ORIJINAL ARAŞTIRMA
Postakut COVID-19 Semptomlarında Kardiyopulmoner Rehabilitasyon ve Ev Temelli Egzersiz Programının Karşılaştırılması
Cardiopulmonary Rehabilitation Versus Home-Based Exercise Program for Post-Acute COVID-19 Symptoms
Received Date : 01 Sep 2023
Accepted Date : 18 Mar 2024
Available Online : 21 Mar 2024
Fulya BAKILANa, İsmail Güneş GÖKMENb, Burcu ORTANCAa, Anıl UÇANc, Emine EYİGÜNd, Fezan MUTLUe, Hatice Merve GÖKMENb, Ayşe EKİMb
aEskişehir Osmangazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Eskişehir, Türkiye
bEskişehir City Hospital, Clinic of Physical Medicine and Rehabilitation, Eskişehir, Türkiye
cEskişehir City Hospital, Clinic of Internal Medicine, Eskişehir, Türkiye
dEskişehir City Hospital, Unit of Nursing, Eskişehir, Türkiye
eEskişehir Osmangazi University Faculty of Medicine, Department of Biostatistics, Eskişehir, Türkiye
Doi: 10.31609/jpmrs.2023-99394 - Makale Dili: EN
Turkiye Klinikleri Journal of Physical Medicine and Rehabilitation Sciences. 2024;27(2):105-13
ÖZET
Amaç: Dispne ve nefes darlığı gibi post-akut koronavirüs hastalığı-
2019 [coronavirus disease-2019 (COVID-19)] semptomlarında, kardiyopulmoner
rehabilitasyon (KPR) ihtiyacı bilinmektedir. Ancak rehabilitasyon
ünitelerinin kapasiteleri tüm post-akut COVID-19 hastalarını üstlenmeye yetmemektedir
ayrıca bu da ekonomi üzerinde büyük bir yüktür. Bu çalışmanın
amacı, KPR ve ev egzersiz programının, post-akut COVID-19 hastalarında
egzersiz dayanıklılığı ve yaşam kalitesi üzerine etkileri kıyaslamaktır. Gereç
ve Yöntemler: Bu retrospektif çalışma, hastanede (n=45) KPR uygulanan
ve ev egzersiz programı verilen (n=43) toplam 88 post-akut COVID-19 hastanın
dosya kayıtları ile yürütülmüştür. Her iki program da aerobik, solunum
ve fleksibilite egzersizlerini içeriyordu (KPR: haftada 3 veya 4 gün, toplam
20 seans, ev egzersiz programı: haftada 3 veya 4 gün, 6 hafta boyunca). Egzersiz
dayanıklılığı ölçümü için primer veri olarak 6 dakika yürüme testi
(6DYT) kullanıldı. Sekonder veri olarak Borg-dispne/yorgunluk, ağrı için
görsel analog skala [visual analogue scale (VAS)] ve Kısa Form-36 (KF-36)
kullanıldı. Tüm tedavi öncesi ve sonrası primer ve sekonder veriler kayıt altına
alındı. Bulgular: KPR grubunda, ev egzersiz programı grubuna göre
Borg-dispne (p=0,004), yorgunluk (p=0,001), VAS-ağrı (p=0,034), KF-36:
fiziksel fonksiyon (p=0,023), fiziksel rol (p=0,049), emosyonel rol (p=0,038),
beden ağrısı (p=0,021), enerji (p=0,001) değerlerindeki gelişmeler daha fazla
idi. Ancak 6DYT değerindeki gelişmeler her iki grupta benzerdi (p=0,266).
Sonuç: KPR ve ev egzersiz programlarının egzersiz enduransı üzerine benzer
etkileri göz önüne alındığında, hem güvenli hem de uygun maliyetli olan
ev egzersiz programlarının, hastane temelli KPR programlarına alternatif olabileceği
kanısındayız.
Anahtar Kelimeler: COVID-19; dispne; rehabilitasyon; yaşam kalitesi
ABSTRACT
Objective: The need for cardiopulmonary rehabilitation
(CPR) for post-acute coronavirus disease-2019 (COVID-19) symptoms such
as dyspnea and fatigue is known. However, rehabilitation units cannot handle
all post-acute COVID-19 patients also this would be a huge economic
burden. This study aimed to compare the effect of CPR and home-based exercise
programs on exercise endurance and quality of life in post-acute
COVID-19 patients. Material and Methods: This retrospective study was
conducted with the records of 88 post-acute COVID-19 patients who received
CPR (n=45) or home exercise programs (n=43). Both programs included
aerobic, breathing, and flexibility exercises (CPR: three or four days
per week for a total of 20 sessions, home exercise program: three or four
days per week over a period of six weeks). The results of the six-minute
walk test (6MWT) were used for exercise endurance as a primary outcome
measure. Borg-dyspnea/fatigue, the visual analog scale (VAS) for pain, and
the Short Form-36 (SF-36) were used as secondary outcome measures. All
before and after primary and secondary outcome measurements were
recorded. Results: Borg-dyspnea (p=0.004), fatigue (p=0.001), VAS-pain
(p=0.034), SF-36: physical function (p=0.023), physical role (p=0.049),
emotional role (p=0.038), bodily pain (p=0.021) energy (p=0.001) showed
more improvement in CPR group than home exercise program group. However,
improvements in the 6MWT were similar in both groups(p=0.266).
Conclusion: Considering that both CPR and home-based exercise programs
showed similar effects on exercise endurance, we believe home exercise
programs which are also safe and cost-effective could be an alternative to
CPR programs.
