Rehabilitation for post-COVID-19 condition through a supervised exercise intervention: A randomized controlled trial

Purpose The aim of the study was to compare the outcomes of patients with post-COVID-19 condition undergoing supervised therapeutic exercise intervention or following the self-management WHO (World Health Organization) rehabilitation leaflet. Methods A randomized controlled trial was carried out that included 39 participants with post-COVID-19 condition who had a chronic symptomatic phase lasting >12 weeks. Comprehensive medical screening, patient-reported symptoms, and cardiorespiratory fitness and muscular strength were assessed. Patients were randomly assigned to a tailored multicomponent exercise program based on concurrent training for 8 weeks (two supervised sessions per week comprised resistance training combined with aerobic training [moderate intensity variable training], plus a third day of monitored light intensity continuous training), or to a control group which followed the WHO guidelines for rehabilitation after COVID-19. Results After follow-up, there were changes in physical outcomes in both groups, however, the magnitude of the change pre–post intervention favored the exercise group in cardiovascular and strength markers: VO2max +5.7%, sit-to-stand −22.7% and load-velocity profiles in bench press +6.3%, and half squat +16.9%, (p < 0.05). In addition, exercise intervention resulted in a significantly better quality of life, less fatigue, less depression, and improved functional status, as well as in superior cardiovascular fitness and muscle strength compared to controls (p < 0.05). No adverse events were observed during the training sessions. Conclusion Compared to current WHO recommendations, a supervised, tailored concurrent training at low and moderate intensity for both resistance and endurance training is a more effective, safe, and well-tolerated intervention in post-COVID-19 conditions.Spanish Ministry of Science and Innovation PID2019-108202RA-I00Centro Médico Virgen de la Caridad 3511

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Efecto de un programa de ejercicio multicomponente en la recuperación de la condición funcional, del estado de ánimo y de la calidad de vida en personas con condiciones post-COVID-19 : proyecto RECOVE

