Abstract
Pulmonary rehabilitation is a multidisciplinary intervention recommended by international guidelines in managing COVID-19 patients and/or post-COVID-19 conditions with mid-and long-term complications of the initial illness. Physiotherapy-based pulmonary rehabilitation has received considerable attention since the COVID-19 pandemic, with supervised exercise training probably the most important component. Current guidelines clearly encourage low- to moderateintensity exercises for COVID-19 recovered patients and discourage high-intensity/vigorous exercises. However, the ongoing interest in high-intensity interval training (HIIT) has extended to post- COVID-19 rehabilitation based on its efficacy and safety in other patient populations. In this perspective, several reasons behind the possibility of the inappropriateness of the HIIT in post-COVID- 19 conditions will be discussed and supported by evidence. In addition, the key points for safe exercise after COVID-19 illness will be listed.
Keywords: Post-COVID-19, pulmonary rehabilitation, exercise, high-intensity interval training, physiotherapy, efficacy.
[1]
Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 long-term effects of COVID-19: A systematic review and meta-analysis. Sci Rep 2021.
[2]
Denay KL, Breslow RG, Turner MN, Nieman DC, Roberts WO, Best TM. ACSM call to action statement: COVID-19 considerations for sports and physical activity. Curr Sports Med Rep 2020; 19(8): 326-8.
[http://dx.doi.org/10.1249/JSR.0000000000000739] [PMID: 32769667]
[http://dx.doi.org/10.1249/JSR.0000000000000739] [PMID: 32769667]
[3]
Barker-Davies RM, O’Sullivan O, Senaratne KPP, et al. The stanford hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020; 54(16): 949-59.
[http://dx.doi.org/10.1136/bjsports-2020-102596] [PMID: 32475821]
[http://dx.doi.org/10.1136/bjsports-2020-102596] [PMID: 32475821]
[4]
Biddle SJH, Batterham AM. High-intensity interval exercise training for public health: A big HIT or shall we HIT it on the head? Int J Behav Nutr Phys Act 2015; 12: 95.
[http://dx.doi.org/10.1186/s12966-015-0254-9] [PMID: 26187579]
[http://dx.doi.org/10.1186/s12966-015-0254-9] [PMID: 26187579]
[5]
Keech A, Way K, Holgate K, Fildes J, Indraratna P, Yu J. HIIT for post-COVID patients within cardiac rehabilitation: Response to letter to the editor. Int J Cardiol 2021; 322: 291-2.
[http://dx.doi.org/10.1016/j.ijcard.2020.08.086] [PMID: 32882289]
[http://dx.doi.org/10.1016/j.ijcard.2020.08.086] [PMID: 32882289]
[6]
Foged F, Rasmussen IE, Bjørn Budde J, et al. Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: A randomised cross-over trial. BMJ Open Sport Exerc Med 2021; 7(3): e001156.
[http://dx.doi.org/10.1136/bmjsem-2021-001156] [PMID: 34493958]
[http://dx.doi.org/10.1136/bmjsem-2021-001156] [PMID: 34493958]
[7]
Rinaldo RF, Mondoni M, Parazzini EM, et al. Deconditioning as main mechanism of impaired exercise response in COVID-19 survivors. Eur Respir J 2021; 58(2): 2100870.
[http://dx.doi.org/10.1183/13993003.00870-2021] [PMID: 33926969]
[http://dx.doi.org/10.1183/13993003.00870-2021] [PMID: 33926969]
[8]
Barbagelata L, Masson W, Iglesias D, et al. Cardiopulmonary exercise testing in patients with Post-COVID-19 syndrome. Med Clin (Barc) 2021; S0025-7753(21): 00462.
[http://dx.doi.org/10.1016/j.medcli.2021.07.007]
[http://dx.doi.org/10.1016/j.medcli.2021.07.007]
[9]
Szekely Y, Lichter Y, Sadon S, et al. Cardiorespiratory abnormalities in patients recovering from coronavirus disease 2019. J Am Soc Echocardiogr 2021; 34(12): 1273-1284.e9.
[http://dx.doi.org/10.1016/j.echo.2021.08.022] [PMID: 34508837]
[http://dx.doi.org/10.1016/j.echo.2021.08.022] [PMID: 34508837]
[10]
Singh I, Joseph P, Heerdt PM, et al. Persistent exertional intolerance after COVID-19: Insights from invasive cardiopulmonary exercise testing. Chest 2021; S0012-3692(21): 03635-7.
[11]
Holtgrefe K. Principles of Aerobic Exercise Therapeutic Exercise Foundations and Techniques. 6th ed. Philadelphia, USA: F.A. Davis Company 2012; pp. 247-50.
[12]
Dani M, Dirksen A, Taraborrelli P, et al. Autonomic dysfunction in ‘long COVID’: Rationale, physiology and management strategies. Clin Med (Lond) 2021; 21(1): e63-7.
[http://dx.doi.org/10.7861/clinmed.2020-0896] [PMID: 33243837]
[http://dx.doi.org/10.7861/clinmed.2020-0896] [PMID: 33243837]
[13]
Nieman DC, Wentz LM. The compelling link between physical activity and the body’s defense system. J Sport Health Sci 2019; 8(3): 201-17.
[http://dx.doi.org/10.1016/j.jshs.2018.09.009] [PMID: 31193280]
[http://dx.doi.org/10.1016/j.jshs.2018.09.009] [PMID: 31193280]
[14]
Souza D, Vale AF, Silva A, et al. Acute and chronic effects of interval training on the immune system: A systematic review with meta-analysis. Biology (Basel) 2021; 10(9): 868.
