BackgroundThe new Corona-Virus disease (COVID-19) can result in a large variety of chronic health issues like impaired lung function, reduced exercise performance, and diminished quality of life. Our study aimed to investigate the efficacy, feasibility, and safety of pulmonary rehabilitation (PR) in COVID-19 patients and to compare outcomes between patients with a mild/moderate and a severe/critical course of the disease.MethodsPatients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive three-week inpatient PR were included in this prospective, observational cohort study. Several measures of exercise performance (6-minute walk distance, 6MWD), lung function (forced vital capacity, FVC), and quality of life (36 question short-form health survey, SF-36) were assessed before and after PR.ResultsFifty patients were included in the study (24 with mild/moderate and 26 with severe/critical COVID-19). On admission, patients had a reduced 6MWD (mild: 509 m [426–539]; severe: 344 m [244–392]), an impaired FVC (mild: 80% [59–91]; severe: 75% [60–91]) and a low SF-36 mental health score (mild: 49 pts [37–54]; severe: 39 pts [30–53]). Patients attended a median of 100% [94–100] of all provided PR sessions. At discharge, patients in both subgroups improved in 6MWD (mild/moderate: +48 m [35–113 m]; severe/critical: +124 m [75–145 m], both p<0.001), FVC (mild/moderate: +7.7% [1.0–17.8], p=0.002; severe/critical: +11.3% [1.0–16.9], p<0.001) and SF-36 mental component (mild/moderate +5.6 pts [1.4–9.2], p=0.071; severe/critical: +14.4 pts [−0.6–24.5], p<0.001). No adverse event was observed.ConclusionOur study shows that PR is a feasible, safe, and effective therapeutic option in COVID-19 patients independent of disease severity.

Improvements in respiratory muscle function after adjunctive IMT did not translate into additional improvements in 6MWD (primary outcome). Additional gains in endurance time and reductions in symptoms of dyspnoea were observed during an endurance cycling test (secondary outcome) TRIAL REGISTRATION NUMBER: NCT01397396; Results.

PR is an effective and cost-effective therapeutic intervention that improves physical performance ability, shortness of breath, and the quality of life in patients with COPD, but it has not yet been fully implemented as recommended in the relevant guidelines. There is a need for targeted, problem-oriented referral to a range of PR programs with problem-specific content. The necessary outpatient PR structures still need to be established in Germany.

Implementation of WBVT improves postural balance performance and muscle power output. The neuromuscular adaptation related to improved balance performance may be an important mechanism of the improvement in exercise capacity after WBVT especially in COPD patients with impaired balance performance and low exercise capacity.

Background and objective Patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnic respiratory failure (CHRF) characteristically have exercise intolerance and limitations in performing conventional training. Therefore, the aim of this study was to investigate the acute effects of non‐invasive ventilation (NIV) as a supportive tool during exercise in CHRF. Methods Two cycle endurance tests (CET) at 60% of the peak work rate were performed. Patients were randomly assigned to cycle in two conditions: (i) high‐pressure NIV (mean inspiratory positive airway pressure: 27 ± 3 cm H2O) along with oxygen supplementation or (ii) control: oxygen‐use only. Transcutaneously measured partial pressure of carbon dioxide (TcPCO2), oxygen saturation and heart rate were continuously recorded. Muscle oxygen availability of intercostal and vastus lateralis muscle was measured during exercise by near‐infrared spectroscopy (NIRS). Results A total of 20 patients with CHRF (forced expiratory volume in 1 s (FEV1): 19 ± 4% predicted, partial pressure of oxygen (PaO2): 55 ± 9 mm Hg, partial pressure of carbon dioxide (PaCO2): 51 ± 7 mm Hg) were recruited in a randomized cross‐over trial. On NIV, COPD patients increased cycle endurance time by 39% compared to oxygen‐use only (663 ± 360 vs 477 ± 249 s, P = 0.013). On NIV, TcPCO2 was significantly lower at rest (44.9 ± 6.2 vs 50.7 ± 6.6 mm Hg, P < 0.001) and at isotime (50.0 ± 5.5 vs 56.1 ± 6.2 mm Hg, P < 0.001). Oxygen availability in the intercostal muscles remained relatively constant with NIV compared to oxygen‐use only. Although patients cycled longer using NIV, a lower increase in exertional dyspnoea at the end of CET (median increase in Borg‐dyspnoea: 2 vs 4, P = 0.003) was reported. Conclusion NIV with high pressures as add‐on to oxygen supplementation increases cycle endurance time, mitigates exertional dyspnoea and limits exercise‐induced hypercapnia in COPD patients with CHRF.

The recommendation for pulmonary rehabilitation (PR) in idiopathic pulmonary fibrosis (IPF) is weak with low-quality evidence. Therefore, the aim of this study is to investigate short-term PR effects and their maintenance after a 3-month follow-up. Fifty-four IPF patients were randomized into a group receiving a 3-week comprehensive, inpatient PR (n = 34, FVC: 74 ± 19% pred.) or usual care (UC) (n = 17, FVC: 72 ± 20%pred.). Outcomes were measured at baseline (T1), after intervention (T2), and 3 months after T2 (T3). A 6-min walk distance (6MWD) was used as the primary outcome and chronic respiratory disease questionnaire (CRQ) scores as the secondary outcome. Change in 6MWD from T1 to T2 (Δ = 61 m, 95% CI (18.5–102.4), p = 0.006) but not from T1 to T3 (∆ = 26 m, 95% CI (8.0–61.5), p = 0.16) differed significantly between groups. Higher baseline FVC and higher anxiety symptoms were significant predictors of better short-term 6MWD improvements. For the change in CRQ total score, a significant between-group difference from T1 to T2 (∆ = 3.0 pts, 95% CI (0.7–5.3), p = 0.01) and from T1 to T3 (∆ = 3.5 pts, 95% CI (1.5–5.4), p = 0.001) was found in favour of the PR group. To conclude, in addition to the short-term benefits, inpatient PR is effective at inducing medium-term quality of life improvements in IPF. PR in the early stages of the disease seems to provoke the best benefits.

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