Practical Recommendations Relevant to the Use of Resistance Training for COVID-19 Survivors

Eight Weeks of Pilates Training Improves Respiratory Measures in People With a History of COVID-19: A Preliminary Study

BACKGROUND

Coronavirus disease 2019 (COVID-19) can result in prolonged and severe damage to the lungs and quality of life (QoL). This study was designed to investigate the effects of 8-week Pilates and Aqua-Pilates training on pulmonary function and QoL in patients with COVID-19.

HYPOTHESIS

Pilates and Aqua-Pilates training promotes similar changes on pulmonary function and QoL in people with a history of COVID-19.

STUDY DESIGN

Randomized controlled trial.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 45 participants (24 men and 21 women) with a history of COVID-19 were assigned randomly to 3 groups: Pilates training (standard Pilates), Aqua-Pilates training (Pilates in water), and Control. The training protocol was performed for 8 weeks (3 sessions per week). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the ratio of FEV1 to the FVC (FEV1/FVC) indices were measured by a spirometer. The 26-item questionnaire World Health Organization Quality of Life (WHOQOL) BREF was used to assess QoL. Data were analyzed using paired-sample t test and analysis of covariance with an alpha level <0.05.

RESULTS

The mean age of the participants was 49.9 ± 6.4 years. After 8 weeks of Pilates and Aqua-Pilates training, there were significant increases in FVC (21.4% for Pilates and 22.1% for Aqua-Pilates, P < 0.05), FEV1 (32.3% for Pilates and 34.7% for Aqua-Pilates, P < 0.05), and FEV1/FVC% (9% for Pilates and 10.3% for Aqua-Pilates, P < 0.05) for the experimental groups, but not for control. Changes for Pilates and Acqua-Pilates were significantly higher than for control. The QoL scores were significantly different within and between the experimental groups, with greater improvements in the Aqua Pilates group than in the Pilates group.

CONCLUSION

An 8-week Pilates or Aqua-Pilates training can improve pulmonary function as much as 34%, depending on the parameter, and QoL in people with a history of COVID-19. Aqua-Pilates training appears to be preferable to standard Pilates.

CLINICAL RELEVANCE

The findings provide important insights into how healthcare professionals can prescribe exercise for COVID-19 survivors.

Relationship between physical exercise and COVID-19 (SARS-CoV-2): systematic review

Background

The SARS-CoV virus is a precursor to the SARS-CoV-2 virus (COVID-19) and has caused millions of deaths worldwide. Although exercise can be a non-pharmacological means for the prevention and treatment of various diseases, the effects on COVID-19 patients are not yet completely clear.

Aims

The aim of this study was to investigate the relationship between physical exercise and symptoms caused by COVID-19.

Methods

The present systematic review was sent for evaluation and received the PROSPERO registration protocol-CRD42021257475. The search for studies related to health and physical exercise was carried out in the following databases; the "National Library in Medicine MEDLINE-Ovid", "Embase", "Web of Science", "SportDiscus-Ebsco", and "Scopus".

Results

Ten articles were included in the systematic review and the findings demonstrated the protective effects of physical exercise in patients with COVID-19. These effects were observed both in symptoms and in the period of hospitalization. In addition, the results show that the benefits of physical exercise seem to collaborate both in an individual manner and as an alternative to drug therapy. Finally, it was possible to verify the effect of physical exercise on variables, such as quality of life, cardiorespiratory capacity, and immunological biomarkers, and on the symptoms of the new Coronavirus.

Conclusions

It is possible to conclude that physical exercise can be a component for the treatment of COVID-19. In addition, it could help to reduce the symptoms and severity of COVID-19, and may be considered as an adjunct to drug therapy in patients contaminated with SARS-CoV-2.

The syndromic triad of COVID-19, type 2 diabetes, and malnutrition

The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype-the COVID-Related Cardiometabolic Syndrome-linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.

Global mapping of exercise interventions among COVID-19 survivors: protocol for a scoping review

INTRODUCTION

The COVID-19 pandemic has posed an unparalleled threat to all dimensions of human health and well-being. The Pan American Health Organization has acknowledged the crucial role of rehabilitation therapies for COVID-19 and emphasised the importance of exercise programmes for COVID-19 survivors. This scoping review outlines our strategy for systematically reviewing published and unpublished literature to investigate the volume of evidence for exercise interventions for COVID-19 survivors.

METHODS AND ANALYSIS

This scoping review will be conducted based on the framework developed by Arksey and O'Malley. Six databases (PubMed/Medline, Scopus, Web of Science, Cochrane Central, ProQuest and CINAHL) will be searched in August 2022 and articles will be considered for inclusion published till July 2022. Studies will be screened by two independent reviewers at the title/abstract and full-text screening stages, as well as data extraction and critical assessment. Data will be extracted in a data extraction form and presented as figures and tables with narratives. This scoping review will give a thorough understanding of the current literature on exercise interventions for COVID-19 survivors, as well as identify knowledge gaps that will guide future research. Preliminary searches will be conducted after the publication of this scoping review protocol.

