The impact of post-COVID multicomponent rehabilitation

Abstract Introduction Post-COVID-19 syndrome is characterized by chronic fatigue and myalgia, among other symptoms, which can limit activities of daily living. Physical therapy protocols with multicomponent exercises combine strength, resistance, balance and gait, producing sig-nificant improvements in functional mobility. Objective Evaluate whether multicomponent rehabilitation is effective in improving functional mobility and quality of life in individuals with post-COVID-19 syndrome. Methods Randomized controlled trial with 59 volunteers, divided into an intervention (IG) and control group (CG), all of whom underwent initial assessment (T0). The IG performed 24 sessions over 12 weeks and the CG did not undergo training. Functional mobility was analyzed using the 6-minute walk test (6MWT) and the Berg balance scale, while the SF-36 questionnaire assessed quality of life. Results In the 6MWT, the IG covered 464.40 + 81.26 meters (T0) and 518.60 + 82.68 meters (T4). The IG Berg scale scores were 48.00 + 4.00 (T0) and 51.90 + 4.26 (T4). In terms of quality of life, the IG obtained mean scores of 96.26 + 10.14 (T0) and 102.60 + 5.53 (T4). None of these measures was statistically significant. Conclusion Individuals who underwent the multicomponent phys-iotherapy protocol showed statistically nonsignificant increases in the variables studied.


Data analysis
The categorical variables were expressed as absolute and relative frequency, and their continuous counterparts

Results
Fifty-nine individuals with post-COVID-19 syndrome were selected, according to the eligibility criteria, in line with the study design and participant allocation, as illustrated in Figure 2.  Participants were aged between 18 and 70 years (52.32 + 11.87), with an average body mass index (BMI) of 28.98 + 7.86 and 34 (57.6%) were women (Table 1).
Of the 59 participants, 36 (61.02%) recovered at home      With respect to quality of life, the IG obtained an increase in the average score from 96.3 (initial assessment) to 102.6 (final reassessment), although not was applied, encompassing twice-weekly 60-minute multicomponent exercises, for 12 weeks (Figure 1): (I) Warm-up (10 minutes): joint mobility, global stretching, breathing techniques such as pursed lips breathing, body positions and diaphragmatic breathing; (II) Resistance (20 minutes): walking; (III) Strength (15 minutes): 7 exercises with 2 sets of 10 repetitions for upper and lower limb muscle groups, using elastic bands, free weights and ankle weights, with weight progressively increased according to the participant's ability; (IV) Balance (5 minutes): postures with a gradual decrease in the support base, dynamic movements that disturb the post-stress center of gravity of muscle groups, dynamic movements when performing secondary tasks individually; as mean and standard deviation.The Kolmogorov-Smirnov test was used to determine quantitative data normality and the chi-squared test to compare groups for sociodemographic, anthropometric and comorbidity characterization.Intention-to-treat analysis was applied to compare the 6MWT, Berg balance scale and SF-36, considering all the participants and groups until the end, regardless of their results.18The means were compared before the intervention and one-way ANOVA was conducted to confirm initial homogeneity for the three groups.Statistical analysis was performed using the Statistical Package for the Social Sciences, version 20.0 for Windows (SPSS Inc, Chicago IL, USA), considering a significance level of p < 0.05 for all the analyses.

Figure 2 -
Figure 2 -Study design and participant allocation according to CONSORT guidelines.19

Ferioli
et al. 23 showed that the 6MWT is useful in post-COVID follow-up, correlating with the severity of the acute phase and with functional/radiological impairment in the chronic phase, and making it possible to assess improvements in exercise capacity.This corroborates IG performance in the present study, since the 6MWT revealed an increase in the average distance covered from 464.4 (initial assessment) to 518.6 meters (final reassessment).Eksombatchai et al.21 studied COVID-19 groups with mild symptoms and walking pneumonia and found a decline from 538 ± 56.8 to 527.5 ± 53.5 meters, corroborating the results obtained by the CG of the present study, with an average decrease in distance covered between initial assessment and final reassessment from 441.2 to 433.9 meters.This study observed that after a 12-week intervention, the average Berg scale score between initial assessment and final reassessment increased from 48 to 51.9, albeit not statistically significant (p ≥ 0.05).Miyamoto et al. 15 infer that the score for a high risk of falling would be less than 45.Giardini e et al. 24 found a decline in dynamic balance and rise in oscillation during static posture in severely affected patients in the acute phase of COVID-19.However, hospitalization may result in balance problems and muscle weakness that are not necessarily related to COVID-19.

Table 2 -
Inter and intragroup comparison after 12 weeks