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Background: COVID-19 ICU patients present respiratory and peripheral muscle weakness both during hospitalisation and following discharge. However, few studies have evaluated muscle strength in non-ICU hospitalised patients. Aim(s): To report the incidence of muscle weakness in non-ICU hospitalised patients and investigate the effect of pulmonary rehabilitation (PR) on respiratory and peripheral muscle strength. Method(s): Maximum static inspiratory (MIP) and expiratory (MEP) muscle pressures, quadriceps muscle force (QF), and handgrip strength were assessed in 21 patients (age: 56+/-12 yrs.) previously hospitalised with COVID-19, 94+/-32 days following discharge. Fifteen out of 21 patients were re-assessed three months later (10 following a PR program and 5 who declined PR and recovered at home (UC)). Result(s): 12/21 patients (57%) had reduced MIP and 18/21 patients (86%) reduced MEP (both <80% pred) (Wilson et al., Thorax 1984;39:535-538). Eleven patients (52%) had reduced QF and handgrip strength (both <80% pred). Data from the 3-month follow up period are presented in table 1. Conclusion(s): A number of patients hospitalised with COVID-19 presented with respiratory and peripheral muscle weakness 3 months following discharge. PR programme improved respiratory and peripheral muscle strength in these patients.
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Background: Patients suffering from long COVID-19 syndrome have reduced emotional status) and impaired functional capacity;the effect of pulmonary rehabilitation (PR) on emotional status and functional capacity remain inconclusive. Aim(s): To investigate the effect of a hybrid PR program on QoL, emotional status and functional capacity in patients with long COVID-19 syndrome. Method(s): 15 patients (age (mean+/-SD): 55+/-14 yrs.) with excessive fatigue due to COVID-19 syndrome (FACIT score (25+/-11) were allocated to PR (n=10) or usual care (UC) (n=5), 85+/-29 days following hospital discharge. PR consisted of 8 outpatient PR sessions (twice weekly for 4 weeks), and 24 home-based PR sessions (3 times/week for 8 weeks). Patients in the UC declined PR and instructed to be physically active. Psychological status was assessed via HADS and Impact Event Scale-Revised (IES-R). Functional capacity was assessed via SPPB, 6MWD, and steps/day. Result(s): Data are presented in table 1. Conclusion(s): PR improves QoL and functional capacity in patients with long COVID-19 syndrome. (Table Presented).
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Aim: To investigate the effects of rehabilitation (Rehab) added to usual care (UC) versus UC on symptoms, mental health and quality of life (QoL) outcomes post COVID-19. Method(s): A supervised Rehab program was offered to 55 post COVID-19 patients who were hospitalized with severe/critical COVID-19 pneumonia and a Copd Assesment Test (CAT) score >= 10, post hospital discharge (6-8 weeks). Twenty-eight patients accepted to enroll to Rehab, whereas 27 refused to participate (UC). All patients were evaluated at baseline and after 2 months. Result(s): Groups were not different in mean age (56 years), gender (53% ), ICU admission (65%), intubation (47%), days of hospitalization (31), number of symptoms (9), and number of comorbidities (1.4). The baseline evaluation was conducted at 82+/-30 days after symptoms onset. Only Rehab was associated with improvements in respiratory symptoms, dyspnea, fatigue, depression/anxiety, cognitive impairment, and QoL. (Table 1) Conclusion(s): Rehabilitation facilitates recovery of symptoms and QoL post COVID-19 that otherwise would remain incomplete with usual care.
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Aim: To investigate the effects of rehabilitation (Rehab) added to usual care (UC) versus UC on functional capacity outcomes in patients with COVID-19 pneumonia. Method(s): A supervised Rehab program was offered to 55 post COVID patients who were hospitalized with severe/critical COVID-19 pneumonia and a COPD Assessment Test (CAT) score >= 10, post hospital discharge (6-8 weeks). Twenty-eight patients accepted to enroll to Rehab, whereas 27 refused to participate (UC). All patients were evaluated at baseline and after 2 months. Result(s): Groups were not different in mean age (56 years), gender (53% ), ICU admission (65%), intubation (47%), days of hospitalization (31), number of symptoms (9), and number of comorbidities (1.4). The baseline evaluation was conducted at 82+/-30 days after symptoms onset. Both Rehab and UC were associated with improvements in functional capacity;however, these were greater following Rehab (Table 1). Conclusion(s): Rehabilitation amplifies the functional recovery post COVID-19. (Figure Presented).