ETHICS AND DISSEMINATION

No human or animal participants were involved in this review. Therefore, ethical committee approval is not required. Transparency will be followed at every review stage. Review findings will be disseminated through peer-review publications or through conference presentations.

Safety, feasibility and initial efficacy of an app-facilitated telerehabilitation (AFTER) programme for COVID-19 survivors: a pilot randomised study

OBJECTIVES

Determine the safety, feasibility and initial efficacy of a multicomponent telerehabilitation programme for COVID-19 survivors.

DESIGN

Pilot randomised feasibility study.

SETTING

In-home telerehabilitation.

PARTICIPANTS

44 participants (21 female, mean age 52 years) discharged home following hospitalisation with COVID-19 (with and without intensive care unit (ICU) stay).

INTERVENTIONS

Participants were block randomised 2:1 to receive 12 individual biobehaviourally informed, app-facilitated, multicomponent telerehabilitation sessions with a licenced physical therapist (n=29) or to a control group (n=15) consisting of education on exercise and COVID-19 recovery trajectory, physical activity and vitals monitoring, and weekly check-ins with study staff. Interventions were 100% remote and occurred over 12 weeks.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was feasibility, including safety and session adherence. Secondary outcomes included preliminary efficacy outcomes including tests of function and balance; patient-reported outcome measures; a cognitive assessment; and average daily step count. The 30 s chair stand test was the main secondary (efficacy) outcome.

RESULTS

No adverse events (AEs) occurred during testing or in telerehabilitation sessions; 38% (11/29) of the intervention group compared with 60% (9/15) of the control group experienced an AE (p=0.21), most of which were minor, over the course of the 12-week study. 27 of 29 participants (93%; 95% CI 77% to 99%) receiving the intervention attended ≥75% of sessions. Both groups demonstrated clinically meaningful improvement in secondary outcomes with no statistically significant differences between groups.

CONCLUSION

Fully remote telerehabilitation was safe, feasible, had high adherence for COVID-19 recovery, and may apply to other medically complex patients including those with barriers to access care. This pilot study was designed to evaluate feasibility; further efficacy evaluation is needed.

TRIAL REGISTRATION NUMBER

NCT04663945.

Resistance Training before, during, and after COVID-19 Infection: What Have We Learned So Far?

At the end of 2019, a severe acute respiratory syndrome caused by SARS-CoV-2 started a pandemic, leading to millions of deaths and many important political and social changes. Even in the absence of contamination, the mobility reduction, social distancing and closing of exercise facilities negatively affected physical activity and conditioning, which is associated with muscle atrophy, loss of muscle strength, and reductions in functional capacity. In cases of infection, it has been shown that increased physical capacity is associated with decreased hospitalization and mortality risk. Although millions of people have died from COVID-19, most contaminated individuals survived the infection, but carried different sequelae, such as the severe loss of physical function and a reduced quality of life. Among different physical exercise models that might help to prevent and treat COVID-19-related conditions, resistance training (RT) might be particularly relevant. Among its benefits, RT can be adapted to be performed in many different situations, even with limited space and equipment, and is easily adapted to an individual's characteristics and health status. The current narrative review aims to provide insights into how RT can be used in different scenarios to counteract the negative effects of COVID-19. By doing this, the authors expect to provide insights to help deal with the current pandemic and similar events the world may face in the future.

Multimodal Benefits of Exercise in Patients With Multiple Sclerosis and COVID-19

Multiple sclerosis (MS) is a demyelinating disease characterized by plaque formation and neuroinflammation. The plaques can present in various locations, causing a variety of clinical symptoms in patients with MS. Coronavirus disease-2019 (COVID-19) is also associated with systemic inflammation and a cytokine storm which can cause plaque formation in several areas of the brain. These concurring events could exacerbate the disease burden of MS. We review the neuro-invasive properties of SARS-CoV-2 and the possible pathways for the entry of the virus into the central nervous system (CNS). Complications due to this viral infection are similar to those occurring in patients with MS. Conditions related to MS which make patients more susceptible to viral infection include inflammatory status, blood-brain barrier (BBB) permeability, function of CNS cells, and plaque formation. There are also psychoneurological and mood disorders associated with both MS and COVID-19 infections. Finally, we discuss the effects of exercise on peripheral and central inflammation, BBB integrity, glia and neural cells, and remyelination. We conclude that moderate exercise training prior or after infection with SARS-CoV-2 can produce health benefits in patients with MS patients, including reduced mortality and improved physical and mental health of patients with MS.

Pathophysiology and rehabilitation management of exercise intolerance in COVID-19 patients

OBJECTIVE

This review aimed to explore the pathophysiology and rehabilitation management of exercise intolerance in COVID-19 patients.

METHODS

We reviewed articles published in 2019-2021 using PubMed, Google Scholar, and CINAHL databases as an electronic database. Data obtained were pathophysiology and rehabilitation management of exercise intolerance in COVID-19 survivors. Types of the article were original articles and systematic or narrative reviews, both published and preprint articles. Articles that were written in English and freely accessible in pdf or HTML format were included.

