Over 760 million cases of Coronavirus disease-2019 (COVID-19) and 6.8 million deaths have been reported worldwide, and many patients that are diagnosed with COVID-19 develop long-lasting complications. Often referred to as post-COVID-19 syndrome or long COVID, these complications often last for at least two months and can cause fatigue, exercise intolerance, a decline in quality of life and dyspnea, among other symptoms. Expert consensus has been to prescribe acute and long-term rehabilitation along the lines of pulmonary rehabilitation (PR), but limited patient data is available to determine the effectiveness of rehabilitation at easing the complications of post-COVID-19.
To address this gap in the literature, a team of researchers led by Dr. Jafar Aljazeeri from the University of Pittsburgh Medical Center (UPMC) set out to study the impact of PR on post-COVID-19 patients. This observational study followed 56 patients that participated in PR at three UPMC programs between December 2020 and September 2022. All patients in the study had laboratory confirmed COVID-19 infections, and subsequent persistent dyspnea, hypoxia, abnormal pulmonary function test results or abnormal chest computed tomography scans that resulted in their referral to PR. The patients completed 8-12 weeks of PR with three 60-90 minute sessions each week, and the program design included disease-specific education for post-COVID-19 patients to help increase self-management of their conditions. The PR program also included supervised exercise training (including resistance training, endurance training and training for daily activities), breathing regulation techniques and consultations with specialty clinicians including psychologists, dietitians, social workers and speech therapists as needed.
To assess post-COVID-19 patient outcomes, the research team reviewed intake and discharge scores for the 6-minute walk test (6MWT), as well as the Shortness of Breath Questionnaire (SOBQ), the modified Borg dyspnea scale, metabolic equivalents (METS), the Patient Health Questionnaire-9 (PHQ-9) and the Lung Information Needs Questionnaire (LINQ). The results showed a significant improvement in 6MWT (with a mean improvement of 84.3 meters), SOBQ, PHQ-9, METs and LINQ, indicating that PR is a promising method to help patients improve exercise capacity and manage the symptoms of post-COVID-19.
While the results show significant increases in outcomes, the research team did note some limitations in their study, including standard observational study limitations and the lack of a control group to rule out natural recovery and other possible explanations for the results, the sample size, and the lack of follow-up data to determine the long-term impacts of PR on the participants. Based on these limitations, the research team recommends the initiation of larger studies to assess the impact of PR participation on post-COVID-19 patients.
Despite the limitations of this specific study, PR should be seen as a promising intervention for patients with post-COVID-19, and patients with this diagnosis should be evaluated for referral to PR to help alleviate long-term symptoms and improve their quality of life.
A visual abstract from the author group that outlines the results of the study can be viewed below, and the full article (Pulmonary Rehabilitation for Post-COVID-19) can be viewed by accessing JCRP through the AACVPR member portal on the AACVPR website.