[http://dx.doi.org/10.3390/biology10090868] [PMID: 34571745]
[http://dx.doi.org/10.3390/biology10090868] [PMID: 34571745]
[15]
Ahmadi Hekmatikar AH, Ferreira Júnior JB, Shahrbanian S, Suzuki K. Functional and psychological changes after exercise training in Post-COVID-19 patients discharged from the hospital: A PRISMA-Compliant systematic review. Int J Environ Res Public Health 2022; 19(4): 2290.
[http://dx.doi.org/10.3390/ijerph19042290] [PMID: 35206483]
[http://dx.doi.org/10.3390/ijerph19042290] [PMID: 35206483]
[16]
Hagiu BA. Moderate exercise may prevent the development of severe forms of COVID-19, whereas high-intensity exercise may result in the opposite. Med Hypotheses 2021; 157: 110705.
[http://dx.doi.org/10.1016/j.mehy.2021.110705] [PMID: 34670172]
[http://dx.doi.org/10.1016/j.mehy.2021.110705] [PMID: 34670172]
[17]
Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. The unique characteristics of COVID-19 coagulopathy. Crit Care 2020; 24(1): 360.
[http://dx.doi.org/10.1186/s13054-020-03077-0] [PMID: 32552865]
[http://dx.doi.org/10.1186/s13054-020-03077-0] [PMID: 32552865]
[18]
Wang JS. Exercise prescription and thrombogenesis. J Biomed Sci 2006; 13(6): 753-61.
[http://dx.doi.org/10.1007/s11373-006-9105-7] [PMID: 16933027]
[http://dx.doi.org/10.1007/s11373-006-9105-7] [PMID: 16933027]
[19]
Sobhani V, Taghizadeh M, Moshkani-Farahani M. Platelet indices and function response to two types of high intensity interval exercise and comparison with moderate intensity continuous exercise among men after coronary artery bypass graft: A randomized trial. ARYA Atheroscler 2018; 14(5): 188-95.
[PMID: 30783408]
[PMID: 30783408]
[20]
Parto P, O’Keefe JH, Lavie CJ. The exercise rehabilitation paradox:Less may be more? Ochsner J 2016; 16(3): 297-303.
[PMID: 27660580]
[PMID: 27660580]
[21]
van der Vorm LN, Huskens D, Kicken CH, et al. Effects of repeated bouts of exercise on the hemostatic system. Semin Thromb Hemost 2018; 44(8): 710-22.
[http://dx.doi.org/10.1055/s-0038-1673619] [PMID: 30290394]
[http://dx.doi.org/10.1055/s-0038-1673619] [PMID: 30290394]
[22]
Franklin BA, Thompson PD, Al-Zaiti SS, et al. Exercise-Related acute cardiovascular events and potential deleterious adaptations follow-ing long-term exercise training: Placing the risks into perspective-an update: A scientific statement from the american heart association. Circulation 2020; 141(13): e705-36.
[http://dx.doi.org/10.1161/CIR.0000000000000749] [PMID: 32100573]
[http://dx.doi.org/10.1161/CIR.0000000000000749] [PMID: 32100573]
[23]
Wewege MA, Ahn D, Yu J, Liou K, Keech A. High-Intensity interval training for patients with cardiovascular disease-is it safe? a system-atic review. J Am Heart Assoc 2018; 7(21): e009305.
[http://dx.doi.org/10.1161/JAHA.118.009305] [PMID: 30376749]
[http://dx.doi.org/10.1161/JAHA.118.009305] [PMID: 30376749]
[24]
Hermann M, Pekacka-Egli AM, Witassek F, Baumgaertner R, Schoendorf S, Spielmanns M. Feasibility and efficacy of cardiopulmonary rehabilitation following COVID-19. Am J Phys Med Rehabil 2020; 99(10): 865-9.
[http://dx.doi.org/10.1097/PHM.0000000000001549] [PMID: 32732746]
[http://dx.doi.org/10.1097/PHM.0000000000001549] [PMID: 32732746]
[25]
Holland AE, Spruit MA, Troosters T, et al. An official european respiratory society/american thoracic society technical standard: Field walking tests in chronic respiratory disease. Eur Respir J 2014; 44(6): 1428-46.
[http://dx.doi.org/10.1183/09031936.00150314] [PMID: 25359355]
[http://dx.doi.org/10.1183/09031936.00150314] [PMID: 25359355]
[26]
Halle M, Bloch W, Niess AM, et al. Exercise and sports after COVID-19-Guidance from a clinical perspective. Transl Sports Med 2021; 4(3): 310-8.
[http://dx.doi.org/10.1002/tsm2.247] [PMID: 34230908]
[http://dx.doi.org/10.1002/tsm2.247] [PMID: 34230908]
[27]
Reed JL, Pipe AL. The talk test: A useful tool for prescribing and monitoring exercise intensity. Curr Opin Cardiol 2014; 29(5): 475-80.
[http://dx.doi.org/10.1097/HCO.0000000000000097] [PMID: 25010379]
[http://dx.doi.org/10.1097/HCO.0000000000000097] [PMID: 25010379]
[28]
Ignaszewski M, Lau B, Wong S, et al. The science of exercise prescription: Martti karvonen and his contributions. B C Med J 2017; 59(1): 38-41.
[29]
Shookster D, Lindsey B, Cortes N, Martin JR. Accuracy of commonly used age-predicted maximal heart rate equations. Int J Exerc Sci 2020; 13(7): 1242-50.
[PMID: 33042384]
[PMID: 33042384]
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