Pulmonary Rehabilitation in Post-COVID-19 Patients Improves Lung Function and Mechanics and Skeletal Muscle, and Immune Response

Abstract

COVID-19 let sequelae beyond the respiratory system, including in skeletal muscle and in immune response. We evaluated the effects of 12 weeks of pulmonary rehabilitation (PR), 3x/week, constituted by aerobic and resistance training on 28 moderate and severe post-COVID-19 patients. The results demonstrated that PR improved lung function, FVC (p<0.02), FEV1 (p<0.02), FEV1/FVC (p<0.01), MEF25% (p<0.006), MEF50% (p<0.03), and MEF75% (p<0.02). PR improved lung mechanics, respiratory impedance (Z5hz, p<0.03); respiratory reactance (X5Hz, p<0.01), resistance of the whole respiratory systems (R5Hz, p<0.03), central airway resistance (RCentral, p<0.03), and peripheral airway resistance (RPeripheral, p<0.02). PR improved peripheral muscle strength, increasing right (p<0.02) and left (p<0.01) hand grip strength and respiratory muscle strength, increasing maximum inspiratory (p<0.02) and expiratory (p<0.03) pressure. Of note, PR reduced pulmonary inflammation (breath condensate), reducing the levels of pro-inflammatory cytokine IL-1beta (p<0.0001) and IL-6 (p<0.0001), while increased the levels of anti-inflammatory cytokine IL-1RA (p<0.0004) and IL-10 (p<0.003), beyond to increase the levels of IFN-gamma (p<0.0002) and IFN-beta (p<0.008). PR reduced the serum levels of pro-inflammatory IL-1beta (p<0.006) and IL-6 (p<0.01), while increased the levels of anti-inflammatory cytokine IL-1RA (p<0.0001) and IL-10 (p<0.0001), increasing the levels of IFN-gamma (p<0.02) and IFN-beta (p<0.001). PR reveals to be beneficial for post-COVID-19 patients, mitigating the sequelae observed in the respiratory system, skeletal muscle and in the immune response.