RESULTS

There were 28 articles eligible for this review. Pathophysiology, rehabilitation management, and both pathophysiology and rehabilitation management were explained in 7, 24, and 4 articles, consecutively.

DISCUSSION

Exercise intolerance is caused by some pathological processes in the respiratory, cardiovascular, and musculoskeletal systems as a result of systemic inflammation. Fatigue and shortness of breath during the activity were the most common symptom in the early phase of COVID-19 and persisted until the follow-up phase. Hospital admission, especially prolonged use of ventilators and immobilization worsen functional impairment resulting in persistent symptoms. Rehabilitation management begins with a functional assessment consisting of symptom assessment and physical examination of the body systems affected. The goals of rehabilitation management are to increase functional capacity, reduce symptoms, improve the ability to perform daily activities, facilitate social reintegration, and improve quality of life. Exercise is an effective intervention to reach these goals. Several studies recommend breathing, and aerobic exercises, as well as resistance exercises for peripheral and respiratory muscles, to improve symptoms and increase functional capacity.

Pregnancy Activity Levels and Impediments in the Era of COVID-19 Based on the Health Belief Model: A Cross-Sectional Study

Physical activity (PA) and exercise benefit both the mother and the fetus. Many pregnant women avoid or severely limit PA, leading to complications before and after delivery. This study elucidated the precise effect of each moderator variable on prenatal physical activity (PPA) by examining demographic factors, the PPA-related health belief level (HBL), and the current PPA level. The health belief model (HBM) in conjunction with the international prenatal physical activity questionnaire was used. The HBL in pregnant parous women (PPW) (3.42) was significantly higher than that in nonpregnant nulliparous women (NNW) (3.06). The PPA level in pregnant nulliparous women (PNW) (5.67 metabolic equivalent-hours per week (MET-h/week)) was lower than in the PPW (6.01 MET-h/week). All HBM dimensions (except for perceived barriers) were positively correlated with exercise expenditure in both PNW and PPW. According to the regression tree, participants in PNW aged ≤ 23 years with annual household incomes > CNY 100,001−150,000 had the highest energy expenditure (10.75 MET-h/week), whereas participants in PPW with a perceived benefit score of >4 had the highest energy expenditure (10 MET-h/week). The results demonstrated that the HBL in all groups was acceptable, whereas the PPA level was lower than the recommended PA level. In both PPW and PNW, the HBL was most strongly correlated with exercise expenditure. There is an urgent need to organize public-interest courses to alleviate household expenditure, raise the HBL about PPA in pregnant and NNW, and ensure personal health in the context of COVID-19.

Functional and Psychological Changes after Exercise Training in Post-COVID-19 Patients Discharged from the Hospital: A PRISMA-Compliant Systematic Review

Millions of people worldwide are infected with COVID-19, and COVID-19 survivors have been found to suffer from functional disabilities and mental disorders such as depression and anxiety. This is a matter of concern because COVID-19 is still not over. Because reinfection is still possible in COVID-19 survivors, decreased physical function and increased stress and anxiety can lower immune function. However, the optimal exercise intensity and volume appear to remain unknown. Therefore, the current systematic review aimed to evaluate the effect of resistance or aerobic exercises in post-COVID-19 patients after hospital discharge. We conducted searches in the Scopus, SciELO, PubMed, Web of Science, Science Direct, and Google Scholar databases. Studies that met the following criteria were included: (i) English language, (ii) patients with COVID-19 involved with resistance or aerobic exercise programs after hospital discharge. Out of 381 studies reviewed, seven studies met the inclusion criteria. Evidence shows that exercise programs composed of resistance exercise (e.g., 1–2 sets of 8–10 repetitions at 30–80% of 1RM) along with aerobic exercise (e.g., 5 to 30 min at moderate intensity) may improve the functional capacity and quality of life (reduce stress and mental disorders) in post-COVID-19 patients. In addition, only one study reported reinfection of three subjects involved with the exercise program, suggesting that exercise programs may be feasible for the rehabilitation of the patients. A meta-analysis was not conducted because the included studies have methodological heterogeneities, and they did not examine a control group. Consequently, the results should be generalized with caution.

Post-COVID-19 rehabilitation: a special look at chronic kidney disease patients

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect the kidney and the presence of chronic kidney disease (CKD) constitutes a higher risk of negative prognosis. SARS-CoV-2 main sequelae in CKD patients are an incomplete recovery of kidney function, muscle weakness and atrophy, breathiness, tiredness, pulmonary fibrosis, and initiation of kidney replacement therapy. The overall aim of this review is to provide a theoretical basis for early improvements of physical function health to all CKD stages by rehabilitation therapies.

CONCLUSION

Chronic kidney disease patients infected with SARS-CoV-2 should be monitored by rehabilitation professionals as the cardiopulmonary, musculoskeletal, and cognitive systems might be deteriorated. Long-term consequences of SARS-CoV-2 are unknown and preventive rehabilitation may attenuate them.