Effects of a concurrent training, respiratory muscle exercise, and self-management recommendations on recovery from post-COVID-19 conditions: the RECOVE trial.

The aim of this study was to determine the effectiveness of physical exercise, respiratory muscle training, and the self-management World Health Organization (WHO) recommendations leaflet on the recovery of physical fitness, quality of life, and symptom status in people with post-COVID-19 conditions. Eighty nonhospitalized adults with a post-COVID-19 condition were randomly assigned to one of four 8-wk parallel intervention groups: 1) multicomponent exercise program based on concurrent training (CT, number of subjects (n) = 20; 3 resistance and endurance supervised sessions per week at low-moderate intensity); 2) inspiratory muscle training (RM, n = 17; 2 standardized daily sessions); 3) a combination of both of the above (CTRM, n = 23); and 4) control group (CON, n = 20; following the WHO guidelines for post-COVID-19-related illness rehabilitation). No significant differences between groups were detected at baseline. Although no significant differences between interventions were detected in the V̇o2max, significant individual improvements were identified in the CT (7.5%; effect size, ES = 0.28) and CTRM (7.8%; ES = 0.36) groups. Lower body muscle strength significantly improved in the CT and CTRM (14.5%-32.6%; ES = 0.27-1.13) groups compared with RM and CON (-0.3% to 11.3%; ES = 0.10-0.19). The CT and CTRM groups improved significantly for dyspnea and fatigue, as did the health status. In addition, significant differences between interventions were described in fatigue and depression scales favoring CT and CTRM interventions. An individualized and supervised concurrent training with or without inspiratory muscle training was safe and more effective than self-care recommendations and inspiratory muscle training alone, to regain cardiovascular and muscular fitness, improve symptom severity, and health status in outpatients with post-COVID-19 conditions.NEW & NOTEWORTHY Eight weeks of concurrent training, with or without inspiratory muscle exercise, was better than WHO "Support for Rehabilitation: Self-Management after COVID-19-Related Illness" recommendations or inspiratory muscle training alone to improve cardiopulmonary fitness, strength, and symptom severity, in a safe and effective manner. The RECOVE trial proved the benefits and utility of a supervised exercise program in people with post-COVID-19 conditions after mild COVID-19 in an ambulatory setting.

Rehabilitation for post-COVID-19 condition through a supervised exercise intervention: A randomized controlled trial.

PURPOSE: The aim of the study was to compare the outcomes of patients with post-COVID-19 condition undergoing supervised therapeutic exercise intervention or following the self-management WHO (World Health Organization) rehabilitation leaflet. METHODS: A randomized controlled trial was carried out that included 39 participants with post-COVID-19 condition who had a chronic symptomatic phase lasting >12 weeks. Comprehensive medical screening, patient-reported symptoms, and cardiorespiratory fitness and muscular strength were assessed. Patients were randomly assigned to a tailored multicomponent exercise program based on concurrent training for 8 weeks (two supervised sessions per week comprised resistance training combined with aerobic training [moderate intensity variable training], plus a third day of monitored light intensity continuous training), or to a control group which followed the WHO guidelines for rehabilitation after COVID-19. RESULTS: After follow-up, there were changes in physical outcomes in both groups, however, the magnitude of the change pre-post intervention favored the exercise group in cardiovascular and strength markers: VO2 max +5.7%, sit-to-stand -22.7% and load-velocity profiles in bench press +6.3%, and half squat +16.9%, (p < 0.05). In addition, exercise intervention resulted in a significantly better quality of life, less fatigue, less depression, and improved functional status, as well as in superior cardiovascular fitness and muscle strength compared to controls (p < 0.05). No adverse events were observed during the training sessions. CONCLUSION: Compared to current WHO recommendations, a supervised, tailored concurrent training at low and moderate intensity for both resistance and endurance training is a more effective, safe, and well-tolerated intervention in post-COVID-19 conditions.

Relationship between the severity of persistent symptoms, physical fitness, and cardiopulmonary function in post-COVID-19 condition. A population-based analysis.

The aim of this study was to determine the relationship between physical fitness, cardiopulmonary function and patient-reported severity of symptoms in people with post-COVID-19 condition. We examined ambulatory patients (n = 72) with post-COVID-19 condition who had a chronic symptomatic phase lasting > 12 weeks from the onset of symptoms, but had not been hospitalized for acute COVID-19. A comprehensive medical screening was conducted, including clinical history, symptomatology, comorbidities, body composition and physical activity levels. We then identified the relationship between physical fitness (cardiorespiratory fitness and muscular strength), cardiopulmonary function (echocardiographic and spirometry parameters) and patient-reported severity of symptoms (fatigue, dyspnea, health-related quality of life, anxiety, and depression). Age, body mass index, sex, number of comorbidities and duration of symptoms were included as potential confounders. Results showed that greater physical fitness and cardiopulmonary function were associated with lower severity of symptoms in people with post-COVID-19 condition. Cardiorespiratory fitness, lower-limb muscle strength, maximal voluntary ventilation and left ventricular ejection fraction account for reducing fatigue and dyspnea. Greater physical activity levels were associated with fewer symptoms and less-severe fatigue and dyspnea. In conclusion, preserving better cardiopulmonary health and physical condition during the course of the disease-even in mild cases-was related to a lower intensity of symptoms in non-hospitalized people with post-COVID-19 condition. It is probable that exercise and physical conditioning are valuable pre- and post-COVID-19 countermeasures that could help decrease the severity, not only of acute infection, but of post-COVID-19 persistent symptoms and prognosis.

Post-COVID-19 Syndrome and the Potential Benefits of Exercise.

The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19.