Efficacy of Therapeutic Exercise in Reversing Decreased Strength, Impaired Respiratory Function, Decreased Physical Fitness, and Decreased Quality of Life Caused by the Post-COVID-19 Syndrome

Fernández-Lázaro, Diego; Santamaría, Gema; Sánchez-Serrano, Nerea; Caeiro, Eva María Lantarón; Calvo, Jesús Seco

doi:10.3390/v14122797

Cited by 27 publications

(18 citation statements)

References 72 publications

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“…The overlapping of somatic and psychiatric symptoms in the course of long COVID-19 requires multidirectional rehabilitation [ 68 , 69 , 70 ]. The CR programs bring improvements in cardiorespiratory fitness, musculoskeletal fitness, and exercise tolerance, regardless of the time from the onset of acute COVID-19 symptoms to the CR, also in the long COVID-19 population [ 71 , 72 , 73 , 74 , 75 ]. Resistance training is an effective treatment for sarcopenia, improving muscle mass, quality, and strength in long COVID-19 patients [ 76 , 77 ].…”

Section: Discussionmentioning

confidence: 99%

Long COVID-19 Syndrome Severity According to Sex, Time from the Onset of the Disease, and Exercise Capacity—The Results of a Cross-Sectional Study

Paradowska-Nowakowska¹,

Loboda

Gołba

et al. 2023

Life

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Symptoms of long COVID-19 syndrome (long COVID-19) are reported by 80% of convalescents up to several months after contracting the coronavirus-19 disease (COVID-19). The study aimed to assess the frequency and correlations of long COVID symptoms with sex, disease severity, time since the onset of the disease, and exercise capacity in a population of Polish convalescents hospitalized as a part of a rehabilitation program after COVID-19. The retrospective analysis was carried out based on medical records concerning reported symptoms, comorbidities, exercise capacity, fatigue and dyspnea on Borg’s scale, arterial oxygen saturation (SpO2), spirometric parameters, chest X-rays/computed tomography scans, systolic pulmonary artery pressure, and left ventricular ejection fraction. The study involved 471 patients aged 63.83 ± 9.93 years who had been hospitalized 191.32 ± 75.69 days from the onset of COVID-19, of which 269 (57.1%) were women. The most common symptoms were fatigue (99.57%), dyspnea (99.36%), and myalgia (97.03%). Women reported more symptoms than men (p < 0.001) and rated their fatigue as more severe (p = 0.021). Patients with depressed moods reported more physical symptoms than others (p < 0.001). Most long COVID symptoms, including dyspnea, fatigue, and depressive symptoms, were found with the same frequency in patients 12–24 weeks and >24 weeks after recovery (p = 0.874, p = 0.400, and p = 0.320, respectively), regardless of acute COVID-19 severity (p = 0.240, p = 0.826, and p = 0.108, respectively). Dyspnea severity correlated with forced vital capacity (FVC) (r = −0.153, p = 0.005), and forced expiratory volume in one second (FEV1) (r = −0.142, p = 0.008). Fatigue severity correlated with impaired FVC and FEV1 (both r = −0.162, p = 0.003). Fatigue and dyspnea inversely correlated with the distance in a six-minute walk test (r = −0.497, p < 0.001, and r = −0.327, p < 0.001). In conclusion, in our cohort, long COVID symptoms are more common in women. Dyspnea/fatigue and depressive symptoms do not tend to subside after an average six-month recovery period. The intensity of perceived fatigue may be exaggerated by the coexistence of neuropsychiatric disorders. Increased fatigue and dyspnea correlate with impaired spirometric parameters and significantly affects convalescents’ exercise capacity.

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Section: Discussionmentioning

confidence: 99%

Long COVID-19 Syndrome Severity According to Sex, Time from the Onset of the Disease, and Exercise Capacity—The Results of a Cross-Sectional Study

Paradowska-Nowakowska¹,

Loboda

Gołba

et al. 2023

Life

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“…Furthermore, respiratory muscle dysfunction has been associated with a decrease in inspiratory muscle strength and higher neuroventilatory activity, which reflects in lower muscle functional performance in the six-minute walking test ( 49 ). Respiratory muscle training, strength training, and/or aerobic exercise, especially low-intensity exercise have been proposed as interventions for PCC, possibly leading to greater physical fitness and improved tolerance to physical effort ( 50 ).…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 condition: systemic inflammation and low functional exercise capacity

de Castro,

Gama,

Ramos

et al. 2024

Front. Nutr.

