The effect of a structured 8-week outpatient exercise training program on post-COVID-19 measures of physical function: a case series

Introduction: Markedly reduced physical function due to respiratory and extrapulmonary complications related to COVID-19 has been reported even among survivors who were not hospitalized. Increasing evidence highlights the value of using the Short Physical Performance Battery (SPPB) to assess post-COVID-19 physical impairment through balance, gait speed, and lower limb strength measurements.
Aim: We investigated the effect of an 8-week outpatient exercise training program on SPPB and other COVID-19-related outcomes in subjects post infection.
Methods: A consecutive sample of one male (P1) and two female participants (P2 and P3) recovered from RT-PCR-confirmed COVID-19, nonsmokers and with no overt pulmonary disease underwent pre- and post-intervention measures of SPPB, the modified Medical Research Council (mMRC) dyspnea and the post-COVID-19 functional status (PCFS) scales. The supervised program consisted of 2 sessions/week of aerobic and strength training to a total of 16 sessions. Aerobic exercise intensity was adjusted weekly so subjects worked at 40-60% of their heart rate reserve on either a treadmill or stationary bike for 10-30 min/session. Resistance training included 2-3 sets of 10-15 reps of both upper (i.e. standing dumbbell press; seated bent over row) and lower extremity exercises (i.e. sit to stand; standing heel raises) with intensity being adjusted weekly with a subjective Borg rating of perceived exertion between “fairly light” and “hard”.
Results: All subjects (mean ± SD age = 59.6 ± 9.7 years and BMI = 27.9 ± 2.9 kg/m) completed the program. At study entry, subjects presented slight functional limitations (i.e. PCFS grade 2) and their physical performance ranged from poor to moderate, with P1, P2 and P3 scoring 3, 6 and 7 out of 12 points in the SPPB, respectively. A significant increase in SPPB scores between pre- and post-training values existed (5.3 ± 2 versus 10 ± 3; t (2) = - 5.29, p = 0.03), with each subject advancing at least one SPPB score category towards better performance. Subjects also had greater post-intervention functional status (i.e. all ending up classified as PCFS grade 1) and reduced dyspnea, with P1 experiencing a minus 3-point change in the mMRC, while P2 and P3 reduced their scores by 1 point.
Conclusion: The present training regimen elicited an improvement in physical performance as assessed by the SPPB, as well as favorable changes in functional status and perceived dyspnea in subjects post COVID-19.