Highlights
- •Pulmonary rehabilitation program is superior to no intervention in improving dyspnea, exercise capacity, lung functions, and fatigue in patients with COVID-19.
- •Both mild and moderate/severe COVID-19 patients can get benefit from the pulmonary rehabilitation program.
- •Pulmonary rehabilitation appears to be safe and beneficial for both acute and chronic COVID-19 patients.
Abstract
Objective
Data Sources
Data Selection
Data Extraction
Data Synthesis
Conclusion
List of abbreviations:
COPD (chronic obstructive pulmonary disease), FVC (forced vital capacity), PR (pulmonary rehabilitation), QoL (quality of life), RCT (randomized controlled trial), SF (Short-Form Health Survey), SGRQ (St. George's Respiratory Questionnaire), 6MWT (6-minute walk test)Keywords
Introduction
(WHO) WHO. WHO Coronavirus (COVID-19) Dashboard 2022. Available at: https://covid19.who.int/. Accessed May 9 2022.
- Mikolajewska A
- Witzenrath M
Methods
Protocol and registration
Search strategy
Selection criteria
Types of participants
Types of interventions
Types of comparators
Types of outcomes
Risk of bias assessment
Data extraction
Statistical analysis
- Ahmed I
- Mustafaoglu R
- Benkhalifa N
- Yakhoub YH.
Results
Study selection

