Background: COVID-19 survivors face the risk of long-term sequelae including fatigue, breathlessness, and functional limitations. Pulmonary rehabilitation has been recommended, although formal... Show moreBackground: COVID-19 survivors face the risk of long-term sequelae including fatigue, breathlessness, and functional limitations. Pulmonary rehabilitation has been recommended, although formal studies quantifying the effect of rehabilitation in COVID-19 patients are lacking. Methods: We conducted a prospective observational cohort study including consecutive patients admitted to an outpatient pulmonary rehabilitation center due to persistent symptoms after COVID-19. The primary endpoint was change in 6-min walk distance (6MWD) after undergoing a 6-week interdisciplinary individualized pulmonary rehabilitation program. Secondary endpoints included change in the post-COVID-19 functional status (PCFS) scale, Borg dyspnea scale, Fatigue Assessment Scale, and quality of life. Further, changes in pulmonary function tests were explored. Results: Of 64 patients undergoing rehabilitation, 58 patients (mean age 47 years, 43% women, 38% severe/critical COVID-19) were included in the per-protocol-analysis. At baseline (i.e., in mean 4.4 months after infection onset), mean 6MWD was 584.1 m (+/- 95.0), and functional impairment was graded in median at 2 (IQR, 2-3) on the PCFS. On average, patients improved their 6MWD by 62.9 m (+/- 48.2, p < 0.001) and reported an improvement of 1 grade on the PCFS scale. Accordingly, we observed significant improvements across secondary endpoints including presence of dyspnea (p < 0.001), fatigue (p < 0.001), and quality of life (p < 0.001). Also, pulmonary function parameters (forced expiratory volume in 1 s, lung diffusion capacity, inspiratory muscle pressure) significantly increased during rehabilitation. Conclusion: In patients with long COVID, exercise capacity, functional status, dyspnea, fatigue, and quality of life improved after 6 weeks of personalized interdisciplinary pulmonary rehabilitation. Future studies are needed to establish the optimal protocol, duration, and long-term benefits as well as cost-effectiveness of rehabilitation. Show less
Gademan, M.G.J.; Exel, H.J. van; Vooren, H. van de; Haest, J.C.W.; Pelt, J. van; Laarse, A. van der; ... ; Swenne, C.A. 2013
In CHF patients exercise capacity is decreased (low physical fitness). The degree of exercise intolerance in CHF is paralleled by an increased mortality, moreover, several studies suggest that... Show moreIn CHF patients exercise capacity is decreased (low physical fitness). The degree of exercise intolerance in CHF is paralleled by an increased mortality, moreover, several studies suggest that increasing exercise capacity in CHF improves prognosis. Therefore, improving exercise capacity is one of the major issues in CHF-related treatment. Besides this decreased exercise capacity CHF patients also have a low autonomic fitness (high neurohumoral activation and a low baroreflex sensitivity (BRS)), which causes structural end-organ damage and increases mortality. The current therapeutic regimen in CHF mainly focuses on the blocking of the neurohumoral activation but not on the removing of neurohumoral activation. In this thesis we have studied the effects of exercise and cardiac resynchronization therapy (CRT) on both physical and autonomic fitness in CHF patients. We found that exercise improves both physical and autonomic fitness. Also, we showed that is possible to increase BRS without actual exercise, by mimicking exercise associated nerve traffic by means of TENS (transcutaneous electrical nerve stimulation). Furthermore, we found that CRT acutely improves BRS, and this improvement had predictive value for the anatomical response after six months of CRT. In conclusion, both exercise and CRT are capable to improve the fitness of CHF patients Show less
