Eight Weeks of Supervised Pulmonary Rehabilitation Are Effective in Improving Resting Heart Rate and Heart Rate Recovery in Severe COVID-19 Patient Survivors of Mechanical Ventilation

Abstract

Background and Objectives: Patients who survive severe COVID-19 require significant pulmonary rehabilitation. Heart rate (HR) has been used as a safety variable in the evaluation of the results of interventions in patients undergoing pulmonary rehabilitation. The aim of this research was to analyse HR during a pulmonary rehabilitation program in post-severe COVID-19 patients who survived mechanical ventilation (MV). The study includes the initial and final evaluations and aerobic training sessions. Materials and Methods: Twenty patients (58 ± 13 years, 11 men) were trained for 8 weeks. A 6-minute walk test (6 MWT) was performed and, subsequently, a supervised and individualised training plan was created. Resting heart rate (RHR), heart rate recovery (HRR), heart rate at minute 6 (HR6 min) and the product of HR6 min and systolic blood pressure (HR6 minxSBP) were measured at 6 MWT. In addition, HR was measured at each training session. Results: After 8 weeks of pulmonary rehabilitation, patients decreased their RHR from 81.95 ± 9.36 to 73.60 ± 9.82 beats/min (p < 0.001) and significantly increased their HRR from 12.45 ± 10.22 to 20.55 ± 7.33 beats/min (p = 0.005). HR6 min presented a significant relationship with walking speed and walked distance after the pulmonary rehabilitation period (r = 0.555, p = 0.011 and r = 0.613, p = 0.011, respectively). HR6 minxSBP presented a significant relationship with walking speed and walked distance after training (r = 0.538, p = 0.014 and r = 0.568, p = 0.008, respectively). In the pulmonary rehabilitation sessions, a significant decrease in HR was observed at minutes 1, 6 and 15 (p < 0.05) between sessions 1 and 6 and at minute 1 between sessions 1 and 12. Conclusions: Eight weeks of individualised and supervised pulmonary rehabilitation were effective in improving RHR and HRR in COVID-19 patients surviving MV. HR is an easily accessible indicator that could help to monitor the evaluation and development of a pulmonary rehabilitation program in COVID-19 patients who survived MV.

Physical Activity in Long COVID: A Comparative Study of Exercise Rehabilitation Benefits in Patients with Long COVID, Coronary Artery Disease and Fibromyalgia

“…A higher volume of training >4 months seems beneficial in cardiac [87] as well as in fibromyalgia patients [88,89]. Likewise, the study of Del Valle et al (2022) had shown an improvement of resting HR after 8 weeks of supervised pulmonary rehabilitation on severe COVID-19 survivor patients [90], while we did not find significant improvement for this parameter in our study. The volume and duration of physical activity proposed in this study was certainly too low to expect autonomous changes.…”

A pulmonary rehabilitation program is an effective strategy to improve forced vital capacity, muscle strength, and functional exercise capacity similarly in adults and older people with post-severe COVID-19 who required mechanical ventilation

“…to conclude that a PR program could be safe, feasible, and effective in patients post COVID-19 after the acute stage, thereby improving their pulmonary function, strength, and quality of life [18]. Thus, PR has proven to be an intervention model with multisystemic impact, which generates signi cant improvements in the cardiorespiratory and musculoskeletal systems, regardless of the severity of the clinical picture [12,13].…”

“…The study was conducted between September 2020 and March 2021 and was approved by the Scienti c Ethics Committee of the Central Metropolitan Health Service, Chile (Resolution N° 378/2021). This study is part of a larger project with previous publications providing preliminary results or secondary analyses [12,13]. All the participants were informed about the procedures of this study, agreed to participate, and signed the informed consent.…”

“…The strength training of the inspiratory muscles was done at each patient's home address (2x per day, 5x/ week). The PR program has been detailed in previous publications [12,13].…”

A pulmonary rehabilitation program is an effective strategy to improve forced vital capacity, muscle strength, and functional exercise capacity similarly in adults and older people with post-severe COVID-19 who required mechanical ventilation

“…The study was conducted between September 2020 and March 2021 and was approved by the Scientific Ethics Committee of the Central Metropolitan Health Service, Chile (Resolution N° 378/2021). This study is part of a larger project with previous publications providing preliminary results or secondary analyses [ 14 , 15 ]. All the participants were informed about the procedures of this study, agreed to participate, and signed the informed consent.…”