Rehabilitation in adult post-COVID-19 patients  in post-acute care with Therapeutic Exercise

Udina, Cristina; Ars, Jordi Fauquet; Morandi, Alessandro; Vilaró, Jordi; Cáceres, Cristina de Miguel; Inzitari, Marco

doi:10.14283/jfa.2021.1

Cited by 75 publications

(152 citation statements)

References 16 publications

(7 reference statements)

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“…A Cochrane Review from September 2020 concluded that the majority of studies are not focusing on the issues of rehabilitation and the efficacy of the physiotherapeutic interventions [120], a finding in line with earlier reviews [121]. However, some data did emerge, pointing for instance to the tangible beneficiary effects of post-ICU post-COVID-19 daily 30 min multicomponent exercise program comprising resistance, endurance, and balance training [122].…”

Section: Covid-19-related Acute Sarcopeniatowards Prevention and Managementmentioning

confidence: 72%

Post-COVID-19 acute sarcopenia: physiopathology and management

et al. 2021

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In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient’s general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome.

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Section: Covid-19-related Acute Sarcopeniatowards Prevention and Managementmentioning

confidence: 72%

Post-COVID-19 acute sarcopenia: physiopathology and management

et al. 2021

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“…Individuals that regularly exercise have improved clinical outcomes and symptomology following SARS-CoV-2 infection ( Cummins et al, 2021 ; de Souza et al, 2021 ; Sallis et al, 2021 ). This has raised awareness on the potential for lifestyle changes, such as exercise, to safeguard against viral disease and has encouraged investigations into the role of exercise in the recovery of the so-called long COVID syndrome ( McGregor et al, 2021 ; Udina et al, 2021 ). The frequent mobilization and redistribution of SARS-CoV-2 specific T-cells with each bout of exercise, combined with an increased lymphatic transportation of neutralizing antibodies, is one potential mechanism by which exercise can improve immunity against SARS-CoV-2 ( Simpson and Katsanis, 2020 ); but how exercise affects cellular and humoral immunity against this novel coronavirus has not been determined.…”

Section: Discussionmentioning

confidence: 99%

Acute exercise increases immune responses to SARS CoV-2 in a previously infected man

Baker

Smith

Zúñiga

et al. 2021

Brain, Behavior, & Immunity - Health

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Evidence is emerging that exercise and physical activity provides protection against severe COVID-19 disease in patients infected with SARS-CoV-2, but it is not known how exercise affects immune responses to the virus. A healthy man completed a graded cycling ergometer test prior to and after SARS-CoV-2 infection, then again after receiving an adenovirus vector-based COVID-19 vaccine. Using whole blood SARS-CoV-2 peptide stimulation assays, IFN-γ ELISPOT assays, flow cytometry, ex vivo viral-specific T-cell expansion assays and deep T-cell receptor (TCR) β sequencing, we found that exercise robustly mobilized highly functional SARS-CoV-2 specific T-cells to the blood compartment that recognized spike protein, membrane protein, nucleocapsid antigen and the B.1.1.7 α-variant, and consisted mostly of CD3+/CD8+ T-cells and double-negative (CD4-/CD8-) CD3+ T-cells. The magnitude of SARS-CoV-2 T-cell mobilization with exercise was intensity dependent and robust when compared to T-cells recognizing other viruses (e.g. CMV, EBV, influenza). Vaccination enhanced the number of exercise-mobilized SARS-CoV-2 T-cells recognizing spike protein and the α-variant only. Exercise-mobilized SARS-CoV-2 specific T-cells proliferated more vigorously to ex vivo peptide stimulation and maintained broad TCR-β diversity against SARS-CoV-2 antigens both before and after ex vivo expansion. Neutralizing antibodies to SARS-CoV-2 were transiently elevated during exercise after both infection and vaccination. Finally, infection was associated with an increased metabolic demand to defined exercise workloads, which was restored to pre-infection levels after vaccination. This case study provides impetus for larger studies to determine if these immune responses to exercise can facilitate viral clearance, ameliorate symptoms of long COVID syndrome, and/or restore functional exercise capacity following SARS-CoV-2 infection.

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“…Our findings suggest that many non-critically ill hospitalized COVID-19 survivors’ ability to resume pre-COVID-19 roles and responsibilities were negatively impacted at least in the short, and possibly, long term 33 . Other studies have found that impaired functional status extended well beyond hospital discharge as patients were reporting persistent symptoms that impact their functional abilities six months after disease onset 29 – 31 , 34 – 36 . Early rehabilitation has been shown to improve physical and cognitive recovery in COVID-19 patients 33 .…”

Section: Discussionmentioning

confidence: 99%

“…Although existing Mental status, ICU Mobility Scale, and Barthel Index scores were readily available in our electronic medical records, these scores did not assess other aspects of important function. A few studies have proposed more comprehensive tools and scoring systems to evaluate the functional status of COVID-19 patients to better predict outcomes and guide treatment after hospital discharge 29 – 32 . For instance, Klok et al proposed the Post-COVID-19 Functional Status (PCFS) scale, a self-reported questionnaire that assesses patients’ ability to live independently, their functional limitations, and their degree of suffering from post-COVID-19 symptoms, pain, depression, or anxiety and categorizes patients into Grades 0–4 based on their responses 32 .…”

Section: Discussionmentioning

confidence: 99%

Characterizing non-critically ill COVID-19 survivors with and without in-hospital rehabilitation

Musheyev

Janowicz

Borg

et al. 2021

Sci Rep

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This study investigated pre-COVID-19 admission dependency, discharge assistive equipment, discharge medical follow-up recommendation, and functional status at hospital discharge of non-critically ill COVID-19 survivors, stratified by those with (N = 155) and without (N = 162) in-hospital rehabilitation. “Mental Status”, intensive-care-unit (ICU) Mobility, and modified Barthel Index scores were assessed at hospital discharge. Relative to the non-rehabilitation patients, rehabilitation patients were older, had more comorbidities, worse pre-admission dependency, were discharged with more assistive equipment and supplemental oxygen, spent more days in the hospital, and had more hospital-acquired acute kidney injury, acute respiratory failure, and more follow-up referrals (p < 0.05 for all). Cardiology, vascular medicine, urology, and endocrinology were amongst the top referrals. Functional scores of many non-critically ill COVID-19 survivors were abnormal at discharge (p < 0.05) and were associated with pre-admission dependency (p < 0.05). Some functional scores were negatively correlated with age, hypertension, coronary artery disease, chronic kidney disease, psychiatric disease, anemia, and neurological disorders (p < 0.05). In-hospital rehabilitation providing restorative therapies and assisting discharge planning were challenging in COVID-19 circumstances. Knowledge of the functional status, discharge assistive equipment, and follow-up medical recommendations at discharge could enable appropriate and timely post-discharge care. Follow-up studies of COVID-19 survivors are warranted as many will likely have significant post-acute COVID-19 sequela.

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Rehabilitation in adult post-COVID-19 patients in post-acute care with Therapeutic Exercise

Cited by 75 publications

References 16 publications

Post-COVID-19 acute sarcopenia: physiopathology and management

Post-COVID-19 acute sarcopenia: physiopathology and management

Acute exercise increases immune responses to SARS CoV-2 in a previously infected man

Characterizing non-critically ill COVID-19 survivors with and without in-hospital rehabilitation

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