Effects of physical training on the quality of life of patients with post-COVID-19 condition

Barbosa de Lira, Andreane Daniele; Tulio, Alexandra Ignes Bruni; Bobato, Heloísa Rodrigues Alves; Gomes, Regina Helena Senff; Motter, Arlete Ana

doi:10.1590/fm.2025.38115

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Original Article • Fisioter. Mov. 38 • 2025 • https://doi.org/10.1590/fm.2025.38115 linkcopy

Effects of physical training on the quality of life of patients with post-COVID-19 condition

Efeitos do treinamento físico na qualidade de vida de pacientes com síndrome pós-COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Post-COVID-19 condition has a significant impact on the quality of life (QOL) of the affected individuals.

Objective: To describe the effects of a pulmonary rehabilitation (PR) program on the health-related quality of life (HRQOL) of patients with post-COVID-19 condition and understand the aspects relevant to their quality of life.

Methods: This is a quasi-experimental study, using an interrupted time series design, involving adult men and women with a history of hospitalization due to SARS-CoV-2 and post-COVID-19 condition who were referred for PR between February 2021 and December 2022. Participants were assessed pre- and post-PR for clinical information, quality of life (using the Nottingham Health Profile - NHP), overall peripheral muscle strength (dynamometry), and dyspnea during activities of daily living ADLs) (mMRC scale).

Results: Thirty-nine individuals participated in the study, 22 (56.4%) of whom were women, with a mean age of 55.8 (± 9.98) years. The most common persistent symptoms were fatigue (64.1%), dyspnea (59%), memory impairment (30.8%), and pain (28.2%). Of the six NHP domains, five showed significant improvement after the intervention. The median total NHP score decreased from 11 points pre-PR to 6 points post-PR (p < 0.001). Dynamometry and mMRC scores also exhibited statistically significant improvements after PR.

Conclusion: Individuals with post-COVID-19 condition experience important impairments in HRQOL, across physical, emotional, social, and sleep-related domains. Pulmonary rehabilitation, through physical training, produced positive effects by improving QOL, increasing overall peripheral muscle strength, and reducing dyspnea during ADLs.

Keywords:
Physiotherapy; COVID-19; SARS-CoV-2; Long COVID; Rehabilitation

Protocol	Exercises	Time (minutes)
Warmup	Active upper limb exercises, static gait	5
Aerobic training	Treadmill or stationary bicycleat 80% of incremental test load	30
Muscle strengthening	Upper and lower limbs,3 sets of 8 to 12 repetitions	5
Functional training	Balance and gait training, functional exercises	5
Muscle stretching	Global	8
Breathing exercises	Ventilatory patterns, broncheal hygiene (if needed)	5
Guidance	Educational guidance on the diseases, preventive easures and at-home exercises	2
Oxygen supplementation	If peripheral oxygen saturation (SpO₂) < 88%, follow the same incremental test parameters	Time required to adapt SpO₂

Overall Data	n (%)
Women	22 (56.4)
Men	17 (43.6)
Age (years)*	55.80 ± 9.98
Body mass index*	32.00 ± 4.52
Days hospitalized*	25.50 ± 15.90
Days in the intensive care unit*	14.50 ± 16.20
Days on invasive mechanical ventilation*	9.59 ± 12.10
Comorbidities
Obesity	27 (69.2)
Hypertension	22 (56.4)
Dyslipidemia	9 (23.1)
Diabetes	8 (20.5)
Hypothyroidism	7 (17.9)
Complaints
Fatigue	25 (64.1)
Dyspnea	23 (59.0)
Memory impairment	12 (30.8)
Pain	11 (28.2)
Others	17 (43.6)

Variables	Pre-PRP	Post-PRP	p-value*
Quality of life
Energy level domain	1 [0.0 – 1.0]	0 [0.0 – 1.0]	0.001
Pain domain	2 [1.0 – 5.0]	1 [0.0 – 3.0]	0.014
Emotional reaction domain	4 [0.0 – 4.0]	1 [0.0 – 2.0]	< 0.001
Sleep domain	1 [0.5 – 3.5]	1 [0.0 – 2.0]	0.001
Social interaction domain	0 [0.0 – 2.0]	0 [0.0 – 1.0]	0.086
Physical skills domain	3 [2.0 – 4.0]	1 [0.0 – 2.0]	< 0.001
Total NHP score	11 [7.0 – 16.5]	6 [3.0 – 11.0]	< 0.001
Overall peripheral muscle strength
Dynamometry	28 [22.0 – 32.0]	30 [24.0 – 35.0]	< 0.001
Dyspnea during ADLs
mMRC	2 [1.0 – 3.0]	1 [0.0 – 1.0]	< 0.001

Variables	Estimate (β)	SE	CI (95%)	df	t	p-value
Intercept	10.05	0.89	8.29/11.81	30	11.19	< 0.010
Group 1 (NHP post-PR/pre-PR)	-4.94	0.82	-6.57/-3.32	37	-5.96	< 0.001
Sex (Male/Female)	-2.52	2.41	-7.26/2.22	30	-1.04	0.306
Age	-0.25	0.10	-0.44/-0.05	30	-2.48	0.019
IMV duration (days)	-8.68	0.06	-0.13/0.13	30	-0.01	0.990
Obesity (Yes/No)	-3.32	2.15	-7.54/0.88	30	-1.54	0.132
mMRC pre-PR	0.87	1.19	-1.46/3.21	30	0.73	0.467
mMRC post-PR	1.37	1.34	-1.26/4.01	30	1.01	0.316
Dynamometry pre-PR	-0.21	0.32	-0.86/0.42	30	-0.66	0.510
Dynamometry post-PR	0.05	0.33	-0.60/0.71	30	0.16	0,872
Group 1 (NHP post-PR/pre-PR) *Age	0.18	0.08	0.02/0.35	37	2.25	0.030

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[1] Note:

[TFN2] ^*
Data shown as mean and standard deviation.