Review Article

Appropriate Timing and Type of Physical Training in Patients with COVID-19 for Muscle Health and Quality of Life: A Systematic Review

Table 2

Overview of eligible studies.

AuthorDesignSettingParticipantMean age (years)Intervention/Physical trainingOutcome

Zha et al. [13]Cohort studyMild COVID-1960 patients with mild COVID-1954 (38–62)MRE consist of four sets: overhead chest and shoulder stretch (1st set), standing heel raises and upper body acupressure (2nd set), upper body rotation (3rd set), and hand acupressure massage (4th set). The full course of MRE (6–8 repetitions) was done two times a day. Interventions were performed for one month.Prevalence rate of symptoms decreased from 41.7% to 11.7% in dry cough, 43.3% to 11.7% in productive cough, 35% to 8.3% in difficulty in expectoration, and 50% to 15% in patient-reported dyspnea.

Li et al. [14]Cohort studyICU16 patients with COVID-19 who admitted to ICUN/AAll 16 patients participated in a regimented sequence of mobility: 10 rolling over and moving on the bed regularly, sitting up in bed, sitting on the bedside, sitting on a chair, standing, and walking (along a 7-m walkway in the ICU) while in ICU.At discharge from the ICU, 61% and 31% of these patients had PEFR and MIP, respectively, below 80% of the predicted value and 46% had de morton mobility index values below the normative value.

Ozyemisci et al. [15]Cohort studyICU35 patients with ARDS secondary to COVID-19 (18 patients in the rehabilitation group and 17 patients in the nonrehabilitation group)Rehab 73 (64–78); nonrehab 70 (62–76) ()Early rehabilitation program consisting of passive or active ROM exercises and NEMS in addition to standard intensive care compared to standard intensive care. Intervention began ≥5 days of the ICU stay and ≥10 days after the onset of COVID-19 symptoms to patients.There was no difference in hand grip strength () following discharge between rehab and nonrehab groups. No adverse event was noted.

Abodonya et al. [16]Cohort studyICU42 recovered patients with COVID-19 (33 men and 9 women) who were weaned from MV (21 patients in IMT groups and 20 patients in the control group)IMT group 48.3 ± 8.5; control group 47.8 ± 9.2 ()After weaned from MV, each patient was instructed to perform incentive breathing exercise in a relaxed sitting position 2 times daily for 2 following weeks. Each session has consisted of 6 inspiratory cycles; each cycle has remained around 5 min of resisted inspiration, followed by 60-second rest time intending to improve inspiratory muscle strength. At the fifth and sixth cycle, each patient was instructed to breath regularly as much as possible in tending to improve inspiratory muscle fitness.2 weeks of IMT improves pulmonary functions (FVC; and FEV1; ), dyspnea (DSI; ), functional performance (6MWD; ), and QOL () compared to the control group.

Li et al. [17]RCTPost-COVID-19 hospital discharge120 COVID-19 survivors with remaining dyspnea complaints (59 patients in the TERECO group and 61 patients in the control group)Intervention 49.17 (10.75); control 52.03 (11.10)Unsupervised home-based 6-week exercise programme comprising breathing control and thoracic expansion, aerobic exercise and LMS exercise, delivered via smartphone, and remotely monitored with heart rate telemetry. Outcome was assessed post-treatment (6 weeks) and followed up again in after 28 weeks.Between-group difference in mean change of 6MWT was 65.45 m () at post-treatment and 68.62 m () at follow-up and squat time was 20.12 m () at post-treatment and 22.23 () at follow-up. Insignificant differences were noted from FEV1, FVC and FEV1/FVC ()
Increase in SF-12 physical component was greater in the TERECO group with treatment effects estimated as 3.79 () at post-treatment and 2.69 () at follow-up.

Nambi et al. [18]RCTPost COVID-1976 men in 60–80 years with post-COVID-19 and sarcopenia (38 men in the LAT group and 38 men in the HAT group)LAT 63.2 ± 3.1; HAT: 4.1 ± 3.2 ()All participants received resistance training for whatever time of the day that they received it, and that in addition they were randomized into two LAT (40–60% of maximum heart rate) and HAT (60–80% of maximum heart rate) groups for 30 minutes/session, 1 session/day, 4 days/week for 8 weeks.At the end of six-months follow-up, the handgrip strength (−3.9), kinesiophobia level (4.7), and QOL (−10.4) shows more improvement () in the LAT group than the HAT group.

ICU: intensive care unit; ARDS: acute respiratory distress syndrome; RCT: randomized controlled trial; NEMS: neuromuscular electrical stimulation; ROM: range of motion; N/A: not available; IMT: inspiratory muscle training; FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; DSI: dyspnea severity index; COVID-19: coronavirus disease-19; MV: mechanical ventilation; QOL: quality of life; MRE: modified rehabilitation exercise; 6MWD: 6-minute walking distance; LMS: lower limb muscle strength; TERECO: telerehabilitation programme in postdischarge patients with COVID-19; LAT: low-intensity aerobic training; HAT: high-intensity aerobic training.