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NASHVILLE, Tenn. -- In patients with significant respiratory disability following hospitalizations for COVID, 8 weeks of daily, supervised pulmonary rehabilitation was associated with significant improvement in exercise tolerance and quality of life in a single-center, retrospective study from India.

The analysis of outcomes among 57 hospitalized patients -- including 10 who needed non-invasive ventilation and 32 requiring mechanical ventilation -- showed significant pre- and post-rehabilitation improvements in exercise ability.

Findings from the study were presented by Pavanjitsingh Dumra, MBBS, of Sparsh Chest Diseases Centre in Ahmedabad, India, during an oral poster session at , the annual meeting of the American College of Chest Physicians.

"These were mostly very sick patients, with some barely able to speak or exercise at all at the beginning of the rehab," Dumra told MedPage Today. "By the end of the 8 weeks, even patients who we thought might not benefit much were doing a lot better."

Dumra said he believes the strategy of targeting the large muscle groups, especially lower limb muscles, contributed to the success of the program.

The 8-week daily therapy comprised breathing strategies, strength training for upper and lower limb muscle groups, endurance training, balance, and coordination training.

Improvement was measured using the validated exercise capacity measures of 30-second sit to stand test (STST), 30-second wall push-up test, (SGRQ), and the .

Roughly two-thirds (68%) of the patients were male, and the average patient age was 65 to 70 years (range 25 to 82).

More than 40% of patients had multiple comorbidities, and 25% had a single comorbidity. Roughly half (48%) of patients had diabetes, 30% had hypertension, and around 17% had chronic lung disease.

Their median hospital stay for COVID-19 was 14 days. Maximum oxygen requirement during their hospital stay was 0-5 L/min for 21, while nine patients needed 6-10 L/min, and 27 required 11-15 L/min.

Twenty-eight patients were discharged with a prescription for home oxygen.

Dumra reported that the median post-rehab improvement was 5 points (IQR 3) on Borg's scale, which measures breathlessness during activity on a 10-point scale. Prior to rehab, most patients rated their breathlessness during activity as severe to maximal; following rehab, only 13 patients rated their post-rehab activity breathlessness as more than very slight (>1 point).

The median change in SGRQ after pulmonary rehabilitation was 40.04 (IQR 22.92), the median change in 30-second STST was 7 (IQR 4), and the median difference in 30-second wall push-up was 8 (IQR 5).

"We can come to the conclusion that pulmonary rehabilitation can be used effectively, and that it is a safe and effective intervention in the absence of any other pharmacotherapy to treat post-COVID lung disease," Dumra said.

In an interview with MedPage Today, Dumra added that several earlier, mostly single-center studies have also shown pulmonary rehabilitation to be an effective treatment for long-COVID dyspnea. But he added that larger, multicenter studies are needed to better understand which rehabilitation strategies lead to the best outcomes.

A of nine studies examining pulmonary rehabilitation in post-COVID patients suggested a benefit, but the reviewers noted that the studies were mostly small, experimental, and of low quality.

All of the studies reported improvements in exercise capacity, pulmonary function, quality of life, or a combination thereof in patients with pulmonary symptoms following hospitalization for COVID-19.

But the reviewers noted that few of the studies evaluated changes in post-COVID symptom severity or frequency, and none of the studies included COVID patients who had not been hospitalized or evaluated outcomes beyond 3 months after initiating pulmonary therapy. They concluded that recommendations or practical guidance for pulmonary rehabilitation should include considerations of "feasibility, current pulmonary rehabilitation capacity, and resource constraints."

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