Chart 1. Pulmonary rehabilitation for COVID-19 survivors. 3 , 11 , 12 .
| General recommendations Physical exercises must be adapted to individual needs and limitations of patients; symptoms during physical exercise (such as dyspnea, desaturation, and fatigue) should be taken into consideration; high-intensity exercises are not recommended; patients should receive instruction regarding the physical, psycho-emotional, and nutritional aspects of each stage of rehabilitation; and preventive measures, such as use of alcohol-based hand sanitizers, physical distancing, and personal protective equipment, are essential during the assessment and on-site monitoring of patients at risk of transmitting the virus or at risk of reinfection. Assessment • Need for oxygen at rest and on physical exertion; physical, cognitive, and emotional status; dyspnea; anxiety; depression; peripheral muscle strength; and respiratory function (spirometry or plethysmography) in individuals with persistent respiratory symptoms or considerable pulmonary involvement During hospitalization • Breathing exercises and bronchial hygiene, if necessary; expectoration into a closed recipient to avoid aerosolization • Early mobilization in bed; body positioning management (sitting and standing); ambulation and light aerobic exercise (walking or cycling) • Exercise characteristics - Intensity: Borg scale score ≤ 3 with a progressive increase to 4-6; frequency: 1-2 times a day; and duration: 10-45 min After hospital discharge (6-8 weeks) • Aerobic exercise: light intensity with gradual increase; 3-5 sessions per week; duration of 20-30 min; and intermittent training for patients with severe fatigue • Strength training for the lower and upper limbs: progressive resistance training in 2-3 sessions per week, 8-12 repetitions • Balance exercises, breathing exercises, and bronchial hygiene, if necessary • Home-based rehabilitation is preferred; if possible, consider instructing family members to help with supervision; if performed at an outpatient clinic, individual sessions are preferable Considerations for telerehabilitation • Patient evaluation (via telemonitoring) with application of questionnaires over the telephone or even physical evaluation by videoconference • Prescription of specific exercises for each patient, allowing them to be supervised (or not) by real-time videoconference • Diary with information about limitations and occasional discomfort during exercises, to ensure safety • Verification of the space and the safety of the place where the exercises will be performed • Aerobic exercises for the lower limbs (e.g., walking) • Strength training of the upper limbs (e.g., light weights, elastic bands, or other) • Strength training of the lower limbs (e.g., squats) • Frequency: at least twice a week to replace supervised training sessions at the outpatient clinic, in addition to an unsupervised home-based exercise program on at least two other days of the week (telemonitoring) • Reassessment via telemonitoring |