The Effects of Exercise Training on Recovery of Biochemical and Hematological Outcomes in Patients Surviving COVID-19: A Randomized Controlled Assessor-Blinded Trial

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Abstract

Background

No previous research has investigated the direct effects of exercise interventions on COVID-19 outcomes. The aim is to investigate the effect of 8 weeks of home-based moderate-intensity continuous training (MICT), resistance training (RT), and combined aerobic and resistance training (CET) on biochemical and hematologic markers associated with COVID-19 symptoms and severity in COVID-19 survivors.

Methods

A total of 547 male and female COVID-19 survivors were screened, and 296 (aged 20–93 years) were randomly assigned in a 1:1:1:1 ratio to one of four groups: MICT ( n = 74), RT ( n = 74), CET ( n = 74), or non-exercise (NON-EX, n = 74). Blood samples were taken at baseline, at week 4, and week 8 after training.

Results

After the intervention, compared with the NON-EX group, all 3 MICT, RT, and CET interventions caused significant improvements in the levels of creatine kinase (CK), lactate dehydrogenase (LDH), C-reactive protein (CRP), troponin-I, d-dimer, creatinine, urea, potassium (K), sodium (Na), white blood cell (WBC), neutrophils, lymphocytes, red blood cells (RBC), platelets, hemoglobin, and hematocrit concentrations ( P < 0.05). CET was effectively superior to MICT and RT in the improvements in the biochemical and hematological variables studied ( P < 0.05).

Conclusions

Overall, the present study demonstrates that long-term MICT plus RT interventions have a synergistic effect in accelerating and enhancing the recovery in patients surviving COVID-19.

Trial registration IRCT20160605028270N3, 6 September 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-022-00546-4.

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Most cited references 61

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Fiona Bull, Salih Al-Ansari, Stuart Biddle … (2020)

Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.

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Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China

Shaobo Shi, Mu Qin, Bo Shen … (2020)

Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. However, information on cardiac injury in patients affected by COVID-19 is limited.

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Author and article information

Contributors

Bakhtyar Tartibian: ba.tartibian@gmail.com

Sirwan Mohammad Amini Khayat: St-s.mohammadamini@urmia.ac.ir

Behzad Hajizadeh Maleki: hajizadeh.sci.phys@gmail.com

Mohammad Chehrazi:

ORCID: http://orcid.org/0000-0003-1770-4170

mohamadchehrazi@gmail.com

Journal

Journal ID (nlm-ta): Sports Med Open

Journal ID (iso-abbrev): Sports Med Open

Title: Sports Medicine - Open

Publisher: Springer International Publishing (Cham )

ISSN (Print): 2199-1170

ISSN (Electronic): 2198-9761

Publication date (Electronic): 23 December 2022

Publication date PMC-release: 23 December 2022

Publication date Collection: December 2022

Volume: 8

Electronic Location Identifier: 152

Affiliations

[1 ]GRID grid.444893.6, ISNI 0000 0001 0701 9423, Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, , Allameh Tabataba’i University, ; Tehran, Iran

[2 ]GRID grid.412763.5, ISNI 0000 0004 0442 8645, Department of Exercise Physiology, Faculty of Physical Education and Sport Science, , Urmia University, ; Urmia, Iran

[3 ]GRID grid.8664.c, ISNI 0000 0001 2165 8627, Department of Exercise Physiology and Sports Therapy, , Justus-Liebig-University, ; Kugelberg 62, Giessen, Germany

[4 ]GRID grid.411495.c, ISNI 0000 0004 0421 4102, Department of Biostatistics and Epidemiology School of Public Health, , Babol University of Medical Sciences, ; Babol, Iran

Author information

Mohammad Chehrazi http://orcid.org/0000-0003-1770-4170

Article

Publisher ID: 546

DOI: 10.1186/s40798-022-00546-4

PMC ID: 9782268

PubMed ID: 36562867

SO-VID: b4c5c910-a65f-478b-92e3-a6a964aebe2e

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 23 January 2022

Date accepted : 13 December 2022

Funding

Funded by: Allameh Tabataba'i University

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Keywords: covid-19,exercise intervention,randomized controlled trial,rehabilitation

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Keywords: covid-19, exercise intervention, randomized controlled trial, rehabilitation

The Effects of Exercise Training on Recovery of Biochemical and Hematological Outcomes in Patients Surviving COVID-19: A Randomized Controlled Assessor-Blinded Trial

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Novel Coronavirus Disease COVID-19

Most cited references 61

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China

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