Appropriate Timing and Type of Physical Training in Patients with COVID-19 for Muscle Health and Quality of Life: A Systematic Review

Abstract

Physical activity is beneficial to modulate immune system function and has inverse relationship to ARDS linked with SARS-CoV-2. Physical activity consists of daily activity and physical training. Studies regarding effect of physical training on patients with COVID-19 are controversial. This systematic review aims to investigate physical training on muscle health and QOL in patients with COVID-19. The literature review was carried out using keywords: (Exercise) AND (COVID) AND (Muscle) AND (Observational Study) in several databases of PubMed and Cochrane Central Register of Controlled Trials (CENTRAL). All references were reviewed using critical appraisal Newcastle Ottawa Scale (NOS) and Centre for Evidence-Based Medicine (CEBM) checklist. The studies were subsequently screened for reporting exercise, muscle, and COVID-19. The descriptions of the extracted data are guided by Preferred Reporting Items for Systematic Reviews (PRISMA) statement with GRADE approach. This study is registered in PROSPERO: ID CRD42021295188. Six studies pooled and entered review synthesis. Studies were reviewed using critical appraisal by NOS and CEBM. Two clinical trial studies and four observational designs were selected. Our result showed physical training improved patients’ outcomes in the acute phase, critical phase, and post-COVID-19 phase. Multiple types of physical trainings were suggested by those studies, and most of them showed beneficial effects to patients with COVID-19 in different phases. The level of evidence by GRADE was downgraded, and further investigations are needed to establish guidelines and strong recommendation for a specific stage of COVID-19.

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy

“…According to the Stanford Hall Consensus Statement for post-COVID-19 rehabilitation [ 110 ], exercising over three metabolic equivalents of task (METs) should be avoided until two/three weeks after overcoming severe symptoms or one week after mild/moderate COVID-19. However, with very mild symptoms, only prolonged and exhaustive activity might be avoided, limiting activity to light efforts [ 110 ]: patients with mild symptoms can exercise, but they should not increase training during the acute phase of the illness [ 111 ]. Once recovered, a progressive increase in exercising is suggested and has been experimenting with various protocols lasting four weeks at least: 12 sessions (three 50-min/1-h sessions per week for four weeks, or two sessions per week for six weeks) [ 112 , 113 ], eight weeks twice a week [ 114 ], three times per week over eight weeks or longer [ 115 ], the activity’s intensity varying from medium to high.…”

Effects of Different Protocols of Moderate-Intensity Intermittent Hypoxic Training on Mental Health and Quality of Life in Brazilian Adults Recovered from COVID-19: The AEROBICOVID Double-Blind Randomized Controlled Study

“…Pre-pandemic studies have shown that a higher level of healthy fitness is associated with better health-related QoL, primarily in the physical component [10]. Different exercise protocols have significantly improved the QoL of adults who have recovered from COVID-19 [11,12]. These improvements could be derived from the improvement in physical capacity and biological and physiological modulation achieved by exercise [9].…”