Modified rehabilitation exercises for mild cases of COVID-19

Abstract

Background: Coronavirus disease 2019 (COVID-19) caused by a new Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently a global pandemic. Gathered clinicopathological evidence in COVID-19 patients shows that alveoli injuries and interstitial changes are the major mechanisms of impaired O2/CO2 exchange. Few rehabilitation exercises concerning COVID-19 patients were reported. Here, we present a modified version of rehabilitation exercises based on the underlying mechanism of the disease to mild cases of COVID-19. These exercises aimed to improve the pulmonary function of patients and ease the expectoration process. Additionally, an essential branch of Traditional Chinese Medicine (TCM) named acupressure was integrated into the exercises to facilitate the recovery and maintenance of pulmonary function. Methods: From March 4, 2020 to May 5, 2020, a total of 60 COVID-19 patients who completed the full course of MRE were enrolled in this observational study. The diagnostic and classification criteria were based on the 7 th edition of Diagnosis and Treatment Guideline of COVID-19 published by the National Health Commission of the People's Republic of China. We prospectively gathered patients' reported outcomes concerning respiration-related symptoms at four different time points, including: (I) at admission; (II) at the time of hospital discharge; (III) two weeks after discharge; (IV) four weeks after discharge. The reported respiratory symptoms included dry cough, productive cough, difficulty in expectoration, and dyspnea.Results: In total, 60 confirmed mild COVID-19 cases were enrolled with a median age of 54 years old. The baseline prevalence for dry cough, productive cough, difficulty in expectoration, and dyspnea were 41.7%, 43.3%, 35.0%, and 50.0%, respectively. The pronounced decline in symptom prevalence was recorded over time. Interestingly, four weeks after discharge, we noticed a lower remission rate in productive cough and difficulty in expectoration. Conclusions:The modified rehabilitation exercises were retrieved from the Eight-Section Brocade, and are specifically designed for rehabilitation of COVID-19 patients at home or health facilities. Based on current findings on pronouncedly improved remission rate in respiratory symptoms, we recommend the MRE as suitable rehabilitation exercise to smooth respiration and ease the expectoration process in mild COVID-19 cases.

Short-Term Effects of a Respiratory Telerehabilitation Program in Confined COVID-19 Patients in the Acute Phase: A Pilot Study

“…Thus, respiratory rehabilitation becomes an attractive strategy in the management of these patients, since it has been observed that pulmonary rehabilitation is effective at improving respiratory function (and, therefore, functional capacities) in different respiratory disorders, such as chronic obstructive pulmonary disease (COPD) or asthma, among others [ 7 , 8 , 9 ]. Indeed, it has been argued that rehabilitation programs that aim to improve the function of the respiratory system should be included in the management of patients with COVID-19 [ 10 , 11 , 12 ]. However, to our knowledge, only one randomized controlled trial studied the effects of respiratory rehabilitation in people infected with COVID-19, and they were elderly subjects [ 13 ].…”

Pulmonary rehabilitation focusing on the regulation of respiratory movement can improve prognosis of severe patients with COVID-19

“…With the symptoms improved, the patients' ability to take care of themselves can also been restored. Likewise, Zha et al applied Chinese martial art Eightsection Brocade to patients with COVID-19 and found the pronouncedly improved remission rate in respiratory symptoms (32). It can be implied that RP was considered to be capable of inducing positive effects on patients' respiratory muscles through diaphragm breathing exercise and lip puckering breathing exercise.…”

Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Update as of August 31st, 2020

“…A detailed overview of the new evidence is provided in the supplementary Digital Material 1: Supplementary Table I (available on Cochrane Rehabilitation website: (https://tr.im/rr_dyn) 7 . Most studies (n=23) were conducted in Europe, 8 in Italy [8][9][10][11][12][13][14][15] , 4 in United Kingdom [16][17][18][19] , 3 in France [20][21][22] , 2 in Germany 23,24 , 2 in Switzerland 25,26 , 1 in Spain 27 , 1 in Portugal 28 , while 2 were performed as International European collaborations 29,30 ; Fifteen researches were performed in Asia (n=15), namely 3 in China [31][32][33] , 2 in Singapore 34,35 , 2 in Japan 36 , 2 in Turkey 37,38 , 2 in India 39,40 , 1 Iran 41 , 1 Kuwait 42 , 1 Pakistan 43 , 1 Taiwan 44 , whereas 11 in Americas , of whom 10 in United States of America (USA) [45][46][47][48][49][50][51][52][53][54] and 1 in Chile 55 . Two studies were carried out by Intercontin...…”

“…Due to the heterogeneity of published studies, a meta-analysis was not appropriate, so the results were qualitatively described. Based on the OCEBM 2011 Levels of Evidence table 58 the majority (76.5%) were level 4 (20 case report 8,16,18,19,21,23,[27][28][29][30]36,37,39,[42][43][44]47,49,51,53 , 10 case series 17,20,22,26,32,34,35,41,48,59 , and 9 historical cohort [9][10][11]13,15,24,[55][56][57] ), whereas the remainder 12 papers (23.5%) were of level 3 (6 cohort 12,25,33,40,46,50 and 6 cross sectional studies) 14,31,38,45,…”

“…Thirty-two studies (62.7%) included COVID-19 patients who were assessed in the acute (20 studies) [16][17][18][19][21][22][23]26,28,32,33,[35][36][37]39,42,44,47,48,57 or post-acute phases (12 studies) 8,9,11,20,25,27,29,34,51,52,54,59 ; no studies described patients in the chronic phase. Seven studies (13.7%) reported data on the impact of COVID-19 infection on subjects with pre-existing health conditions, i.e.…”