Keywords: COVID-19; dyspnea; rehabilitation; quality of life
REFERENCES
- Pavli A, Theodoridou M, Maltezou HC. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res. 2021;52:575-81. [Crossref] [PubMed] [PMC]
- Ceravolo MG, de Sire A, Andrenelli E, et al. Systematic rapid "living" review on rehabilitation needs due to COVID-19: update to March 31st, 2020. Eur J Phys Rehabil Med. 2020;56:347-53. Update in: Eur J Phys Rehabil Med. 2020;56:354-60. Update in: Eur J Phys Rehabil Med. 2020;56:508-14. [Crossref] [PubMed]
- Liu K, Zhang W, Yang Y, et al. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract. 2020;39:101166. [Crossref] [PubMed] [PMC]
- Hermann M, Pekacka-Egli AM, Witassek F, et al. Feasibility and efficacy of cardiopulmonary rehabilitation after COVID-19. Am J Phys Med Rehabil. 2020;99:865-9. [Crossref] [PubMed] [PMC]
- Gloeckl R, Leitl D, Jarosch I, et al. Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study. ERJ Open Res. 2021;7:00108-2021. [Crossref] [PubMed] [PMC]
- Udina C, Ars J, Morandi A, et al. Rehabilitation in adult post-COVID-19 patients in post-acute care with Therapeutic Exercise. J Frailty Aging. 2021;10:297-300. [Crossref] [PubMed] [PMC]
- Betschart M, Rezek S, Unger I, et al. Feasibility of an outpatient training program after COVID-19. Int J Environ Res Public Health. 2021;18:3978. [Crossref] [PubMed] [PMC]
- Marchionni N, Fattirolli F, Fumagalli S, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation. 2003;107:2201-6. [Crossref] [PubMed]
- Szarvas Z, Fekete M, Horvath R, et al. Cardiopulmonary rehabilitation programme improves physical health and quality of life in post-COVID syndrome. Ann Palliat Med. 2023;12:548-60. [Crossref] [PubMed]
- Barbara C, Clavario P, De Marzo V, et al. Effects of exercise rehabilitation in patients with long coronavirus disease 2019. Eur J Prev Cardiol. 2022;29:e258-e60. [Crossref] [PubMed] [PMC]
- Al Chikhanie Y, Veale D, Schoeffler M, et al. Effectiveness of pulmonary rehabilitation in COVID-19 respiratory failure patients post-ICU. Respir Physiol Neurobiol. 2021;287:103639. [Crossref] [PubMed] [PMC]
- Spielmanns M, Pekacka-Egli AM, Schoendorf S, et al. Effects of a comprehensive pulmonary rehabilitation in severe post-COVID-19 patients. Int J Environ Res Public Health. 2021;18:2695. [Crossref] [PubMed] [PMC]
- Blair J, Corrigall H, Angus NJ, et al. Home versus hospital-based cardiac rehabilitation: a systematic review. Rural Remote Health. 2011;11:1532. [Crossref] [PubMed]
- Besnier F, Gayda M, Nigam A, et al. Cardiac rehabilitation during quarantine in COVID-19 pandemic: challenges for center-based programs. Arch Phys Med Rehabil. 2020;101:1835-8. [Crossref] [PubMed] [PMC]
- Prokop M, van Everdingen W, van Rees Vellinga T, et al; COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296:E97-E104. [Crossref] [PubMed] [PMC]
- ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-7. Erratum in: Am J Respir Crit Care Med. 2016;193:1185. [Crossref] [PubMed]
- Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377-81. [Crossref] [PubMed]
- Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med. 2001;38:633-8. [Crossref] [PubMed]
- Kocyigit H, Aydemir O, Fisek G, et al. [Validity and reliability of Turkish version of short form 36: a study of patients with rheumatoid disorder]. J Drug Ther. 1999;12:102-6. [Link]
- Deschenes M, Garber CE. Chapter 7. General Principles of Exercise Prescription. In: Pescatello LS, Riebe D, Thompson PD. (Eds.). ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins; 2014. p:173.
- Kurtaiş Aytür Y, Füsun Köseoglu B, Özyemişci Taşkıran Ö, et al. Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation. Turk J Phys Med Rehabil. 2021;67:129-45. [Crossref] [PubMed] [PMC]
- Zampogna E, Paneroni M, Belli S, et al. Pulmonary rehabilitation in patients recovering from COVID-19. Respiration. 2021;100:416-22. [Crossref] [PubMed] [PMC]
- Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220-32. [PubMed] [PMC]
- Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, et al. Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review. Int J Clin Pract. 2021;75:e14357. [Crossref] [PubMed] [PMC]
- Reina-Gutiérrez S, Torres-Costoso A, Martínez-Vizcaíno V, et al. Effectiveness of pulmonary rehabilitation in interstitial lung disease, including coronavirus diseases: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2021;102:1989-97.e3. [Crossref] [PubMed] [PMC]
- Ouellet P, Lafrance S, Pizzi A, et al. Region-specific exercises vs general exercises in the management of spinal and peripheral musculoskeletal disorders: a systematic review with meta-analyses of randomized controlled trials. Arch Phys Med Rehabil. 2021;102:2201-18. [Crossref] [PubMed]
- Dalbosco-Salas M, Torres-Castro R, Rojas Leyton A, et al. Effectiveness of a primary care telerehabilitation program for post-COVID-19 patients: a feasibility study. J Clin Med. 2021;10:4428. [Crossref] [PubMed] [PMC]