Musculoskeletal Consequences from COVID-19 and the Importance of Pulmonary Rehabilitation Program

Pulmonary Rehabilitation Program Is an Effective Treatment Approach for Post-COVID-19 Syndrome Patients

Background/Objectives: Patients with post-COVID-2019 syndrome may have reduced functional capacity and physical activity levels. The pulmonary rehabilitation program (PRP)-an exercise training program-is designed to restore these functions and has been shown to improve dyspnea, exercise capacity, and other measures in these patients. This study aimed to analyze the effects of the RP on post-COVID-19 syndrome patients with respect to objective and subjective functional capacity, balance, and musculoskeletal strength. Methods: A prospective interventional trial was conducted before and after this phase. Patients were referred to the hospital with a confirmed diagnosis of SARS-CoV-2 and subsequently directed to the RP. These patients underwent an 8-week pulmonary rehabilitation program (45-min sessions 3 times/week). Each session consisted of stationary cycle-ergometer and resistance musculoskeletal exercises tailored to individuals' performance. They were evaluated pre- and post-PRP using the maximal handgrip strength (HGS) test, timed up-and-go test, 6-min walk test and its derived variables, and Duke Activity Status Index questionnaire. Results: From 142 hospitalized patients admitted with a diagnosis of SARS-CoV-2 infection, 60 completed the program, with an attendance rate of 85%. Nineteen patients were categorized as severe/critical, with a significantly higher hospital stay, compared to mild/moderate patients, and there were no differences in terms of sex distribution, age, or BMI between groups. Compared to the pre-PRP evaluation, both groups showed significant (p < 0.001) improvements in TUG, HGS, DASI D6MWT, 6MWS, and DSP variables after the PRP conduction. In addition, the groups exhibited similar improvement patterns following PRP (intragroup analysis), with no intergroup differences. Conclusions: RPs promote both objective and subjective functional capacity in patients with post-COVID-19 syndrome, with no difference in improvement regardless of the severity of the initial infection.

Effect of COVID-19 on Musculoskeletal Performance in Gait and the Timed-Up and Go Test

INTRODUCTION

The total number of confirmed cases of COVID-19 caused by the SARS-CoV-2 virus infection is over 621 million in the world. In approximately 63% of cases, the patient still experiences persistent symptoms 30 days after the onset of symptoms or hospitalisation, and 45.9% of patients have experienced or will experience symptoms for at least three months. Despite the prevalence of chronic symptoms and pathological changes that may affect gait and functional mobility in people with a history of COVID-19, there are few publications investigating the impact of these abnormalities. This study aims to determine the long-term effects of COVID-19 on gait and the Timed-Up and Go Task.

MATERIAL AND METHODS

A total of 30 individuals took part in the experiment. The subjects in the study group were infected with the COVID-19 virus and required hospital treatment. Prior to the study, the subjects had no chronic diseases or other conditions affecting the musculoskeletal system. The non-infected by COVID-19 group was a healthy population with no history of COVID-19 disease. The study used the inertial system wireless motion analysis system based on 15 inertial sensors (inertial measurement units, IMUs). IMU sensors were placed on the following body segments: head, sternum, middle and lower spine, shoulder, arm, forearm, hand, shank, for the left and right limb. Movement task reports generated from the recording were created using myoRESEARCH 3.10. The subjects in the study group were asked to perform a movement task test-the Timed-Up and Go Test (TUG): sit-to-stand, walk (3 m) without change in direction, walk termination, and stand-to-sit.

RESULTS

It took 46% longer for those infected by COVID-19 (participants) to complete the entire movement task compared to those in the not-infected by COVID-19 group. Sit-to-Stand Time [s] was greater in the infected by COVID-19 group and was 2.1 ± 0.7. Mean Walking Speed [m/s] was lower than in the not-infected by COVID-19 group and was 0.26 ± 0.07. Walking cadence [steps/min] was lower and was 21.2 ± 1.2. Infected by COVID-19 participants achieved a smaller anterior pelvic tilt angle (p < 0.001) and a smaller hip flexion angle (p = 0.025), with an increase in knee (p < 0.001) and ankle (p < 0.001) flexion angles.

CONCLUSIONS

Individuals in the infected by COVID-19 group present changes in the ranges of motion and the time to complete the TUG task, despite the fact that at least eight weeks passed after hospital discharge.

Disuse-induced skeletal muscle atrophy in disease and non-disease states in humans: mechanisms, prevention, and recovery strategies

Decreased skeletal muscle contractile activity (disuse) or unloading leads to muscle mass loss, also known as muscle atrophy. The balance between muscle protein synthesis (MPS) and muscle protein breakdown (MPB) is the primary determinant of skeletal muscle mass. A reduced mechanical load on skeletal muscle is one of the main external factors leading to muscle atrophy. However, endocrine and inflammatory factors can act synergistically in catabolic states, amplifying the atrophy process and accelerating its progression. Additionally, older individuals display aging-induced anabolic resistance, which can predispose this population to more pronounced effects when exposed to periods of reduced physical activity or mechanical unloading. Different cellular mechanisms contribute to the regulation of muscle protein balance during skeletal muscle atrophy. This review summarizes the effects of muscle disuse on muscle protein balance and the molecular mechanisms involved in muscle atrophy in the absence or presence of disease. Finally, a discussion of the current literature describing efficient strategies to prevent or improve the recovery from muscle atrophy is also presented.