According to a new systematic review and meta-analysis published in JAMA Network Open, rehabilitation interventions that include breathing exercises and physical training are associated with improvements in functional exercise capacity, difficulty breathing, and quality of life in patients with long COVID or post-COVID condition (PCC).
“There is an urgent need for evidence-based rehabilitation interventions to support people affected by PCC,” the researchers write in the study’s introduction.
The study relied on 14 randomized clinical trials comprising 1,244 PCC patients. All trials evaluated respiratory training and exercise-based rehabilitation therapies in patients with PCC to placebo, normal care, a waiting list, or a control.
The primary outcome examined was increases in functional exercise capacity, which is most typically described by improvements in the 6-minute walking test, which is a functional test that measures how quickly patients can cover a given amount of meters in a 6-minute walk. Fatigue, functional leg strength and endurance, dyspnea (breathing problems), respiratory function, and quality of life were all secondary outcomes.
Women made up 45% of the trial participants included in the study, while PCC patients had a median age of 50 years. Six trials included patients who had previously been hospitalized with COVID-19 infection, while three trials included patients who had not previously been hospitalized. There were five experiments with mixed populations.
Breathing easier, better quality of life
Breathing exercises were the most prevalent rehabilitation strategy seen in the trials. Physical activity without a breathing exercise component was also an intervention, as was breathing exercises with resistance and aerobic training.
Rehabilitation therapies were linked with gains in functional exercise capacity (standardized mean differences [SMD], 0.56; 95% credible interval [CrI], 0.87 to 0.22) with moderate confidence in seven studies including 389 individuals.
During the 6-minute walking test, patients in the intervention group covered 35.84 meters (m) more than patients in the control group (95% confidence interval [CI], 34.97 m to 36.71 m).
Researchers examined rehabilitation and dyspnea in eight studies. When compared to usual care, rehabilitation therapies were linked with a larger improvement in functional exercise ability (SMD, 1.00; 95% CrI, 1.94 to 0.10).
In five trials, rehabilitation therapies were linked with a greater improvement in quality of life when compared to the control group (SMD, 0.41; 95% CrI, 0.73 to 0.06).
Superiority is quite likely.
“The analysis consistently showed that rehabilitation interventions had a greater probability of being superior to usual care across all outcomes, with probabilities ranging between 85% and 99%,” the authors said.
Across all outcomes, the study consistently demonstrated that rehabilitation therapies had a higher likelihood of being superior to normal care.
It is worth noting that rehabilitation and exercise had the least influence on the most prevalent PCC symptom: weariness.
“We found limited evidence quantifying the association of rehabilitation interventions with fatigue during everyday activities,” the researchers said.