Physical exercise as a treatment for persisting symptoms post-COVID infection: review of ongoing studies and prospective randomized controlled training study.

BACKGROUND AND PURPOSE: No evidence-based treatment is available for patients with persisting symptoms post-COVID-19 infection. We hypothesized that physical exercise may represent a safe and effective treatment option for post-COVID. METHODS: We performed a systematic search of the literature that revealed a lack of randomized training studies in patients post-COVID. Based on these findings, a prospective randomized controlled study with open-label and blinded endpoint evaluation was designed. 272 patients with symptoms of fatigue persisting over 6 weeks post-COVID infection were screened. Patients with pathological cardiovascular findings were excluded. 57 patients consented and were randomized to 4 weeks of supervised personalized strength and endurance training or usual care. The follow-up period was 3 and 6 months. RESULTS: There were no adverse events related to the training. Spiroergometry of the training group showed a significantly higher increase in VO2peak (10.0 ± 12.7% vs. 0.1 ± 8.9%, p < 0.01, respectively) and oxygen pulse (9.8 ± 10.8% vs. 0.0 ± 13.9%, p < 0.05, respectively). Parameters of the Multidimensional Fatigue Inventory-20, McGill Quality of Life Questionnaire, and Post-COVID-19 Functional Status were improved after 4 weeks in both groups. In the follow-up period, the total physical activity per week was significantly greater in the exercise group than in controls (1280 ± 1192 min vs. 644 ± 554 min, p < 0.05, respectively). The improvements in fatigue and quality of life were not statistically different between the training and usual care groups. CONCLUSION: Exercise is safe and improves maximal exercise capacity in post-COVID patients. Fatigue and quality of life improve over time in individuals that are willing to participate in a training study irrespective of their allocation. REGISTRATION: German Clinical Trials Register: DRKS00026686. Date of registration: 27.09.2021.

Intraday and interday reliability of pelvic floor muscles electromyography in continent woman.

AIMS: Vaginal surface electromyography (sEMG) is a tool used for the diagnosis and therapeutic intervention of urinary incontinence. Current sEMG systems differ in regard to electrode arrangement and data reproducibility. The aim of this study was to determine the intrasession, intraday, and interday reliabilities of sEMG parameters using a probe with circumferential electrode-position. METHODS: The intrasession, intraday, and interday reliabilities of maximum isometric voluntary contractions (MVC) of the pelvic floor muscles were assessed for 19 healthy continent women. Three sEMG parameters that are used to describe muscle activity were verified: maximal EMG (EMGmax ), mean over 500 ms around EMGmax (EMGA0.5 ), and mean over 2 seconds during MVC plateau (EMGA2-4 ). Relative and absolute reliability parameters were calculated, and the statistical methods described by Bland and Altman were applied to the data. RESULTS: We observed substantial reliabilities for all obtained parameters (EMGmax , EMGA2-4 , and EMGA0.5 ) in regard to the intrasession measurements (ICC = 0.93-0.97; CI = 0.86-0.99). Overall, the intraday reliability has been moderate (ICC = 0.64-0.75; CI = 0.27-0.90). EMGmax (ICC = 0.75; CI = 0.45-0.90) and EMGA2-4 (ICC = 0.73, CI = 0.42-0.89) were higher than EMGA0.5 (ICC = 0.64; CI = 0.27-0.85). However, the interday reliability was only fair for EMGmax (ICC = 0.48; CI = 0.04-0.77) and EMGA0.5 (ICC = 0.51; CI = 0.07-0.78) but moderate for EMGA2-4 (ICC = 0.65; CI = 0.28-0.85). CONCLUSIONS: This intrasession, intraday, and interday reliability results are similar to the results reported in the literature using probes with longitudinally oriented bars. The mean sEMG signal over 2 seconds (EMGA2-4 ) exhibited the highest reliability and is recommended for further studies. The interday reliability might be enhanced by considering the menstruation cycle.