The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19.

The aim of this study was to determine the effectiveness of physical exercise, respiratory muscle training and the self-management WHO recommendations leaflet on the recovery of physical fitness, quality of life and symptom status in people with post COVID-19 conditions. Eighty non-hospitalized adults with a post-COVID-19 condition were randomly assigned to one of four 8-week parallel intervention groups: multicomponent exercise program based on concurrent training- CT (n= 20; 3 resistance and endurance supervised sessions per week at low-moderate intensity); b) inspiratory muscle training- RM (n= 17; 2 standardized daily sessions); c) a combination of both of the above- CTRM (n= 23); d) control group- CON (n= 20; following the WHO guidelines for post-COVID-19 related illness rehabilitation). No significant differences between groups were detected at baseline. While no significant differences between interventions were detected in the VO2max, significant individual improvements were identified in the CT (7.5%; ES=0.38) and CTRM (7.8%; ES=0.28) groups. Lower body muscle strength significantly improved in the CT and CTRM (14.5-32.6%; ES=0.27-1.13) groups compared to RM and CON (-0.3-11.3%; ES=0.19-0.00). The CT and CTRM groups improved significantly for dyspnea and fatigue, as did the health status. In addition, significant differences between interventions were described in fatigue and depression scales favouring CT and CTRM interventions. An individualized and supervised concurrent training with or without respiratory muscle training was safer and more effective than self-care recommendations and inspiratory muscle training alone, to regain cardiovascular and muscular fitness, improve symptom severity and health status in outpatients with post-COVID-19 conditions.

Purpose The aim of the study was to compare the outcomes of patients with post‐COVID‐19 condition undergoing supervised therapeutic exercise intervention or following the self‐management WHO (World Health Organization) rehabilitation leaflet. Methods A randomized controlled trial was carried out that included 39 participants with post‐COVID‐19 condition who had a chronic symptomatic phase lasting >12 weeks. Comprehensive medical screening, patient‐reported symptoms, and cardiorespiratory fitness and muscular strength were assessed. Patients were randomly assigned to a tailored multicomponent exercise program based on concurrent training for 8 weeks (two supervised sessions per week comprised resistance training combined with aerobic training [moderate intensity variable training], plus a third day of monitored light intensity continuous training), or to a control group which followed the WHO guidelines for rehabilitation after COVID‐19. Results After follow‐up, there were changes in physical outcomes in both groups, however, the magnitude of the change pre–post intervention favored the exercise group in cardiovascular and strength markers: VO 2 max +5.7%, sit‐to‐stand −22.7% and load‐velocity profiles in bench press +6.3%, and half squat +16.9%, (p < 0.05). In addition, exercise intervention resulted in a significantly better quality of life, less fatigue, less depression, and improved functional status, as well as in superior cardiovascular fitness and muscle strength compared to controls ( p < 0.05). No adverse events were observed during the training sessions. Conclusion Compared to current WHO recommendations, a supervised, tailored concurrent training at low and moderate intensity for both resistance and endurance training is a more effective, safe, and well‐tolerated intervention in post‐COVID‐19 conditions.

The aim of this study was to determine the relationship between physical fitness, cardiopulmonary function and patientreported severity of symptoms in people with post-COVID-19 condition. We examined ambulatory patients (n = 72) with post-COVID-19 condition who had a chronic symptomatic phase lasting > 12 weeks from the onset of symptoms, but had not been hospitalized for acute COVID-19. A comprehensive medical screening was conducted, including clinical history, symptomatology, comorbidities, body composition and physical activity levels. We then identified the relationship between physical fitness (cardiorespiratory fitness and muscular strength), cardiopulmonary function (echocardiographic and spirometry parameters) and patient-reported severity of symptoms (fatigue, dyspnea, health-related quality of life, anxiety, and depression). Age, body mass index, sex, number of comorbidities and duration of symptoms were included as potential confounders. Results showed that greater physical fitness and cardiopulmonary function were associated with lower severity of symptoms in people with post-COVID-19 condition. Cardiorespiratory fitness, lower-limb muscle strength, maximal voluntary ventilation and left ventricular ejection fraction account for reducing fatigue and dyspnea. Greater physical activity levels were associated with fewer symptoms and less-severe fatigue and dyspnea. In conclusion, preserving better cardiopulmonary health and physical condition during the course of the disease-even in mild cases-was related to a lower intensity of symptoms in non-hospitalized people with post-COVID-19 condition. It is probable that exercise and physical conditioning are valuable pre-and post-COVID-19 countermeasures that could help decrease the severity, not only of acute infection, but of post-COVID-19 persistent symptoms and prognosis.

