Long COVID: la riabilitazione mirata è fondamentale

Some people suffer from certain long-term consequences after a corona disease, which fall under the term Long COVID. The most common symptoms include exhaustion, breathing difficulties, fatigue, shortness of breath, memory and concentration difficulties as well as a general decline in quality of life. After 12 weeks of symptoms, one speaks of the so-called post-COVID syndrome. Some patients, particularly those who were in the ICU, experienced symptoms associated with cases of PTSD (post-traumatic stress disorder).

Long COVID Can Severely Affect the Quality of Life

These findings show that the road to recovery can last for several months and that it is important that specialized rehabilitation is available to support patients. A research team – which involved multidisciplinary specialists from the University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds Community Healthcare NHS Trust and Leeds Beckett University – followed 100 people who recovered from COVID-19 four to eight weeks after they were released.

The patients were divided into two groups: those who had become seriously ill and required intensive care, and those who were treated on a ward without requiring intensive care. The patients were contacted by a member of the hospital’s rehabilitation team and asked a series of questions about their recovery and any remaining symptoms. More than 60 percent of the people treated on he ward reported fatigue, with a third of them describing it as moderate or severe. In patients who were in intensive care, 72 percent reported fatigue. The second most common symptom was shortness of breath. People in both groups reported experiencing a feeling of shortness of breath that had not existed before contracting COVID-19. This was higher in the group of the most ill, the intensive care group, than in those who had been treated on  a ward. The third most common symptoms were neuropsychological. The research survey found that nearly a quarter of those who were on the ward and just under half of those who were in the ICU had some of the symptoms of PTSD.

Special Rehabilitation Program for Long COVID Patients

A rehabilitation program that helps people with Long COVID reduce their symptoms and increase activity levels has shown impressive results. It is based on a gradual increase in a patient’s physical activity. Before beginning the program, program participants reported an average of three meltdowns per week where they were physically, emotionally, or cognitively exhausted after mild physical or mental exertion. Six weeks later, at the end of the program, this was reduced to an average of once a week. Patients also experienced a modest improvement in their ability to be active and a better quality of life.

The pacing program was conducted by the long-standing Leeds Community Healthcare NHS Trust COVID service and evaluated by clinicians and researchers from the University of Leeds and Leeds Beckett University. According to the researchers, the program, which involves a supervised increase in physical activity, has the potential to be an effective treatment option.

Return to Physical Activity Should be Gradual

The six-week study in Leeds enrolled 31 people with Long COVID. On average, they had COVID for about 17 months before participating in this program. They suffered from a range of symptoms, in addition to fatigue, including brain fog, shortness of breath, headaches and palpitations. Patients followed a step-by-step return-to-physical activity program called the World Health Organization (WHO) CR-10 Borg stimulation protocol, which takes them through five levels of activity. They practiced the program at home. The first phase is designed to prepare for a return to activity and includes breathing exercises and gentle stretches. The fifth phase includes activities that patients did before their illness, such as regular exercise.

During the program, patients received weekly calls from their treating physician to review their progress. They were instructed to stay at each level for at least seven days and not overexert themselves in order to keep their condition stable. Patients completed a questionnaire each week to assess their exercise levels before a decision was made on whether to proceed to the next stage of the pacing protocol.

Over the six weeks, there was not only a reduction in collapses, but also an improvement in activity levels and quality of life. In terms of relieving Long COVID symptoms, the greatest benefits were seen in reducing fatigue, shortness of breath and headaches.

However, the researchers note that physicians supporting Long COVID patients still lack an awareness that a gradual return to physical activity could aid recovery. This study contributes to the current understanding by highlighting the potential of a structured stimulation protocol to gradually improve activity levels.

Endurance and Strength Training to Overcome Long COVID

A randomized study with 80 adults who were in outpatient treatment with Long COVID wanted to find out how exercise activities, respiratory muscle training and the WHO self-management recommendations affect the symptoms and physical fitness of the patients. The subjects were divided into four intervention groups (sports group, breathing group, combination group and control). At the beginning of the investigation, there was no real difference between the groups. After eight weeks, however, the participants in the exercise and combination groups saw a significant improvement in muscle strength, in contrast to the control and breathing groups. They also experienced less shortness of breath and fatigue, and overall health was better. Depression also improved in the first two groups. The results of the study make it clear that endurance and strength training combined are more effective in overcoming Long COVID and enabling better well-being and a return to good physical fitness than just respiratory muscle training and self-management recommendations.

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