Introducción Aproximadamente el 10% de los pacientes que han sufrido una COVID-19 aguda van a desarrollar como complicación a largo plazo síntomas persistentes de larga duración. Esta entidad, denominada condición post-COVID-19 se caracteriza por presentar síntomas que duran al menos 2 meses y que no se pueden explicar con un diagnóstico alternativo. Los síntomas más comunes incluyen la fatiga, la disnea y las manifestaciones neurocognitivas. Su importancia radica no solo en su frecuencia, si no en que, generalmente, tienen un impacto grave en el funcionamiento de las personas que la sufren, limitando su capacidad para la realización de las actividades de la vida diaria y la reincorporación a la vida laboral. Objetivos El objetivo principal del estudio es evaluar la eficacia clínica y la seguridad de un tratamiento personalizado basado en ejercicio físico multicomponente con o sin entrenamiento de la musculatura inspiratoria supervisado en comparación con el grupo de control para mejorar la condición clínica, la función cardiopulmonar y la situación funcional de pacientes que desarrollan condiciones post-COVID-19 cuya atención en la fase aguda se realizó en el ámbito ambulatorio. Metodología El proyecto RECOVE es un ensayo controlado aleatorizado, de cuatro brazos paralelos que compara la eficacia de un programa de ejercicio personalizado, basado en el entrenamiento de ejercicios multicomponente (EC) y/o el entrenamiento de los músculos inspiratorios (ECMR y MR), con el seguimiento autónomo de las recomendaciones de autocuidado emitidas por la OMS (Organización Mundial de la salud) (CON), en la recuperación de síntomas persistentes y de las limitaciones funcionales de las personas con condiciones post- COVID-19. Resultados La evolución sintomática de los pacientes tras 8 semanas de seguimiento mostró que el número total de síntomas persistentes disminuyó significativamente en la totalidad de la muestra, así como el porcentaje de pacientes que consideraron que sus síntomas persistían en intensidades moderadas o graves (p<0,001). Si bien no se detectaron diferencias significativas en las estimaciones del VO2max entre las intervenciones, hubo mejoras individuales significativas tanto en el grupo de EC (∆ = 7,5 %; ES = 0,38) como en el grupo ECRM (∆ = 7,8 %; ES = 0,28). Lo mismo ocurrió con la fuerza muscular de extremidades inferiores, que solo mejoró significativamente en los grupos EC y ECRM (∆ = 14,5% - 32,6%; ES = 0,27 - 1,13) en comparación con los grupos MR y CON (∆ = -0,3% - 11,3%; ES = 0,19 - 0,00). El entrenamiento de la musculatura respiratoria no aportó beneficios añadidos al CON o sobre el EC solo. Respecto a la evolución de la intensidad de los síntomas, solo los grupos EC y ECRM mejoraron significativamente en las escalas de disnea (mMRC) y de fatiga (CFS-Linkert y FSS), al igual que ocurrió con la percepción de la calidad de su estado de salud físico y mental (SF-12). Además, cuando se compararon las intervenciones entre sí, la intensidad de la fatiga (FSS y CFS-Linkert) y de la depresión (PHQ-9) fueron significativamente más bajas en los grupos con EC y ECMR en comparación con los grupos MR y CON. No se produjo ningún evento adverso derivado de la realización de ejercicio físico en los grupos evaluados. Conclusiones Ocho semanas de entrenamiento concurrente, con o sin ejercicio de los músculos inspiratorios, fueron superiores a las recomendaciones para el autocuidado y manejo de los síntomas elaborado por la OMS o que el entrenamiento de los músculos inspiratorios realizado de forma aislada en la recuperación de la condición post-COVID-19. Un programa supervisado y adaptado individualmente al paciente con condiciones post-COVID-19 permitió mejorar la condición física cardiopulmonar (VO2max), la fuerza de miembros inferiores, pero también la gravedad de los síntomas, y esto se consiguió de una manera segura y eficiente.Introduction Approximately 10% of patients who have experienced acute COVID-19 will develop long-term persistent symptoms as a complication. This entity, termed post-COVID-19 condition is characterized by symptoms lasting at least 2 months that cannot be explained by an alternative diagnosis. The most common symptoms include fatigue, dyspnea and neurocognitive manifestations. Their importance lies not only in their frequency, but also in the fact that they generally have a severe impact on the functioning, limiting their ability to perform activities of daily living and return to work. Objectives The main objective of the study is to evaluate the clinical efficacy and safety of a personalized and supervised treatment based on multicomponent physical exercise with or without inspiratory muscle training compared to the control group in improving the clinical condition, cardiopulmonary function and functional status of patients with post-COVID-19 conditions whose acute phase care was managed in the outpatient setting. Methodology The RECOVE project is a randomized, four parallel-arm, randomized controlled trial comparing the efficacy of a personalized exercise program, based on multicomponent exercise training (CT) and/or inspiratory muscle training (CTRM and RM), with self-care recommendations issued by the WHO (World Health Organization) (CON), in the recovery of persistent symptoms and functional limitations of people with post-COVID-19 conditions. Results The symptomatic evolution of the patients after 8 weeks of follow-up showed that the total number of persistent symptoms decreased significantly in the whole sample, as well as the percentage of patients who considered that their symptoms persisted in moderate or severe intensities (p<0.001). While no significant differences in VO2max estimates were detected between interventions, there were significant individual improvements in both the CT group (∆7.5 %; ES=0.38) and the CTRM group (∆ = 7.8%; ES = 0.28). The same was true for lower extremity muscle strength, which only improved significantly in the CT and CTRM groups (∆ = 14.5% - 32.6%; ES = 0.27 - 1.13) compared with the RM and CON groups (∆ = -0.3 % - 11.3 %; ES = 0.19 - 0.00). Respiratory muscle training did not provide added benefits over CON or over CT alone. Only the CT and CTMR groups improved significantly on the dyspnea (mMRC) and fatigue (CFS-Linkert and FSS) scales, as did the perception of the quality of their physical and mental health status (SF-12). In addition, when the interventions were compared with each other, the intensity of fatigue (FSS and CFS-Linkert) and depression (PHQ-9) were significantly lower in the CT and CTRM groups compared with the RM and CON groups. There were no adverse events resulting from physical exercise in any group. Conclusions Eight weeks of concurrent training, with or without inspiratory muscle training, was superior to the recommendations for self-care and symptom management developed by WHO or inspiratory muscle training alone in post-COVID-19 condition recovery. A supervised program individually tailored to the patient with post-COVID-19 conditions allowed to improve cardiopulmonary fitness (VO2max), lower limb strength, but also symptom severity, and this was achieved in a safe and efficient manner

Post-COVID-19 Syndrome and the Potential Benefits of Exercise

The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th