Home exercise training with remote supervision can assist post-COVID rehabilitation

Brazilian researchers conducted a randomized clinical trial to test the safety and efficacy of a 12-week home exercise program for 32 volunteers who had been hospitalized after contracting COVID-19.

By Karina Toledo  |  Agência FAPESP – A home exercise program to be followed without equipment and under remote supervision by physical education professionals proved safe and effective to combat two possible complications of COVID-19: arterial stiffness, and loss of strength in the muscles involved in breathing. 

Researchers at São Paulo State University (UNESP) and the Federal University of São Carlos (UFSCar) in Brazil reached this conclusion as a result of a clinical trial involving 32 COVID-19 patients hospitalized between July 2020 and February 2021. The average age of the group of men and women was 52.

“Despite the relatively small number of participants, we were able to detect statistically significant differences in these two variables. It should be stressed that the program was safe despite taking place at home. No volunteers suffered any adverse effects due to exercise,” said Emmanuel Ciolac, a professor in the Bauru School of Sciences (FC-UNESP) and principal investigator for the trial.

About a month after they were discharged from hospital, the volunteers were submitted to a battery of tests and randomly divided into two groups. One (the control group) was merely advised to exercise regularly and asked to return to the university after 12 weeks for another assessment. The rest (the exercise group) were trained to perform aerobic and strength exercises, and then given a handbook with instructions. This group was monitored remotely by the researchers once a week via telephone calls and messaging.

“They were urged to perform resistance exercises at least three times a week, as well as 150 minutes of aerobic activity per week,” said Vanessa Teixeira do Amaral, a master’s student in the Graduate Program in Movement Sciences at FC-UNESP and first author of an article with detailed results of the trial posted to the preprint platform medRxiv (awaiting peer review). The study was supported by FAPESP.

The tests conducted at the end of the 12-week period included assessment of weight and body mass index (BMI), blood pressure, heart rate, and pulse wave velocity (PWV), a measure of arterial stiffness.

“In PWV, sensors placed on the carotid artery [in the neck] and femoral artery [in the groin] send data to a device running software that calculates the rate at which the heart pumps blood between these two points. Higher rates mean stiffer arteries. More than 10 meters per second is considered an indication of possible cardiovascular complications,” Amaral explained.

The researchers also tested ́pulmonary function by spirometry, and respiratory muscle strength using a manometer that measured maximum inspiratory pressure and maximum expiratory pressure.

Lastly, they performed standard physical tests to assess the volunteers’ muscular strength and overall health. 

Complementary therapy

According to Ciolac, the assessed parameters for all participants improved after 12 weeks, but PWV fell to a significant extent only in the exercise group. He explained that arterial stiffness is one of the consequences of the inflammation triggered throughout the organism by COVID-19, but also a process that occurs naturally with aging. It increases the risk of hypertension and cardiovascular problems such as heart attack and stroke. At an advanced stage it can lead to kidney failure, and disorders of the liver or other organs.

“In the exercise group, 35% were over 10 meters per second [m/s] in the first PWV test. After 12 weeks, we observed an average drop of 2 m/s, a very good effect, and all members of the group were under 10 m/s in the second test,” Ciolac said.

The respiratory improvement was only statistically significant in the exercise group, all of whom had maximum inspiratory pressure that was lower than expected for their age at the start of the program. Only half were so rated after 12 weeks of training. In the case of maximum expiratory pressure, the proportions were 58% and 33% respectively.

“The findings suggest that home exercise training with remote supervision can be a potential adjuvant therapy for the rehabilitation of patients who have been hospitalized with COVID-19,” Ciolac said.

The article “Cardiovascular, respiratory and functional effects of tele-supervised home-based exercise training in individuals recovering from COVID-19 hospitalization: a randomized clinical trial” is at: www.medrxiv.org/content/10.1101/2022.01.24.22269745v1.full.pdf.