Efecto de un programa de ejercicio multicomponente en la recuperación de la condición funcional, del estado de ánimo y de la calidad de vida en personas con condiciones post-COVID-19proyecto RECOVE

Abstract

Introduction - Approximately 10% of patients who have experienced acute COVID-19 will develop long-term persistent symptoms as a complication. This entity, termed post-COVID-19 condition is characterized by symptoms lasting at least 2 months that cannot be explained by an alternative diagnosis. The most common symptoms include fatigue, dyspnea and neurocognitive manifestations. Their importance lies not only in their frequency, but also in the fact that they generally have a severe impact on the functioning, limiting their ability to perform activities of daily living and return to work. Objectives - The main objective of the study is to evaluate the clinical efficacy and safety of a personalized and supervised treatment based on multicomponent physical exercise with or without inspiratory muscle training compared to the control group in improving the clinical condition, cardiopulmonary function and functional status of patients with post-COVID-19 conditions whose acute phase care was managed in the outpatient setting. Methodology - The RECOVE project is a randomized, four parallel-arm, randomized controlled trial comparing the efficacy of a personalized exercise program, based on multicomponent exercise training (CT) and/or inspiratory muscle training (CTRM and RM), with self-care recommendations issued by the WHO (World Health Organization) (CON), in the recovery of persistent symptoms and functional limitations of people with post-COVID-19 conditions. Results - The symptomatic evolution of the patients after 8 weeks of follow-up showed that the total number of persistent symptoms decreased significantly in the whole sample, as well as the percentage of patients who considered that their symptoms persisted in moderate or severe intensities (p<0.001). While no significant differences in VO2max estimates were detected between interventions, there were significant individual improvements in both the CT group (∆7.5 %; ES=0.38) and the CTRM group (∆ = 7.8%; ES = 0.28). The same was true for lower extremity muscle strength, which only improved significantly in the CT and CTRM groups (∆ = 14.5% - 32.6%; ES = 0.27 - 1.13) compared with the RM and CON groups (∆ = -0.3 % - 11.3 %; ES = 0.19 - 0.00). Respiratory muscle training did not provide added benefits over CON or over CT alone. Only the CT and CTMR groups improved significantly on the dyspnea (mMRC) and fatigue (CFS-Linkert and FSS) scales, as did the perception of the quality of their physical and mental health status (SF-12). In addition, when the interventions were compared with each other, the intensity of fatigue (FSS and CFS-Linkert) and depression (PHQ-9) were significantly lower in the CT and CTRM groups compared with the RM and CON groups. There were no adverse events resulting from physical exercise in any group. Conclusions - Eight weeks of concurrent training, with or without inspiratory muscle training, was superior to the recommendations for self-care and symptom management developed by WHO or inspiratory muscle training alone in post-COVID-19 condition recovery. A supervised program individually tailored to the patient with post-COVID-19 conditions allowed to improve cardiopulmonary fitness (VO2max), lower limb strength, but also symptom severity, and this was achieved in a safe and efficient manner.