Medical Rehabilitation of Patients with Post-COVID-19 Syndrome-A Comparison of Aerobic Interval and Continuous Training

Johanna M Mooren; René Garbsch; Hendrik Schäfer; Mona Kotewitsch; Melina Waranski; Marc Teschler; Boris Schmitz; Frank C Mooren

doi:10.3390/jcm12216739

Medical Rehabilitation of Patients with Post-COVID-19 Syndrome-A Comparison of Aerobic Interval and Continuous Training

J Clin Med. 2023 Oct 25;12(21):6739. doi: 10.3390/jcm12216739.

Authors

Johanna M Mooren^{1

2}, René Garbsch^{1

2}, Hendrik Schäfer^{1

2}, Mona Kotewitsch^{1

2}, Melina Waranski^{1

2}, Marc Teschler^{1

2}, Boris Schmitz^{1

2}, Frank C Mooren^{1

2}

Affiliations

¹ Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany.
² DRV Clinic Königsfeld, Center for Medical Rehabilitation, 58256 Ennepetal, Germany.

Abstract

Introduction: Post-COVID-19 syndrome (PCS) is a multisystemic disorder marked by impaired physical performance as one lead symptom. Since it has been suggested that endurance training as part of medical rehabilitation may be effective in improving physical performance capacity in PCS, this study aimed to compare different modes of aerobic endurance training.

Methods: A total of 110 PCS patients (49.3 ± 11.8 years; 38% women; time after infection = 260.2 ± 127.5 days) underwent detailed clinical screening including symptom-limited cardiopulmonary exercise testing at admission and after 4-6 weeks of inpatient medical rehabilitation. Questionnaires were used to assess disease perception. Patients performed controlled isocaloric cycle ergometer training (3-5 sessions/week; 18 min) as either continuous training (CT) at 50% of maximal workload or as interval training (IT; load = 60%, relief = 30%). Outcomes of PCS patients were compared to coronary artery disease patients (CAD; n = 96) to evaluate overall training effectiveness.

Results: Training participation was comparable between the groups, with no indication of training-specific exercise-induced fatigue. Overall, PCS patients improved significantly by a mean of 6.8 ± 12.1% for W at VT1; 3.1 ± 10.0% for VO₂ at VT1; 5.5 ± 14.7% for O₂ pulse at VT1; 7.5 ± 15.0% for W at VO_2peak; 2.7 ± 11.0% for VO_2peak and 4.6 ± 12.4% for O₂ pulse at VO_2peak (all p < 0.05) with no significant differences between groups (p > 0.05). Both groups showed reduced levels of fatigue, anxiety, and depression as well as improved quality of life and wellbeing (all p < 0.05). Compared to guideline-based cardiac rehabilitation, PCS patients showed a similar improvement in workload and oxygen uptake compared to CAD patients.

Conclusion: PCS patients benefit from aerobic endurance training performed as moderate continuous or interval training as part of a medical rehabilitation program in terms of improved physical exercise capacity and disease perception. The results for PCS patients are comparable to the guideline-based rehabilitation of CAD patients.

Keywords: SARS-CoV-2; aerobic endurance training; fatigue; long COVID; severe acute respiratory syndrome.

Grants and funding

F.C.M. and B.S. are supported by the European Commission within the Horizon 2020 framework program (grant number: 101017424).