletes who return to training after recovering from COVID-19 experience positive effects on their fatigue, sleep, and mood. It is important to prioritize anxiety assessment and interventions during the short period after returning and to continue monitoring fatigue levels and implementing recovery interventions over a longer period of time.
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Affiliation(s)
- Chenhao Tan
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Jinhao Wang
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Guohuan Cao
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Yelei He
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Jun Yin
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Yudan Chu
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | | | - Longji Li
- Shanghai University of Sport, Shanghai, China
| | - Jun Qiu
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
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