{"id":10690,"date":"2023-08-07T06:00:13","date_gmt":"2023-08-07T05:00:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=10690"},"modified":"2023-07-31T09:38:54","modified_gmt":"2023-07-31T08:38:54","slug":"managing-the-post-covid-19-syndrome","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2023\/08\/07\/managing-the-post-covid-19-syndrome\/","title":{"rendered":"Managing the Post-COVID-19 Syndrome"},"content":{"rendered":"

Harnessing the Power of Home-based Exercise Interventions<\/span><\/i><\/p>\n

Keywords: <\/b>quality of life, functional capacity, exercise training<\/span><\/p>\n

Why is this study important?<\/b><\/p>\n

The World Health Organization (WHO) has recently announced that COVID-19 no longer constitutes a public health emergency of international concern. This, however, does not mean the end of the pandemic or of its short and long-term consequences. Convalescent patients of COVID-19 often experience a myriad of health impairments, including exertional intolerance, worse functional capacity, and persistent symptoms (eg, fatigue, muscle weakness, myalgia, and dyspnea) that directly impact their quality of life. In fact, the post-acute effects of COVID-19 have already revealed more than 200 symptoms and 50 health conditions that commonly develop or persist after SARS-CoV-2 infection that can last several months (or even years, particularly, in those who had acute severe\/critical illness). Based on the available literature, the prevalence of this condition varies widely, ranging from approximately 10% to 80% of those who had been infected (1). Even though the numbers vary, in best estimates, we are talking about millions of people suffering from this condition worldwide. Therefore, the post-COVID-19 syndrome is still an ongoing health issue which deserves appropriate attention.<\/span><\/p>\n

Exercise has been considered as a \u201cmedicine\u201d for a broad spectrum of chronic diseases that, despite their distinct nature, share similar symptoms and manifestations (2). Resistance exercises have gathered widespread recognition for its efficacy in increasing skeletal muscle mass, strength and functionality, whereas endurance exercises are especially known for enhancing cardiorespiratory fitness. Both types of exercise also have been shown to alleviate fatigue and bodily pain (eg, myalgia). Due to the pandemic-imposed restrictions on accessing exercise centres, home-based exercise training emerges as a promising alternative. Considering the positive effects on a multitude of health-related outcomes (including quality of life), it was reasonable to assume a therapeutic role for a home-based exercise programme in the post-COVID-19 syndrome management.\u00a0 This blog will explore this further and is based on a <\/span>study<\/span><\/a> recently published in BJSM (3).<\/span><\/p>\n

How did the study go about this?<\/b><\/p>\n

We recruited 50 survivors of severe\/critical COVID-19 (in line with WHO severity classification) and divided them randomly into two groups:\u00a0<\/span><\/p>\n

1) CONTROL (standard of care) and\u00a0<\/span><\/p>\n

2) HBET (home-based exercise training).\u00a0<\/span><\/p>\n

CONTROL received general lifestyle advice, while HBET followed a remotely semi-supervised training program tailored to each patient (based on their post-COVID functional status – PCFS score), in addition to standard of care. The training program included exercises to be performed at home using body weight or household materials, progressing over the weeks based on individual capacity and perceived exertion. In addition to online monitoring, patients also received support material, such as exercise cards providing instructions on how to properly perform each exercise. We assessed health-related quality of life, cardiorespiratory fitness, pulmonary function, functional capacity, body composition, and persistent symptoms at baseline and after 16 weeks.<\/span><\/p>\n

What did the study find?<\/b><\/p>\n

We found a meaningful effect of HBET on physical domains of health-related quality of life, reflecting improvements in functional capacity and some persistent symptoms (ie, muscle weakness and myalgia). Even considering suboptimal adherence (71.2%) to HBET, secondary analysis (per protocol) also revealed positive results in other outcomes, such as cardiorespiratory fitness, body composition, and fatigue severity, further supporting the benefits of exercise interventions for these patients. Conversely, we did not find significant effects on any psychological symptoms (eg, anxiety and depression), which we speculate stem from lack of social contact in combination with environmental issues (ie, performing exercise indoors).<\/span><\/p>\n

What are the key take-home points?<\/b>\u00a0<\/span><\/p>\n