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Purpose To compare the effects of free-weight and machine-based resistance training on strength, hypertrophy, and joint discomfort. Methods Thirty-eight resistance-trained men participated in an 8-week resistance program allocated into free-weight (n = 19) or machine-based (n = 19) groups. Training variables were identical for both modalities, so they only differed in the use of barbells or machines to execute the full squat, bench press, prone bench pull, and shoulder press exercises. The velocity-based method was implemented to accurately adjust the intensity throughout the program. Strength changes were evaluated using 8 velocity-monitored loading tests (4 exercises x 2 modalities) and included the relative one-repetition maximum (1RMRel), as well as the mean propulsive velocity against low (MPVLow) and high (MPVHigh) loads. Ultrasound-derived cross-sectional area (CSA) of quadriceps (proximal and distal regions), pectoralis major, and rectus abdominis was measured to examine hypertrophy. Complementarily, WOMAC and DASH questionnaires were administrated to assess changes in lower- and upper-limb joint discomfort. Outcomes were compared using ANCOVA and percentage of change (∆) statistics. Results Each group significantly (p < 0.001) increased 1RMRel, MPVLow, and MPVHigh for both modalities tested, but especially in the one they trained. When considering together the 8 exercises tested, strength changes for both modalities were similar (∆ differences ≤1.8%, p ≥ 0.216). Likewise, the CSA of all the muscles evaluated was significantly increased by both modalities, with no significant differences between them (∆ difference ≤ 2.0%, p ≥ 0.208). No between-group differences (p ≥ 0.144) were found for changes in stiffness, pain, and functional disability levels, which were reduced by both modalities. Conclusions Free-weight and machine-based modalities are similarly effective to promote strength and hypertrophy without increasing joint discomfort.

BackgroundAlthough the superior effectiveness of free‐weight over machine‐based training has been a traditionally widespread assumption, longitudinal studies comparing these training modalities were scarce and heterogeneous.ObjectiveThis research used the velocity‐based method to compare the effects of free‐weight and machine‐based resistance training on athletic performance and muscle architecture.MethodsThirty‐four resistance‐trained men participated in an 8‐week resistance training program allocated into free‐weight (n = 17) or machine‐based (n = 17) groups. Training variables (intensity, intraset fatigue, and recovery) were identical for both groups, so they only differed in the use of a barbell or specific machines to execute the full squat, bench press, prone bench pull, and shoulder press exercises. The velocity‐based method was implemented to accurately adjust the planned intensity. Analysis of covariance and effect size (ES) statistics were used to compare both training modalities on a comprehensive set of athletic and muscle architecture parameters.ResultsNo between‐group differences were found for any athletic (p ≥ 0.146) and muscle architecture (p ≥ 0.184) variable. Both training modalities significantly and similarly improved vertical jump (Free‐weight: ES ≥ 0.45, p ≤ 0.001; Machine‐based: ES ≥ 0.41, p ≤ 0.001) and lower limb anaerobic capacity (Free‐weight: ES ≥ 0.39, p ≤ 0.007; Machine‐based: ES ≥ 0.31, p ≤ 0.003). Additionally, the machine‐based group meaningfully enhanced upper limb anaerobic power (ES = 0.41, p = 0.021), whereas the free‐weight group significantly improved the change of direction (ES = ‐0.54, p = 0.003) and 2/6 balance conditions analyzed (p ≤ 0.012). Changes in sprint capacity (ES ≥ ‐0.13, p ≥ 0.274), fascicle length, and pennation angle (ES ≤ 0.19, p ≥ 0.129) were not significant for either training modality.ConclusionAdaptations in athletic performance and muscle architecture would not be meaningfully influenced by the resistance modality trained.