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IntroductionPost-COVID-19 condition (PCC) is characterised by a plethora of symptoms, with fatigue appearing as the most frequently reported. The alterations that drive both the persistent and post-acute disease newly acquired symptoms are not yet fully described. Given the lack of robust knowledge regarding the mechanisms of PCC we have examined the impact of inflammation in PCC, by evaluating serum cytokine profile and its potential involvement in inducing the different symptoms reported.MethodsIn this cross-sectional study, we recruited 227 participants who were hospitalised with acute COVID-19 in 2020 and came back for a follow-up assessment 6–12 months after hospital discharge. The participants were enrolled in two symptomatic groups: Self-Reported Symptoms group (SR, n = 96), who did not present major organ lesions, yet reported several debilitating symptoms such as fatigue, muscle weakness, and persistent loss of sense of smell and taste; and the Self-Reported Symptoms and decreased Pulmonary Function group (SRPF, n = 54), composed by individuals with the same symptoms described by SR, plus diagnosed pulmonary lesions. A Control group (n = 77), with participants with minor complaints following acute COVID-19, was also included in the study. Serum cytokine levels, symptom questionnaires, physical performance tests and general clinical data were obtained in the follow-up assessment.ResultsSRPF presented lower IL-4 concentration compared with Control (q = 0.0018) and with SR (q = 0.030), and lower IFN-α2 serum content compared with Control (q = 0.007). In addition, SRPF presented higher MIP-1β serum concentration compared with SR (q = 0.029). SR presented lower CCL11 (q = 0.012 and q = 0.001, respectively) and MCP-1 levels (q = 0.052 for both) compared with Control and SRPF. SRPF presented lower G-CSF compared to Control (q = 0.014). Female participants in SR showed lower handgrip strength in relation to SRPF (q = 0.0082). Male participants in SR and SRPF needed more time to complete the timed up-and-go test, as compared with men in the Control group (q = 0.0302 and q = 0.0078, respectively). Our results indicate that different PCC symptom profiles are accompanied by distinct inflammatory markers in the circulation. Of particular concern are the lower muscle function findings, with likely long-lasting consequences for health and quality of life, found for both PCC phenotypes.

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“…pharmacological intake, are in progress due to a better understanding of the underlying mechanisms of long‐COVID (Ora et al, 2023). Different meta‐analyses support positive effects of pulmonary rehabilitation (Chen, Shi, et al, 2022) or exercise (Fernández‐Lázaro et al, 2022) in health‐related quality of life and function in individuals with long‐COVID. However, Umesh et al observed that 50% of clinical trials are focused on pulmonary long‐COVID symptoms (Umesh et al, 2022).…”

Section: Current Management Of Long‐covidmentioning

confidence: 99%

Precision management of post‐COVID pain: An evidence and clinical‐based approach

Fernández‐de‐las‐Peñas

Nijs

Giordano

et al. 2023

European Journal of Pain

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BackgroundPain after a SARS‐CoV‐2 acute infection (post‐COVID pain) is becoming a new healthcare emergency but remains underestimated and most likely undertreated due to a lack of recognition of the phenomenon and knowledge of the underlying pain mechanisms. Evidence supporting any particular treatment approach for the management of post‐COVID pain is lacking. Large variability in the patient response to any standard pain treatments is clinically observed, which has led to calls for a personalized, tailored approach to treating patients with chronic post‐COVID pain (i.e. ‘precision pain medicine’). Applying the global concerted action towards precision medicine to post‐COVID pain could help guide clinical decision‐making and aid in more effective treatments.MethodsThe current position paper discusses factors to be considered by clinicians for managing post‐COVID pain ranging from identification of the pain phenotype to genetic consideration.ResultsThe ability of clinicians to phenotype post‐COVID pain into nociceptive, neuropathic, nociplastic or mixed type is suggested as the first step to better planification of a treatment programme. Further, the consideration of other factors, such as gender, comorbidities, treatments received at the acute phase of infection for onset‐associated COVID‐19 symptoms, factors during hospitalization or the presence of emotional disturbances should be implemented into a treatment programme.ConclusionsAccordingly, considering these factors, management of post‐COVID pain should include multimodal pharmacological and non‐pharmacological modalities targeting emotional/cognitive aspects (i.e. psychological and/or coping strategies), central sensitization‐associated mechanisms (i.e. pain neuroscience education), exercise programmes as well as lifestyle interventions (e.g. nutritional support and sleep management).SignificanceThis position paper presents an evidence‐based clinical reasoning approach for precision management of post‐COVID pain.

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Efficacy of Therapeutic Exercise in Reversing Decreased Strength, Impaired Respiratory Function, Decreased Physical Fitness, and Decreased Quality of Life Caused by the Post-COVID-19 Syndrome

Cited by 27 publications

References 72 publications

Long COVID-19 Syndrome Severity According to Sex, Time from the Onset of the Disease, and Exercise Capacity—The Results of a Cross-Sectional Study

Long COVID-19 Syndrome Severity According to Sex, Time from the Onset of the Disease, and Exercise Capacity—The Results of a Cross-Sectional Study

Post-COVID-19 condition: systemic inflammation and low functional exercise capacity

Precision management of post‐COVID pain: An evidence and clinical‐based approach

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