Six-month outcomes and effect of pulmonary rehabilitation among patients hospitalized with COVID-19: a retrospective cohort study

Yaoshan Dun, Chao Liu, Jeffrey W Ripley-Gonzalez, Ping Liu, Nanjiang Zhou, Xun Gong, Baiyang You, Yang Du, Jiyang Liu, Bo Li, Suixin Liu, Yaoshan Dun, Chao Liu, Jeffrey W Ripley-Gonzalez, Ping Liu, Nanjiang Zhou, Xun Gong, Baiyang You, Yang Du, Jiyang Liu, Bo Li, Suixin Liu

Abstract

Background: Patients appear to maintain sequelae post-coronavirus disease 2019 (COVID-19) affecting daily life and physical health. We investigated the changes in and the effects of pulmonary rehabilitation (PR) on exercise capacity and immunology six months after COVID-19 hospitalization.

Methods: This retrospective cohort reviewed 233 COVID-19 patients admitted from 17 January 2020 to 29 February 2020. Ninety-eight patients who completed 2-week and 6-month follow-ups and tests were included. Among 98 patients, 27 completed at least five sessions of PR at the First Hospital of Changsha, China, during the 6-month convalescence were allocated to the PR group; the reminder who had not performed any PR were assigned to the control group. The primary outcome was the change in six-minute walk distance (6-MWD) between the 2-week and 6-month follow-ups, which was assessed via analysis of covariance with a covariate of propensity score that adjusted for the potential confounders. Secondary outcomes were the changes in 6-MWD, SARS-CoV-2 immunoglobulins, T-lymphocytes and blood chemistry, which were evaluated via paired tests.

Results: Participants' ages ranged from 19 to 84 years (M = 47, standard deviation (SD)=15) 45.9% identified as male. During the 6-month convalescence, 6-MWD increased 27.0%, with a mean [95% CI] of 113 [92-134] m (p < .001). SARS-CoV-2 IgG and IgM decreased 33.3% (p = .002) and 43.8% (p = .009), CD4+ T cells increased 7.9% (p = .04), and the majority of blood chemistry significantly changed. The patients in the PR group acquired a greater increase in 6-MWD than those in control (unadjusted, 194 [167-221] m, p < .001; adjusted, 123 [68-181] m, p < .001), dose-responsiveness of PR on 6-MWD was observed (p < .001). No differences in immunity variables and blood chemistry were observed between groups.

Conclusions: These findings suggest PR may be a strategy to promote the improvement of exercise capacity after COVID-19.

Keywords: COVID-19; biomarker; exercise; immunity; rehabilitation; respiration.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Flowchart of participants. COVID-19: coronavirus disease 2019; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
(A) Clinical symptoms in the COVID-19 patients during hospitalization; (B) changes in exercise capacity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific immunoglobulins, T lymphocytes and biochemical and haematological biomarkers in the COVID-19 patients during the 6-month convalescence period. COVID-19: coronavirus disease-19; SD: standard deviation; 95% CI: 95% confidence interval; 6-MWD: six-minute walk distance; WBC: white blood cells; CD3+: mature human T lymphocytes; CD4+: helper/inducer T lymphocytes; CD8+: suppressor/cytotoxic T lymphocytes; WBC: white blood cell; Lymph.: lymphocytes; Neu.: neutrophils; Eos.: eosinophils; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen. *Any symptoms indicate if a patient has any of the following symptoms: fever, cough, fatigue, anorexia, sore throat, dyspnoea, myalgia, diarrhoea, headache and dizziness. †The value of relative change was calculated by the equation of (value of change/baseline value)×100. The absolute changes in variables during the 6-month convalescence period were assessed by paired t-test and Wilcoxon’s sign-rank test for normal and non-normal distribution variables, respectively.
Figure 3.
Figure 3.
The effect of pulmonary rehabilitation on exercise capacity in COVID-19 patients during the 6-month convalescence period in a dose-dependent way. The difference between changes in 6-minute walk distance (6-MWD) across groups was assessed by analysis of covariance (ANCOVA) with a covariate of propensity score that adjusted for sex, age, body weight, baseline 6-MWD, physical activity per week during the 6-month recovery period, and COVID-19 classification, comorbidity and the use of antibiotics during hospitalization. Post hoc analysis for each comparison was also performed. The mean difference and 95% confidence interval in the high-volume pulmonary rehabilitation group vs. control group are 165 (101–229) m; low-volume vs. control is 88 (22–154); high-volume vs. low-volume is 77 (34–120), p values for each assessment are marked on the figure accordingly (N = 98, control 71, low-volume PR 14, high-volume PR 13).

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Source: PubMed

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