Personalized interdisciplinary pulmonary rehab improves outcomes in adults with long COVID

Personalized interdisciplinary pulmonary rehabilitation resulted in improvements in exercise capacity, functional status, dyspnea, fatigue and quality of life among adults with long COVID-19, researchers reported in Respiration.

“In light of a fast-increasing disease burden of long COVID, strategies to improve long-term outcomes of patients are urgently needed,” Stephan Nopp, MD, from the department of medicine in the clinical division of hematology and hemostaseology at the Medical University of Vienna, and colleagues wrote. “Currently, guidance statements and position papers propose acute and long-term rehabilitation. However, these recommendations are based on expert consensus only without evidence from dedicated studies evaluating the beneficial effects of inpatient or outpatient rehabilitation in patients suffering from long-term health impairments after COVID-19.”

The prospective, observational cohort study enrolled 58 consecutive patients (mean age, 46.8 years; 43.1% women) admitted to an outpatient pulmonary rehab center due to persistent symptoms after COVID-19 from May 2020 to April 2021. Researchers performed initial functional capacity, respiratory function, dyspnea and quality of life assessments at baseline. Patients then underwent individualized pulmonary rehab, including endurance, strength and inspiratory muscle training, over 6 weeks. Sessions were three times per week for 3 to 4 hours per session.

The primary outcome was change in 6-minute walk distance after the 6-week interdisciplinary individualized pulmonary rehab program. Secondary outcomes included change in post-COVID-19 functional status scale, Borg dyspnea scale, Fatigue Assessment Scale and quality of life.

Thirty-eight percent of patients were hospitalized with severe/critical COVID-19 and 62% of patients were quarantined at home with mild to moderate COVID-19. Mean 6-minute walk distance was 584.1 m and functional impairment was a median of 2 on the post-COVID-19 functional status scale at baseline.

Researchers reported improved 6-minute walk distance by an average of 62.9 m compared with baseline (P < .001), with 70.6% of patients increasing their distance by more than 30.5 m. There was also an improvement on the post-COVID-19 functional status scale of one grade after 6 weeks of rehabilitation (P < .001).

Secondary outcomes also improved with dyspnea, fatigue and quality of life (P < .001 for all). In addition, during pulmonary rehab, researchers observed increased FEV₁ (P = .011), lung diffusion capacity (P = .037) and inspiratory muscle pressure (P < .001).

“Long-term effects of rehabilitation and the observed improvement of pulmonary function need to be addressed in future trials,” the researchers wrote.