Physical exercise as a treatment for persisting symptoms post-COVID infection: review of ongoing studies and prospective randomized controlled training study

Background and purpose No evidence-based treatment is available for patients with persisting symptoms post-COVID-19 infection. We hypothesized that physical exercise may represent a safe and effective treatment option for post-COVID. Methods We performed a systematic search of the literature that revealed a lack of randomized training studies in patients post-COVID. Based on these findings, a prospective randomized controlled study with open- label and blinded endpoint evaluation was designed. 272 patients with symptoms of fatigue persisting over 6 weeks post- COVID infection were screened. Patients with pathological cardiovascular findings were excluded. 57 patients consented and were randomized to 4 weeks of supervised personalized strength and endurance training or usual care. The follow-up period was 3 and 6 months. Results There were no adverse events related to the training. Spiroergometry of the training group showed a significantly higher increase in VO2peak (10.0 +/- 12.7% vs. 0.1 +/- 8.9%, p < 0.01, respectively) and oxygen pulse (9.8 +/- 10.8% vs. 0.0 +/- 13.9%, p < 0.05, respectively). Parameters of the Multidimensional Fatigue Inventory-20, McGill Quality of Life Questionnaire, and Post- COVID-19 Functional Status were improved after 4 weeks in both groups. In the follow-up period, the total physical activity per week was significantly greater in the exercise group than in controls (1280 +/- 1192 min vs. 644 +/- 554 min, p < 0.05, respectively). The improvements in fatigue and quality of life were not statistically different between the training and usual care groups. Conclusion Exercise is safe and improves maximal exercise capacity in post-COVID patients. Fatigue and quality of life improve over time in individuals that are willing to participate in a training study irrespective of their allocation. [GRAPHICS] .

Automated summary

This study found that physical exercise after COVID-19 infection can safely and effectively improve maximal exercise capacity and quality of life in patients. Fatigue decreases over time. Additionally, individuals who participated in the exercise program had significantly higher levels of physical activity during the follow-up period compared to those in the control group.