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Background: Exercise tolerance is limited in patients suffering from long COVID-19 syndrome several months after the acute phase of the disease. The effect of pulmonary rehabilitation (PR) on exercise tolerance is inconclusive. Aim(s): To investigate the effect of a hybrid PR program, combining outpatient and home-based PR, on exercise capacity in long COVID-19 syndrome. Method(s): 15 patients (age (mean+/-SD): 55+/-14 yrs.) with excessive fatigue due to long COVID-19 syndrome (FACIT score (25+/-11) were allocated to PR (n=10) or usual care (UC) (n=5) groups 85+/-29 days from hospital discharge. PR consisted of 8 outpatient PR sessions (twice weekly for 4 weeks), and 24 home-based PR sessions (3 times/week for 8 weeks). Patients in the UC were instructed to be physically active. Exercise tolerance was assessed during a cardiopulmonary exercise test to the limit of tolerance (Tlim). Result(s): Results are presented in table 1. Conclusion(s): A hybrid programme of PR improves exercise tolerance in patients with long COVID-19 syndrome.
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Aim: We assessed safety of high-intensity [IV1] constant-load exercise (CLE) and intermittent exercise (HIIT) in 14 post-severe-COVID-19 patients (63+/-13 years;78.6% male;BMI: 28+/-5, without comorbidities) between July 2020 and April 2021 after 55+/-22 days of COVID-induced acute respiratory failure. Method(s): The crossover study balanced exercise intensity between CLE at 70% of peak work rate (WRpeak) to the limit of tolerance (Tlim) and HIIT including 1 min exercise at 100% WRpeak, alternated with 1 min at 40% WRpeak to Tlim. Gas exchange, ventilation, electrocardiography and symptoms were assessed. Result(s): Exercise endurance time and total work output were not different between HITT and CLE (Table 1). At Tlim, none of the ventilatory or cardiovascular responses differed between HITT and CLE and there was no difference in the intensity of symptoms (Table 1). Conclusion(s): Individuals with ongoing symptomatic COVID-19 could safely undertake high intensity exercise performed continuously or intermittently.
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Purpose: The COVID-19 pandemic has increased the demand for tele-medicine, particularly for lung transplant (LTX) recipients who are immunosuppressed and often live far from transplant centres. We report the feasibility of a 3-month semi-automated tele-coaching intervention in this population. Methods: The intervention consists of a pedometer and smartphone app, allowing transmission of activity data to a platform (Linkcare v2.7) that provides feedback, activity goals, education and contact with the researcher as required. Remote assessment pre- and post-intervention included patient acceptability using a project specific questionnaire, physical activity using accelerometry (Actigraph GT3X), HADS and the SF-36 questionnaire. Results: So far, all eligible patients approached were willing to be randomised to the intervention or usual care (n=14;COPD=4, ILD=7;CF=1;PH=2). For the intervention, usage of the pedometer was excellent, with patients wearing it for 6.9±0.1 days/week and rating the pedometer and telephone contact (9±2 out of 10) as the most vital aspects. Patient feedback has been positive, with 80% of patients responding that they ‘liked’ taking part and that it ‘helped them a lot’ to increase their activity levels. Daily steps and VMU are presented in Figure 1 and SF-36 scores in Figure 2. There were no changes in HADS scores between groups. Conclusion: Tele-coaching appears feasible in LTX recipients, with patients showing excellent adherence and providing positive feedback after 3 months. This is promising, with the on-going need to develop and evaluate ways of supporting patients remotely.
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S21 Figure 1Daily steps using accelerometry (Actigraph GTX3), at baseline (hospital discharge), 3 months and 6 months for lung transplant recipients assigned to the intervention group (n=5)[Figure omitted. See PDF]ConclusionTele-coaching appears feasible in lung transplant recipients, with patients wearing the pedometer and interacting well with the app over 3 months. This is promising in the current climate, with the need to develop and evaluate innovative ways of supporting patients remotely.
