Eficácia de um protocolo de reabilitação cardiopulmonar na função pulmonar e muscular respiratória de pacientes com síndrome pós Covid-19: um ensaio clínico randomizado

Abstract

Introduction: The emergence of COVID-19 required quick and effective responses in the field of Public Health. After acute infection, 80% of people who have been infected can develop post-COVID-19 syndrome, which consists of persistent symptoms such as fatigue and dyspnea. Cardiopulmonary rehabilitation is used to enable this recovery, however, the literature is still scarce regarding the exercises that most benefit this population and which protocols and parameters are adequate to enhance the results. Objective: to evaluate the efficacy of a rehabilitation protocol on pulmonary and respiratory muscle function in patients with post-COVID-19 syndrome. Methods: This is a randomized controlled clinical trial involving two groups of participants: (1) cardiopulmonary rehabilitation; (2) control. The cardiopulmonary rehabilitation group participated in a rehabilitation program that consisted of: lung expansion therapy, respiratory muscle training, upper limb strengthening exercise and aerobic exercise on a treadmill. The control group participated in lectures remotely. The pulmonary and respiratory muscle function of the subjects and the sensation of dyspnea were evaluated. Initially, descriptive analyzes and histogram inspections were performed to determine data normality. Differences between groups and their respective 95% confidence intervals were calculated using mixed linear models with interaction terms: group and time. Results: An increase in maximal inspiratory pressure (mean difference of 26.31 cmH2O); maximum sustained load (29.41 cmH2O) and maximum sustained time (5.88 min) and reduction in dyspnea sensation (-1.45 points) was observed after the cardiopulmonary rehabilitation protocol. After the intra-group analysis, the participants of the rehabilitation group obtained improvement in forced vital capacity (0.31 L); forced expiratory volume in the first second (0.34 L) and peak expiratory flow (0.90 L/s). However, the protocol was not associated with changes in pulmonary function after inter-group analysis, the same occurred for the thickening fraction (3.32%) and diaphragmatic mobility (0.14 cm) during the basal breathing of these patients. Conclusion: Cardiopulmonary rehabilitation proved to be an important complementary alternative to existing treatments, because it improves maximal inspiratory pressure, maximum sustained load, maximum sustained time and reduces the sensation of dyspnea after inter-group analysis.