Development of endurance training program for patient diagnosed with post-COVID syndrome: A case report

ABSTRACT

BACKGROUND AND PURPOSE: Post-Covid Syndrome is the chronic phase after COVID-19 when a person no longer has a positive polymerase chain reaction (PCR) test, however continues to display symptoms. Symptoms include fatigue, post-exertional malaise, cognitive dysfunction, shortness of breath and transient or long-term orthostatic intolerances such as Postural Orthostatic Tachycardia Syndrome (POTS). There is limited evidence on exercise guidelines for Post-Covid Syndrome. The purpose of this case study is to describe the physical therapy (PT) plan of care for patient with Post-Covid Syndrome. CASE DESCRIPTION A 51-year-old female with diagnosed COVID-19 with a nonremarkable recovery at home. Her past medical history was significant for depression, anxiety and migraines. She was active, engaging in hiking and recreational sports. She developed Post-Covid Syndrome and POTS five months later, with medical testing negative for brain MRI, echocardiogram, EKG, pulmonary function test, and bloodwork. Positive tests indicative of POTS, included the cardiac stress test and active stand test. PT started four months later to address fatigue and muscle weakness. She presented with mild cognitive impairment, impaired cardiovascular endurance and standing balance, left upper and lower extremity weakness. She was unable to walk more than 0.5 miles, required rest breaks during activity of daily living, and was unable to return to work. Based on exercise guidelines by De Wandele et al. for POTS, an exercise program was developed. Vitals (BP, HR, oxygen saturation and BORG Rating of Perceived Exertion) were monitored each session. The program was implemented at a frequency of 2 times/week for 10 visits and 1 time/week at home. The mode of exercise was endurance training using recumbent ergometer at 75% of max HR or Borg RPE of 13-15. Total intervention time was 30 minutes including 10 minutes for warm-up and cool-down. Patient was assessed at evaluation and progress report, 10 visits later with the 6- minute walk test (6MWT) to assess endurance, the Modified Fatigue Impact Scale (MFIS) to assess perceived fatigue severity and its impact on function, subjective activity diary of post-exertional malaise, and the EURO-Quality of Life (EUROQOL-5) to determine overall health. OUTCOMES: The patient completed supervised sessions without adverse reactions. She maintained the target HR and demonstrated improved 6MWT by 87 m, MFIS by 18 points and EUROQOL-5 by 8 points after 10 visits. She also had reduced post-exertional malaise episodes from twice a day to twice a week. DISCUSSION: This cardiovascular endurance training program is correlated with positive improvements in endurance, fatigue severity, and quality of life in a person with PostCovid Syndrome. Post-Covid Syndrome is a developing diagnosis and there is limited data on its clinical course of recovery. Further research is needed to develop specific exercise guidelines for Post-Covid Syndrome.