Study Reinforces Personalized Exercise Rehabilitation for Patients with Long COVID

Caring for patients with long COVID without post-exertional symptom exacerbation by exercise rehabilitation of both strength and endurance training was confirmed and reinforced by personalizing the program to patients and their symptoms, according to a study published in Environmental Research and Public Health.¹

Claire Colas

Credit: Jean Monnet University

“Exercise in long COVID could be relevant to limit the potential consequences of the pathology both in terms of symptoms (eg, fatigue and breathlessness) and exercise intolerance,” wrote lead investigator, Claire Colas, a PhD student associated with Jean Monnet University, and colleagues. “More generally, the autonomic alteration described in these patients could be counterbalanced by regular physical activity.”

However, patients with autonomic dysfunction should be paid special attention to. In certain cases, post-exertional symptom exacerbation is characterized by a worsening of symptoms, generally 12 – 48 hours after activity, following physical or mental exertion which can last for days or weeks. A symptom-titrated exercise protocol or a contraindication to exercise is sometimes necessary in this patient population.²

The prospective, comparative study using patients from the COVIMOUV and CITIUS studies evaluated exercise rehabilitation to improve muscular, cardiorespiratory, and autonomic functions. Investigators evaluated long COVID patients (n = 38) after a 4-week exercise intervention of 3 sessions per week compared with 2 control groups comprised of patients with fibromyalgia (n = 38) and coronary artery disease (n = 38). The efficacy of exercise training was determined using a cardiopulmonary exercise test, supine heart rate variability recording at rest, and a handgrip force test before and after the rehabilitation program.

Eligible patients were adults (aged ≥18 years) with a previously confirmed COVID-19 infection, showed persistent asthenia >3 months in the long COVID cohort, acute coronary syndrome treated within the last 6 months in the coronary artery disease patient cohort, and a fibromyalgia diagnosis based on the 2016 American College of Rheumatology (ACR) criteria in the fibromyalgia cohort.

The long COVID cohort was comprised of 55% women with a mean age of 46.9 years, most patients with fibromyalgia were women (92%) with a mean age of 47.4 years, and 24% of patients in the coronary artery disease cohort were women with a mean age of 61.4 years. Significant differences between groups were reported in terms of age, sex, and tobacco consumption at baseline. Half of patients in the long COVID cohort were overweight.

The cardiorespiratory and muscular parameters were improved after the exercise rehabilitation in all 3 groups (P <.001). No significant difference was observed for autonomic variables. The exercise rehabilitation did not improve autonomic function.

Investigators noted limitations including the absence of a control group for patients with long COVID. Therefore, they were unable to evaluate the evolution of treated patients with the natural evolution of symptoms. Further, significant differences at baseline were observed, which indicated a noncomparability between cohorts. The analysis showed an improvement in physical parameters, although this could be influenced by the quantity of exercise performed in daily life outside of the exercise intervention, which was not assessed. Lastly, the small sample of patients did not allow investigators to draw definitive conclusions from the study.

“Our results showed a similar improvement in main physical performance parameters… demonstrating that exercise rehabilitation for long COVID patients without post-exertional symptom exacerbation was as effective as exercise rehabilitation for other patients,” investigators concluded.

References

1. ^{Colas C, Le Berre Y, Fanget M, et al. Physical Activity in Long COVID: A Comparative Study of Exercise Rehabilitation Benefits in Patients with Long COVID, Coronary Artery Disease and Fibromyalgia. Int J Environ Res Public Health. 2023;20(15):6513. Published 2023 Aug 3. doi:10.3390/ijerph20156513}
2. ^{Blitshteyn, S.; Whiteson, J.H.; Abramoff, B.; Azola, A.; Bartels, M.N.; Bhavaraju-Sanka, R.; Chung, T.; Fleming, T.K.; Henning, E.; Miglis, M.G.; et al. Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Autonomic Dysfunction in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). PM R 2022, 14, 1270–1291}