Rehabilitation management of patients with COVID-19: lessons learned from the first experience in China

Abstract

INTRODUCTION Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management. EVIDENCE ACQUISITION A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as “high quality.” No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.

Chronic pain after COVID-19: implications for rehabilitation

“…37 Emerging reports from Wuhan, which is now operating several rehabilitation institutions for COVID-19 survivors, and Italy indicate a significant symptom burden in COVID-19 survivors including anxiety, sleep disorders, fatigue, limited exercise tolerance, and memory and executive function impairment. 38 Such symptoms are likely to be exacerbated or even attributed to pain, although this is yet to be explored. What remains unclear is the level of rehabilitation that will be possible for different countries in the early phase of recovery.…”

Exergaming as a Supportive Tool for Home-Based Rehabilitation in the COVID-19 Pandemic Era

“…14 In keeping with this, some preliminary data showed a high prevalence of residual functional limitations (e.g., sleep and mood disorders) even among patients with mild disease. 15 Given the complexity and variability of clinical manifestations and long-term outcomes, the implementation of multidisciplinary and personalized rehabilitation strategies for COVID-19 patients may represent a step forward in the management of these patients after the acute phase.…”

Candesartan could ameliorate the COVID-19 cytokine storm

“…The beneficial effect of ARB treatment may not be limited to acute SARS-CoV-2 infection and COVID-19 severity but may extend to ameliorate long-term consequences of the disease. Pulmonary fibrosis leading to pulmonary arterial hypertension and irreversible respiratory failure is likely to occur in patients recovered from acute respiratory distress syndrome (ARDS) associated with critically severe COVID-19 [ 57 , 129 , 130 ]. We found highly significant negative correlations between genes upregulated by glutamate and normalized by Candesartan in our neuronal cultures with transcriptome signatures of alveolar cells, fibroblasts and macrophages from post mortem human fibrotic lungs, indicative of alterations in mitochondrial biogenesis and enhanced oxidative stress, inflammation and senescence [ 29 ] (Supplemental Table 4).…”