Effects of a 16-week home-based exercise training programme on health-related quality of life, functional capacity, and persistent symptoms in survivors of severe/critical COVID-19: a randomised controlled trial

Abstract: Original research Igor Longobardi ‍ ‍,1 Karla Goessler,1 Gersiel Nascimento de Oliveira Júnior,1 Danilo Marcelo Leite do Prado,1 Jhonnatan Vasconcelos Pereira Santos,1 Matheus Molina Meletti,1 Danieli Castro Oliveira de Andrade,2 Saulo Gil ‍ ‍,1 João Antonio Spott de Oliveira Boza,1 Fernanda Rodrigues Lima,2 Bruno Gualano ‍ ‍,1,2 Hamilton Roschel ‍ ‍1,2 ► Additional supplemental material is published online only. To view, please visit the journal online (http://d​ x.​doi.​ org/1​ 0.​1136/b​ jsports-​2022-​ 106681). 1 Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, SP, Brazil 2 Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil Correspondence to Professor Hamilton Roschel, Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, 01246-­ 903, SP, Brazil; ​hars@​usp.b​ r Accepted 8 April 2023 © Author(s) (or their employer(s)) 2023. No commercial re-­use. See rights and permissions. Published by BMJ. To cite: Longobardi I, Goessler K, de Oliveira Júnior GN, et al. Br J Sports Med Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bjsports-2022-106681 ABSTRACT Background Long-­lasting effects of COVID-­19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-­related quality of life (HRQoL). We investigated the effects of a home-­based exercise training (HBET) programme on HRQoL and health-­related outcomes in survivors of severe/critical COVID-­19. Methods This was a single-­centre, single-­blinded, parallel-­ group, randomised controlled trial. Fifty survivors of severe/ critical COVID-­19 (5±1 months after intensive care unit discharge) were randomly allocated (1:1) to either a 3 times a week (~60–80 min/session), semi-­supervised, individualised, HBET programme or standard of care (CONTROL). Changes in HRQoL were evaluated through the 36-­Item Short-­Form Health Survey, and physical component summary was predetermined as the primary outcome. Secondary outcomes included cardiorespiratory fitness, pulmonary function, functional capacity, body composition and persistent symptoms. Assessments were performed at baseline and after 16 weeks of intervention. Statistical analysis followed intention-­to-­treat principles. Results After the intervention, HBET showed greater HRQoL score than CONTROL in the physical component summary (estimated mean difference, EMD: 16.8 points; 95% CI 5.8 to 27.9; effect size, ES: 0.74), physical functioning (EMD: 22.5 points, 95% CI 6.1 to 42.9, ES: 0.83), general health (EMD: 17.4 points, 95% CI 1.8 to 33.1, ES: 0.73) and vitality (EMD: 15.1 points, 95% CI 0.2 to 30.1, ES: 0.49) domains. 30-­second sit-­to-­stand (EMD: 2.38 reps, 95% CI 0.01 to 4.76, ES: 0.86), and muscle weakness and myalgia were also improved in HBET compared with CONTROL (p<0.05). No significant differences were seen in the remaining variables. There were no adverse events. Conclusion HBET is an effective and safe intervention to improve physical domains of HRQoL, functional capacity and persistent symptoms in survivors of severe/critical COVID-­19. Trial registration number NCT04615052.