# Long-term effects of difference dosage of pulmonary rehabilitation program in post severe COVID-19 patients

## TL;DR

This study shows that personalized pulmonary rehabilitation programs for severe post-COVID-19 patients improve lung function and quality of life, with benefits lasting up to a year regardless of session count.

## Contribution

The study demonstrates that shorter, personalized pulmonary rehabilitation programs yield durable benefits in post-severe COVID-19 patients.

## Key findings

- All groups showed sustained clinical and psychological improvements at 1 year.
- Shorter programs (12 sessions) were as effective as longer ones in maintaining long-term benefits.
- Improvements in physical and mental fatigue were significant and stable in the 36-session group.

## Abstract

COVID-19 can lead to severe respiratory complications requiring invasive mechanical ventilation (IMV). Post-acute sequelae often include reduced pulmonary function, decreased physical capacity, and impaired quality of life. Pulmonary rehabilitation programs (PRPs) have shown promise in aiding recovery, but the long-term effectiveness and optimal dosage (number of sessions) remain unclear.

A experimental, repeated-measures study was conducted at Hospital El Carmen de Maipú, Chile, involving 60 adults (male and female) who had received IMV due to severe COVID-19. Participants completed an individualized PRP consisting of sessions held twice weekly. Each session included 30 minutes of aerobic exercise, 20 minutes of strength training, and 10 minutes of stretching exercises. Participants were assigned to one of three intervention arms: 12, 24, or 36 sessions. Clinical outcomes included spirometric parameters, 6-min walk distance (6-MWD), Hand Grip Strength (HGS), functional status, and dyspnea. Psychological outcomes included quality of life and fatigue. Assessments were conducted at baseline, post-intervention, and 1 year after the intervention.

Twelve-session group, significant improvements in Maximum Inspiratory Pressure (MIP) and 6-MWD were observed (p < 0.05). Clinical and psychological improvements were sustained at 1 year. Twenty four-session group, significant changes were found in Forced Vital Capacity (FVC % predicted) and right-hand grip strength (HGS) (p < 0.05). Improvements in clinical and psychological variables persisted at 1 year, though additional gains were observed only in spirometric parameters between post-intervention and follow-up. Thirty six-session group, participants experienced significant improvements in physical and mental Fatigue Assessment Scale (FAS) scores, total FAS, and bodily pain (p < 0.05). These benefits remained stable at the 1-year evaluation, with no significant changes between post-intervention and follow-up.

Individualized PRPs produced significant improvements in clinical and psychological outcomes in patients recovering from severe COVID-19 requiring IMV. Importantly, these benefits were maintained 1 year after the intervention, regardless of the number of sessions (12, 24, or 36). The lack of significant long-term differences among groups suggests that a shorter but personalized rehabilitation program may be sufficient to produce durable improvements in this population. These findings support the implementation of tailored PRPs as a key component of post-COVID-19 care.