Study characteristics
Author, Country, Year, Stage, and Severity | Sample Size and Comorbidities N (IG/CG) | Ventilatory Support Used During Illness. N (IG/CG) | Length of Inpatient Stay Mean+SD Days | Interventions | Duration/ Session | Outcome Measures | Results |
---|---|---|---|---|---|---|---|
Li et al, 29 China, 2021 Chronic Moderate/severe | 118 (59/61) - Heart Disease – Hypertension – Diabetes – Obesity - Lung disease | 103 (49/54) | 26.18 (15.25) | Pulmonary Rehabilitation | -Breathing control and thoracic expansion, aerobic exercise, and LMS exercises are specified in a 3-tiered exercise plan with difficulty and intensity scheduled to increase over time. -Exercise program was 40-60 minutes per session, with 3-4 sessions per week, for a total of 6 weeks. | - 6MWT – PFTs - HRQOL - Borg RPE - Squat Test | After 6 weeks of PR program, exercise capacity, dyspnea, lung functions, and quality of life were significantly improved in intervention group as compared to control group (P<.001). |
Liu et al 18 , China, 2020 Acute Mild | 72 (36/36) - Hypertension – Diabetes – Osteoporosis | Not reported | Not reported | Pulmonary Rehabilitation | -Respiratory muscle training (device-based: threshold PEP); Cough exercise; diaphragmatic training; stretching exercise; home exercise -10 minutes/session, 2 sessions per week for 6 weeks. | - PFTs - 6MWT - SF-36 scores – FIM - SAS anxiety - SDS depression. | After 6 weeks of pulmonary rehabilitation program, exercise capacity, lung functions, and quality of life were significantly improved in intervention group as compared to control group (P<.001). The SAS and SDS scores in the intervention group decreased after the intervention, but only anxiety had significant statistical significance within and between the 2 groups. |
Blanco et al 28 ., Spain, 2021 Acute Mild | 36 (18/18) | Not reported | Not reported | Telerehabilitation | Strengthening exercise program; 60 minutes/session, 1 session/day, for 1 week. | - 6MWT – STST - Dyspnea | After 1 week of telerehabilitation program, exercise capacity, muscle performance, and dyspnea were significantly improved in intervention group as compared to control group (P<.001). |
Gerez et al 30 ., Spain, 2021 Acute Mild | 38 (19/19) | Not reported | Not reported | Telerehabilitation | Breathing and airway cleaning exercise program were 60 minutes per session, with 2 sessions per day, for 1 week. | - 6MWT - 30 STST -Dyspnea | After 1 week of telerehabilitation program, exercise capacity, muscle performance, and dyspnea were significantly improved in intervention group as compared to control group (P<.001). |
Pehlivan et al 34 ., Turkey, 2021Acute Mild | 34 (17/17) | 3 (1/2) | Not reported | Telerehabilitation | - Breathing exercises, active breathing techniques, lower and upper limb exercises, walking and wall squat exercises, delivered as a synchronized exercise program via videoconferencing; 3 sessions/week, 6 weeks. | - 30 STST -Dyspnea -Fatigue - Quality of life (SGRQ) | A significant improvement was observed in intervention group in terms of dyspnea (P=.035), 30STS (P=.005),) and SGRQ scores. |
Abodonya et al 31 ., Saudi Arabia, 2021Chronic Moderate/severe | 42 (21/21) | 42 (21/21) | 19.7±8.6 | Inspiratory muscle Training+ Breathing exercise | Breathing exercise (device-based: threshold PEP) 2 times daily for 2 weeks while intervention group received additional 2 sessions of IMT daily for 5 days a week for 2 weeks. | - PFTs – DSI – HRQoL - 6MWT | Two weeks of pulmonary rehabilitation program has significantly improved exercise capacity, lung functions, and dyspnea in intervention group (FVC%, P=.047, FEV1%, P=.039, DSI, P=.001, QOL, P<.001, and 6-MWT, P<.001), whereas the control group displayed nonsignificant changes (P>.05). |
Amaral et al 32 ., Brazil, 2022 Chronic Mild | 32 (12/10) – Hypertension – Diabetes -Obesity -Respiratory disease -cardiovascular disease | Not reported | Not reported | Telerehabilitation | Resistance and aerobic exercise 3 sessions/week and aerobic exercise 5 sessions/week, for 12 weeks | -6MWT -FTSTS -Grip strength -PFTs | Both groups similarly increased (P<.001) forced vital capacity (absolute and % of predicted), forced expiratory volume in the first second (absolute and % of predicted), and handgrip strength during follow-up. However, only exercise group increased MIP (24.7 ± 7.1 cmH2O, P<.001), MEP (20.3 ± 5.8 cmH2O, P=.021), and MEP % pred (14.3 ± 22.6 %, P=.042) during follow-up. |
Blanco et al 33 ., Spain, 2022 Acute Mild | 77 (55/22) | Not reported | Not reported | Telerehabilitation | Exp 1 = strengthening exercise program; 1 session/d, 7 d/week, 2 weeks Exp 2 = breathing and airway cleaning exercise program; 1 session/d, 7 d/week, 2 weeks | -6MWT -VASF -Dyspnea (MD-12) - 30STST -Borg scale | All the outcome measures were significantly improved in exercise group as compared to control group (P<.05). The greatest effect sizes were found in the Borg Scale (R2 = 0.548) and MD-12 questionnaire (R2 = 0.475). |
Details of intervention
Risk of bias
Effects of pulmonary rehabilitation
Exercise capacity

Dyspnea

Lung functions

Fatigue

Quality of life

Safety of PR program
Discussion
medpagetoday. Mental health challange afte Covid-19 Recovery. Available at: https://www.medpagetoday.com/infectiousdisease/covid19/86556. Accessed January 10, 2022.
Study limitations, strengths, and future implications
Conclusion
Acknowledgments
Appendix. Supplementary materials
References
(WHO) WHO. WHO Coronavirus (COVID-19) Dashboard 2022. Available at: https://covid19.who.int/. Accessed May 9 2022.
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medpagetoday. Mental health challange afte Covid-19 Recovery. Available at: https://www.medpagetoday.com/infectiousdisease/covid19/86556. Accessed January 10, 2022.
Article info
Publication history
Footnotes
The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Disclaimer: R.M. is Editorial board member for Turkish Journal of Physiotherapy and Rehabilitation, while I.Y. is advisory board member for Journal of Exercise therapy and Rehabilitation. All other authors have nothing to declare.