Pulmonary Rehabilitation in the Post-COVID Condition: A systematic review with meta-analysis

Abstract

Introduction: Long COVID encompasses patients who remain symptomatic after the acute phase of the disease, characterized by the persistence or onset of symptoms 12 weeks after the resolution of the infection. Despite advances in knowledge of the acute phase, there are still aspects that need clarification regarding patient recovery, prevention of sequelae, and strategies to mitigate symptoms. Objective: The efficacy of structured pulmonary physiotherapy in adults with post-COVID-19 sequelae was described. Methods: [HC1.1] Systematic review with meta-analysis. Searches were conducted in the Medical Literature Analysis and Retrieval System Online (PubMed/MEDLINE), Embase, Cochrane Library, and Latin American and Caribbean Health Sciences Literature databases. Studies involving adults were included and subjected to qualitative synthesis and meta-analysis. Results: The initial search identified 2,329 records. After applying the eligibility criteria, 15 clinical trials were selected for qualitative analysis. The interventions evaluated included inspiratory muscle training, respiratory exercises, in-person pulmonary rehabilitation, cardiopulmonary rehabilitation, telerehabilitation, and multimodal programs. Conclusion: Structured pulmonary and cardiopulmonary rehabilitation promotes clinically relevant benefits in adults with post-COVID-19 conditions. Consistent improvement in objective functional capacity was evidenced, mainly by the increase in the distance covered in the 6-minute walk test (6MWD), in addition to positive impacts on cardiorespiratory fitness and ventilatory muscle strength. The summarized evidence supports the inclusion of cardiopulmonary rehabilitation as a therapeutic pillar in the management of long-term COVID, requiring, however, prescription guided by the clinical phenotype.