Table 1.
Characteristics of included studies.
| References Study design | Sample size |
Age (years)
Mean (SD) |
Inclusion criteria | ICU/MV history | Co-morbidity | Comparison groups | Treatment regimen | Frequency | Total session/ duration/ follow-up | Outcomes |
|---|---|---|---|---|---|---|---|---|---|---|
| Liu et al. (16) China 2020 RCT |
36 | 69.4 (8.0) | 1. A definite diagnosis of COVID-19; 2. Aged ≥ 65 years; 3. 6 months after the onset of other acute diseases; 4. MMSE score > 21; 5. No COPD or any other respiratory disease; 6. FEV1 in 1s ≥70%. |
NR | Hypertension T2MD osteoporosis | E: respiratory rehabilitation | Respiratory muscle training(device-based: threshold PEP); Cough exercise; diaphragmatic training; stretching exercise; home exercise. |
10 min/ session, 2 sessions/ week |
6 weeks | 1. Pulmonary function (FEV1, FVC, FEV1/FVC, DLCO) 2. Exercise capacity (6-MWT) 3. QoL (SF-36) 4. Activities of daily living (FIM scale) 5. Anxiety and depression assessment(SDS, SAS) |
| 36 | 68.9 (7.6) | C: no care | N/A | N/A | N/A | |||||
| Abodonya et al. (15) Saudi Arabia 2021 quasi-RCT |
21 | 48.3 (8.5) | 1. Negative COVID; 2. Hemodynamically stable; 3. Respiratory rate <25breath/min; 4. Negative inspiratory force <25 cm H2O; 5. Minute ventilation <10L/min; 6. PO2/FIO2 > 200. |
All admitted in ICU (mean length of MV 13.3 ± 7.6d/ 12.9 ± 8.4d) |
NR | E: IMT+IBE | 6 inspiratory cycles with 5min of resisted inspiration, followed by 60-second rest time in each cycle (device-based: threshold PEP) | 2 sessions/ day, 5 days/week |
20 sessions/ 2 weeks |
1. Pulmonary function (FEV1, FVC, DSI) 2. Exercise capacity (6-MWT) 3. QoL (EQ-5D-3L) 4. Dyspnea severity index (DSI) |
| 21 | 47.8 (9.2) | C: IBE | NR | 2 times daily | 14 times/ 2 weeks | |||||
| Li et al. (17) China 2020 RCT |
59 | 49.2 (10.8) | 1. Discharged from one of the participating hospitals after inpatient treatment for COVID-19; 2. mMRC dyspnea score of 2–3. |
86.6% with Oxygen support or non-invasive ventilation |
Heart disease Hypertension Diabetes Obesity Lung disease (including Inactive TB) Others |
E: TERECO+ education |
Breathing control and thoracic expansion, aerobic exercise, LMS exercises specified in a 3-tiered exercise plan with difficulty and intensity scheduled to increase over time. +short education as control | 40–60 mins/session, 3–4 sessions/ week + teleconsultations once/week |
18-24 sessions/ 6 weeks, follow up for 28 weeks |
1. Exercise capacity (6-MWT) 2. LMS (static squat test) 3. Pulmonary function (FEV1, FVC, FEV1/FVC, MVV, PEF) 4. QoL (SF-12) 5. Perceived dyspnea (mMRC) 6. Adverse events |
| 60 | 52.0(11.1) | C: education | 10-min standardized educational Instruction on exercise, life-style, basic hygiene | Once at baseline | follow up for 28 weeks |
MV, mechanical ventilation; E, experiment group; C, control group; MMSE, mini-mental state examination; T2DM, type 2 diabetes mellitus; PEP, positive expiratory pressure; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; DLCO, diffusing lung capacity for carbon monoxide; 6-MWT, 6-min walk test; FIM, Functional Independence Measure; QoL, quality of life; SF-36, Short Form Health Survey-36; SDS, self-rating depression scale; SAS, self-rating anxiety scale; IMT, inspiratory muscle training; IBE, incentive spirometer exercise; Eq-5D-3L, EuroQuality-5Dimensions-3Levels questionnaire; DSI, dyspnea severity index; mMRC dyspnea score, modified British Medical Research Council dyspnea score; TERECO, tele-rehabilitation program for COVID-19; LMS, lower limb muscle strength; MVV, maximum voluntary ventilation; PEF, peak expiratory flow; SF-12, Short Form Health Survey-12; NA, not applicable; NR, not reported.