CARDIO-PULMONARY REHABILITATION IN MODERATE TO SEVERE COVID 19 PATIENTS COMPARED TO CARDIAC ISCHEMIC PATIENTS

K. Forton¹, C. Douin², M. Lamotte¹, A. Gillet¹, P. Van De Borne¹

¹Erasmus Hospital, Brussels, Belgium, ²Montlégia Hospital, Liège, Belgium

Background: Pulmonary rehabilitation (PR) for COVID-19 patients has recently been recommended by expert 6 to 8 weeks after discharge (Spruit and coll. ERJ, 2020). However, the literature is relatively poor on this subject, and only few studies have described the benefits.

Purpose: Our aim was to evaluate the benefits of cardio-pulmonary rehabilitation on severe to moderate COVID-19 patients (who require a hospitalization with oxygen therapy for minimum one week or intensive care) and compare their results to cardiac patients.

Methods: 25 COVID-19 patients (16 males and 9 females, 61 ± 8 years old) were matched by sex, age, height and weight with 25 cardiac ischemic patients and underwent a cardio-pulmonary exercise testing (CPET) on bike at the beginning of their rehabilitation program (1 month after discharge) and after 23 ± 5 rehabilitation sessions. The PR program combined high intensity interval training (HIIT) exercises on a bike and resistance exercises for major lower limb muscle groups. Ventilation (VE), carbon dioxide production (VCO2) and oxygen consumption (VO2) were measured at each step of the CPET as well as heart rate (HR) and arterial saturation (SpO2).

Results: At the beginning of their rehabilitation, COVID-19 patients presented a reduced physical capacity with a VO2 max and maximal workload at respectively 71% and 70% of predicted value and an exercise hyperventilation measured by a higher VE/VCO2 slope (37 ± 6). No differences were found with cardiac population. COVID 19 patients presented a relatively high respiratory exchange ratio (RER) and a preserved ventilatory reserve. Exercise was mainly limited by peripheral muscle deconditioning. After rehabilitation, the VO2 max and maximal workload increased significantly in COVID 19 group respectively by 22% and 22%, and by 19% and 21% in cardiac patients, with no statistical difference between group. Moreover, exercise hyperventilation (VE/VCO2 slope) decreased by 10% (3 points) in both groups.

Conclusions: Severe to moderate COVID 19 patients are deconditioned at 1 month after discharge but have the same revalidation potential as the cardiac patients, more described in the literature. Future study is needed to compare our results with COVID19 patients who did not undertake a revalidation to evaluate spontaneous recovery.

Implications: Even if cardio-pulmonary rehabilitation is probably not the only parameter which explains the partial recovery of moderate to severe COVID-19 patients, it certainly helps to improve their physical capacity and reduce exercise hyperventilation. Physiotherapists have to promote pulmonary rehabilitation after moderate to severe COVID 19.

Funding acknowledgements: Unfunded

Keywords:
High intensity interval training (HIIT)
Rehabilitation

Topics:
COVID-19
Cardiorespiratory

Did this work require ethics approval? Yes

Institution: Erasmus Hospital

Committee: Erasme Ethical Committee

Ethics number: B4062020000188