Impacto de um programa com treinamento funcional por telerreabilitação sobre a função pulmonar, capacidade de exercício e qualidade de vida em pacientes pós COVID-19: ensaio clínico randomizado

Abstract

Introduction: 2020 was marked by the COVID-19 pandemic caused by SARS-CoV-2. This viral disease can damage several systems, and the respiratory system becomes the main target to establish systemic sequelae and dysfunctions that, when associated, can predispose to intolerance to physical exertion. Face-to-face physical rehabilitation strategies to restore impaired functions in these patients is a challenge, mainly due to the restrictive measures of social isolation and in this sense, remote home strategies can contribute to the recovery of patients after COVID 19. Aim: to evaluate the effectiveness and feasibility of a functional training program for telerehabilitation on lung function, exertion tolerance and quality of life in post-COVID-19 individuals. Methods: randomized clinical trial, with the participation of individuals recovered from COVID-19 who were allocated to the functional training group with telerehabilitation and lectures (GT) and a control group with lectures (CG). Thirty individuals were evaluated (60% women) with a mean age of 48.2 ± 12.8 years and a mean BMI of 29.0 ± 6.3 kg/m2. The intervention protocol lasted for eight weeks, performed by video call during 3x/week. A total of eight lectures on health education themes were held with remote meetings every two weeks between researchers and participants. Lung function, exercise tolerance and quality of life were evaluated. Statistics were performed using Excel spreadsheets and the SPSS 20.0 program. Normality and homoscedasticity were assessed using the Shapiro-Wilk and Levene tests, respectively. For inferential analyses, the one-way ANOVA test with Post hoc Bonferroni, Student's t test or Mann-Whitney U test were used. It was considered as a statistical difference p < 0.05. Results: in the intragroup analysis, there was a significant increase in vital capacity (VC) and FEV1 for the TG (p = 0.000; p = 0.001), with an increase in VC for the CG (p = 0.006). There were no significant differences in forced VC for the TG and CG (p = 0.144; p = 0.383, respectively) and in the FEV1/FVC ratio (p = 0.275; p = 0.197, respectively). In the analysis of the mean difference between groups, it appears that VC and FEV1 presented better responses with functional training (p = 0.032; p = 0.018, respectively). No other statistical differences were found for FVC and FEV1/FVC (p = 0.167; p = 0.434, respectively). The TG had a significant increase in the distance covered (469.80 [429.43 - 510.16] vs 591.63 [560.04 - 623.23] meters; p = 0.003). In the analysis between groups, the TG had an increase of 121.84 meters and the CG was of 6.56 meters (p = 0.000). In the intragroup analysis, the CG showed a significant reduction in oxygen saturation (98.2 [97.9 - 98.5] vs 97.9 [97.5 - 98.2] %; p = 0.048), but with no statistical difference in the analysis between groups (p = 0.115). No significant differences were observed in the intragroup and between-group analyzes in the subjective perception of exertion and respiratory rate (p > 0.05, for all comparisons). In the intragroup analysis, the TG had an improvement in all domains of quality of life (p < 0.05). In the analysis of the mean difference between groups, it is observed that the TG showed improvement compared to the CG, in the domains of functional capacity (p = 0.015), physical limitations (p = 0.03), pain (p = 0.00), vitality (p = 0.04) and in the overall score (p = 0.04). Conclusion: remotely supervised functional training was able to improve pulmonary parameters, exercise tolerance and quality of life in patients who presented sequelae after COVID-19. The telerehabilitation protocol with functional training proved to be safe and effective in recovering the functionality of individuals who survived COVID-19.