The Effect of Mechanotherapy and Virtual Reality on Cardiovascular Activity and the Severity of Shortness of Breath in Patients with Post COVID-19 Syndrome: A Prospective Randomized Study

Abstract

INTRODUCTION. At present, there is an urgent need to develop modern rehabilitation programs for COVID-19 patients with long-lasting residual symptoms of the disease, primarily from the cardiopulmonary system.
 AIM. To assess the impact of a comprehensive medical rehabilitation program using virtual reality technologies, robotic mechanotherapy with biofeedback and interactive balance therapy on the severity of hypoxic syndrome, shortness of breath and cardiovascular activity in patients who have undergone COVID-19 and have manifestations of post-COVID syndrome (long COVID).
 MATERIAL AND METHODS. The study sample consisted of 120 patients aged 40 to 70 years who had suffered COVID-19 within 16 months prior to inclusion in the study and had manifestations of SPCN, who were randomized into 2 groups. In the main group (n = 60), a new complex of medical rehabilitation was prescribed against the background of basic treatment: 1) sessions on the robotic biofeedback simulator for lower limb muscle training Con-Trex, #10; 2) balance therapy (sensorimotor training) using the biofeedback simulator Stabilan 012, #10; 3) training on the rehabilitation interactive markerless system with virtual reality technology Nirvana, #10. In the control group (n = 60) patients received only basic treatment: 1) a special complex of therapeutic gymnastics performed in the hall with a physical therapy instructor, № 10; 2) low-intensity laser radiation, № 10; 3) speleo-exposure, № 10; 4) medical massage on the chest area, № 10. Research methods included clinical examination, anamnesis collection and cardiopulmonary testing and assessment of dyspnea severity before the beginning of rehabilitation and immediately after its completion.
 RESULTS AND DISCUSSION. In the period from 1 to 6 months after COVID-19, 90.0 % of patients had dyspnea, as well as a decrease in peak oxygen consumption and high values of heart rate (HR), systolic and diastolic blood pressure (BP) at peak exercise. The application of a new complex of medical rehabilitation in patients with post-COVID disorder syndrome contributed to a more significant, than in the standard method of rehabilitation, increase in cardiorespiratory endurance, which is manifested in the increase in the maximum work performed by 12.9 % and oxygen consumption of the first ventilation threshold by 6.3 % and in the decrease in diastolic BP at peak load by an average of 7 mm Hg. hg according to cardiopulmonary testing, as well as an increase in the proportion of patients with mild (up to 60.0 %) or no dyspnoea (up to 26 %) and a decrease in the number of patients with moderate dyspnoea (up to 13.3 %), severe and very severe dyspnoea (up to 0 %). Most of the authors in their studies also note a high frequency of shortness of breath, along with such manifestations of post- COVID-19 syndrome as general weakness, poor exercise tolerance.
 CONCLUSION. A new comprehensive medical rehabilitation program using virtual reality technologies, robotic mechanotherapy with biofeedback and interactive balance therapy are recommended to reduce the severity of hypoxic syndrome and dyspnea and improve cardiovascular performance in patients with post-COVID syndrome.