Cardiorespiratory and skeletal muscle damage due to COVID-19: making the urgent case for rehabilitation

ABSTRACT

Introduction

It has become increasingly evident that COVID-19 contributes to multiorgan pathophysiology. The systemic inflammatory response increases both pro-inflammatory cytokine and chemokine levels, leading to immune dysregulation and increasing the likelihood of incurring cardiac and pulmonary injuries.

Areas covered

Longer periods of hospitalization (~20 days) increase susceptibility to ICU-acquired muscle weakness and deconditioning, which decreases muscle function and functional capacity. These conditions affect the quality of life in the post-COVID-19 period and require multi-disciplinary approaches to rehabilitate the cardiopulmonary and musculoskeletal systems of these patients. In this context, this narrative review, which included articles published in the Embase, PEDro and PubMed databases up to December 2020, is focused on discussing the essential role of exercise and rehabilitation health professionals in the COVID-19 recovery process, from hospitalization to hospital discharge, addressing strategies for professionals to mitigate the cardiac and pulmonary impairments associated with hospitalization to home or ambulatory rehabilitation, purposing ways to conduct rehabilitation programs to restore their functional status and quality of life after the infection.

Expert opinion

In the current environment, these findings further point to the vital role of rehabilitation health professionals in the coming years and the urgent need to develop strategies to assist COVID-19 survivors.

KEYWORDS:

• COVID-19
• exercise
• rehabilitation
• respiratory therapy
• cardiac rehabilitation
• quality of life

Article highlights

• COVID-19 contributes to multiorgan pathophysiology due to a systemic inflammatory response and immune dysregulation.

• The cardiorespiratory system can be directly or indirectly affected by COVID-19 and a portion of patients who survive may have limiting impairments in cardiorespiratory function.

• Exercise has anti-inflammatory properties working as a modulator of the immune system; moderate-intensity exercise is recommended to improve immune function, being related to lower incidences of upper respiratory tract infections.

• The benefits of exercise in rehabilitation programs are well recognized and highly recommended for patients with COPD, CHF and other comorbidities, especially to improve musculoskeletal function.

• Multidisciplinary approaches and rehabilitation programs are needed to restore functional status, exercise capacity, independence and quality of life, and rehabilitation specialists play a vital role in this field.

Declaration of interest

R Silva and M Oliveira have received PhD scholarships from CAPES. G Back has received a MSc scholarship from CAPES. C Goulart has received a PhD scholarship from FAPESP. A Borghi-Silva has received a research grant (Thematic Project – Process #2015/26,501-1) from FAPESP. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the São Paulo Research Foundation (FAPESP – Process #2015/26501-1) and Coordination for the Improvement of Higher Education Personnel (CAPES).