Interval training in the treatment of chronic effects of COVID-19

ABSTRACT

BACKGROUND AND PURPOSE: The World Health Organization categorized COVID-19 as a pandemic on March 11th, 2020. Since then, maximizing survival of those infected has been the major focus of many health services. Those who suffered from the virus are now experiencing ongoing symptoms that may last several months or more. These symptoms can include fatigue, pain, muscle atrophy, weakness, and functional impairments. Due to the lack of evidence on the long-term effects of COVID-19 healthcare providers may take into account research from other relevant and more extensively studied respiratory illnesses. The purpose of this case report is to highlight the use of available research from SARS-COV in the rehabilitation of a young, previously healthy patient with severe effects of COVID-19. CASE DESCRIPTION The patient is a 45-year-old male diagnosed with COVID19 in May 2020. He was diagnosed with a severe case and admitted to the Intensive Care Unit with hypoxemia for 4 days. His past medical history included celiac disease, post-traumatic stress disorder, and two pulmonary embolisms from COVID-19 for which he was prescribed Apixaban. He was evaluated by physical therapy in the Veterans Affairs Telehealth system in September 2020. The patient's chief complaint was fatigue and inability to perform his usual functions. This was demonstrated by the inability to ambulate greater than 2 min without rest breaks. At the time of evaluation his gait speed was >35 m/s highlighting his severely deconditioned state. The patient was treated for 12 visits over 6 months using interval training with a rate of perceived exertion progression three days per week utilizing concepts from high intensity interval training. This intervention was based upon available research on treatments of similar respiratory conditions such as SARS-COV. OUTCOMES: The patient's meaningful functional improvements included the following patient specific functional scale improved from a range of 0-2 to a range of 8-10, 2-minute step test from 93 to 100 steps, 5 times sit to stand from 15 to 11 seconds, and 6 -minute walk test from 540 m to 600 m. Patient's PROMIS score was also taken 4 months into treatment falling into normal ranges with a T-score of 47.7 for the global physical health score. DISCUSSION: Due to limited available evidence on the treatment of long-term effects of COVID19 clinicians may interpret the best evidence for similar conditions such as SAR-COV. In the absence of evidence for effective treatments in outpatient physical therapy for a patient with novel COVID-19, using evidence from conditions with similar physiological effects seemed to be an effective strategy. Interval training reduces the ventilatory demand of exercise and reduces the sense of breathing effort as sustained traditional aerobic exercise may not be tolerated in this population. This case highlights an approach that warrants further study in this population.