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Introduction To prevent infection during the peak of the COVID-19 pandemic, COPD patients were instructed to 'shield', resulting in restrictions to usual daily activities, potentially negating health benefits attained during pulmonary rehabilitation (PR). The aim of this study was to determine the impact of a shielding period on physical activity levels and health-related quality of life (HRQoL) in COPD patients who completed a course of supervised PR before shielding in March 2020 Methods COPD patients who completed an 8-week PR course between January and March 2020 were enrolled into this single centre, observational cohort study. Physical activity was measured using accelerometry (Actigraph wGT3X) and the Clinical Visit of Proactive Physical Activity in COPD (CPPAC) instrument (that captures the domains of amount and difficulty of physical activity;Gimeno-Santos et al. ERJ 2015) in the week preceding PR, the week following completion of PR and for a week 3 months following completion of PR during the shielding period (April to July 2020). Additionally, assessment of HRQoL (COPD Assessment Test [CAT] and Clinical COPD Questionnaire [CCQ]) and psychological wellbeing (Hospital Anxiety and Depression Scale [HADS]) was undertaken. Results In ten COPD patients (FEV1: 55±23% predicted), a significant and clinically meaningful decrease in daily steps was shown from post-PR to shielding (4129±2245 versus 2508±1186 steps/day;p=0.030), as well as pre-PR to shielding (3681±2025 versus 2508±1186 steps/day;p=0.015). Likewise, there was a significant and clinically meaningful worsening in the C-PPAC score from post-PR to shielding (68 ±13 versus 59±13 points;p=0.060), but not pre-PR to shielding (61±11 versus 59±13 points;p=1.000). There were no statistically or clinically meaningful changes in HADS and CAT scores. However, the worsening in CCQ scores from post-PR to shielding did exceed clinically meaningful margins (±0.4 points) for both functional (+0.5 points) and mental domains (+0.7 points). Conclusions In COPD, the shielding period had a negative impact on physical activity levels, evidenced by reduced daily steps compared to not only post-PR, but also pre-PR. This decline below baseline values could have led to further physical deconditioning, potentially reversing some of the benefits gained during PR and worsening long term disease-related outcomes.
ABSTRACT
IntroductionTo prevent infection during the peak of the COVID-19 pandemic, COPD patients were instructed to ‘shield’, resulting in restrictions to usual daily activities, potentially negating health benefits attained during pulmonary rehabilitation (PR). The aim of this study was to determine the impact of a shielding period on physical activity levels and health-related quality of life (HRQoL) in COPD patients who completed a course of supervised PR before shielding in March 2020.MethodsCOPD patients who completed an 8-week PR course between January and March 2020 were enrolled into this single centre, observational cohort study. Physical activity was measured using accelerometry (Actigraph wGT3X) and the Clinical Visit of Proactive Physical Activity in COPD (C-PPAC) instrument (that captures the domains of amount and difficulty of physical activity;Gimeno-Santos et al. ERJ 2015) in the week preceding PR, the week following completion of PR and for a week 3 months following completion of PR during the shielding period (April to July 2020). Additionally, assessment of HRQoL (COPD Assessment Test [CAT] and Clinical COPD Questionnaire [CCQ]) and psychological wellbeing (Hospital Anxiety and Depression Scale [HADS]) was undertaken.ResultsIn ten COPD patients (FEV1: 55±23% predicted), a significant and clinically meaningful decrease in daily steps was shown from post-PR to shielding (4129±2245 versus 2508±1186 steps/day;p=0.030), as well as pre-PR to shielding (3681±2025 versus 2508±1186 steps/day;p=0.015). Likewise, there was a significant and clinically meaningful worsening in the C-PPAC score from post-PR to shielding (68±13 versus 59±13 points;p=0.060), but not pre-PR to shielding (61±11 versus 59±13 points;p=1.000). There were no statistically or clinically meaningful changes in HADS and CAT scores. However, the worsening in CCQ scores from post-PR to shielding did exceed clinically meaningful margins (±0.4 points) for both functional (+0.5 points) and mental domains (+0.7 points).ConclusionsIn COPD, the shielding period had a negative impact on physical activity levels, evidenced by reduced daily steps compared to not only post-PR, but also pre-PR. This decline below baseline values could have led to further physical deconditioning, potentially reversing some of the benefits gained during PR and worsening long term disease-related outcomes.