Cardiopulmonary Rehabilitation in Long-COVID-19 Patients with Persistent Breathlessness and Fatigue: The COVID-Rehab Study

Abstract

(1) Background: Cardiopulmonary and brain functions are frequently impaired after COVID-19 infection. Exercise rehabilitation could have a major impact on the healing process of patients affected by long COVID-19. (2) Methods: The COVID-Rehab study will investigate the effectiveness of an eight-week cardiopulmonary rehabilitation program on cardiorespiratory fitness (V˙O2max) in long-COVID-19 individuals. Secondary objectives will include functional capacity, quality of life, perceived stress, sleep quality (questionnaires), respiratory capacity (spirometry test), coagulation, inflammatory and oxidative-stress profile (blood draw), cognition (neuropsychological tests), neurovascular coupling and pulsatility (fNIRS). The COVID-Rehab project was a randomised clinical trial with two intervention arms (1:1 ratio) that will be blindly evaluated. It will recruit a total of 40 individuals: (1) rehabilitation: centre-based exercise-training program (eight weeks, three times per week); (2) control: individuals will have to maintain their daily habits. (3) Conclusions: Currently, there are no specific rehabilitation guidelines for long-COVID-19 patients, but preliminary studies show encouraging results. Clinicaltrials.gov (NCT05035628).

Post-COVID-19 syndrome symptoms after mild and moderate SARS-CoV-2 infection

“…Myalgia and palpitations were also frequent in the present study which was not in agreement with previous studies [5.9% for myalgia ( 13 ) and 8.3% for palpitations ( 14 )]. Finally, respiratory symptoms, including cough (14%) and breathlessness (28%) were less frequent than expected and in comparison, with other studies ( 15 , 16 ) where respiratory symptoms are more frequent (30–50% for breathlessness).…”

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

“…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. Cattadori et al reported that the literature on COVID-19 exercising, by trials or expert consensus, suggests practicing aerobic and resistance training, respiratory, diaphragmatic and cough exercises, and stretching [ 107 ].…”

“…Cardiorespiratory fitness, muscle function, and joint health should be assessed to detect primary manifestations of long COVID-19 syndrome (such as exertional fatigue and dyspnea), tailor physical exercise, enhance functional capacity and health [ 108 ], and improve quality of life. Several papers reported that, among the functional screening and assessment procedures, the most popular seems to be the 6-Minute Walking Test to estimate the aerobic capacity and exercise tolerance [ 107 , 109 , 114 , 115 , 116 , 118 , 126 ] and the hand grip to measure strength [ 107 , 114 , 116 ]. In addition, laboratory tests such as spirometry and transthoracic echocardiogram are frequently used to evaluate cardiorespiratory functionality with direct measurements [ 107 ].…”

“…Balance is a further common investigated feature, e.g., by the Berg Balance Scale for balance [ 108 , 116 ]. The measurement of fatigue, necessary to tailor or manage exercise execution and the consequent effects, is usually and regularly accomplished, generally by the 10- or 20-point Borg rating for perceived exertion scales [ 107 , 114 , 115 , 116 , 118 , 127 , 128 ]. Finally, behavioral psychology questionnaires such as the short form health survey 36 (SF-36) [ 115 ], the post-acute (long) COVID-19 quality of life [ 123 ], or the pediatric quality of life (PedsQL) inventory–parent proxy report [ 121 ] should be administered to evaluate the quality of life, which recovery or improvement is, in the end, the outcome of any therapy and rehabilitation intervention.…”

“…Cattadori et al concentrated on specific exercise guidelines they retrieved from original articles or review literature [ 107 ]. They suggested a multicomponent exercising protocol that includes aerobic continuous and interval training (walking and cycling), resistance/strength training (upper and lower body), inspiratory muscle training (using hand-held resistance tools), cough exercising (active coughs), diaphragmatic muscle training (from supine position), stretching and mobilization, balance, and flexibility exercising (static and dynamic), slow breathing exercising [ 107 , 113 , 114 , 115 ]. Among the more promising interventions, because of their physical (diaphragmatic breathing, postural alignment, cardiovascular, balance, and neuromuscular training) and psychological benefits (on cognitive functions, anxiety and depression), Tai Chi has been suggested as a multicomponent activity to counteract long COVID-19 [ 129 ].…”