Table 1.

Proposed components of a pulmonary rehabilitation programme for PTLD or for COVID survivors.

Methods
Components	Indication	Interventions	Adoptions to special settings and situations
Aerobic exercise: Endurance Training (limited evidence on COVID)1, 8, 9, 31, 78, 81, 82, 88	- Impaired exercise capacity, limited by dyspnoea, fatigue and or other symptoms. - Restriction in daily life activities.	• Treadmill and/or cycle-ergometer • 30 min. 2–5 times/week for 4–8 weeks • Continuous or interval training • Low-Intensity (40–60%) or Hight-Intensity (60–80%) set according to  - maximal heart rate (220-age) or  - maximal oxygen consumption or  - the equation of Luxton or  - symptom limited (target Borg scale ≤4) • In- or out-patients or tele-monitoring • Suggest maintenance program	• Free walks 30 min. 2–5 times/week for 4–8 weeks • Intensity set according to perceived symptoms (target Borg scale ≤4) • Out-patients or home setting • Suggest maintenance program
Strength training: Upper and lower extremities (limited evidence on TB and COVID)1, 9, 31, 78, 81, 82, 88	Sarcopenia, reduced strength of peripheral muscles. Lower muscle weakness with risk for falls. Impaired activities of daily living involving the upper extremities (including dressing, bathing, and household tasks)	• free weights (dumbbells and ankle-brace) • 20–30 min. 2–5 times/week for 4–8 weeks • 2–3 set of 6–12 repetitions • Intensity set to 80% of MVV or 1MR and/or adjusted on perceived muscles fatigue (target Borg scale ≤4) • In or out-patients or tele-monitoring Suggest maintenance program	• free weights (dumbbells and ankle-brace) • 20–30 min. 2–5 times/week for 4–8 weeks 2–3 set of 6–12 repetitions • Intensity set according to perceived muscles fatigue (target Borg scale ≤4) • Out-patients or home setting • Suggest maintenance program
Inspiratory muscle training (limited evidence on TB and COVID)1, 79, 96	Impaired respiratory muscle function, altered respiratory mechanics, decreased chest wall compliance or pulmonary hyperinflation	• load threshold devices, seated and using a nose clip • Intensity/load set at 30–60% of maximal inspiratory pressure • Interval training, 3 sets with10 breaths followed by 1-minute break between each set. • 15–20 min. 2–5 times/week for 4–8 weeks	Not applicable
Calisthenics and stretching exercises (limited evidence on TB and COVID)31, 79, 82	Impaired daily life activities	• Calisthenics exercises • Stretching exercises • Nordic walking or Aqua fitness or home exercise • 2–5 times per week for 30 min	• Calisthenics exercises • Stretching exercises • Home exercises • 2–5 times per week for 30 min
Respiratory exercise (limited evidence on TB and COVID)31, 78, 79, 82	Dynamic hyperinflation Resting tachypnea Dyspnoea	• Adaptive breathing strategies • yoga breathing • pursed-lips breathing • computer-aided • breathing feedback • 2–4 times per week for 30 min each	• Adaptive breathing strategies • yoga breathing • pursed-lips breathing • computer-aided • 2–4 times per week for 30 min each
Education (limited evidence on TB and COVID)31, 78	Impaired/reduced self-efficacy and collaborative Self-Management	• Structured and comprehensive educational programmes • Age specific, gender-sensitive, delivered in the local language and extended to family and/or care-givers • Individual or group sessions • 15–60 min. • Importance of physical activity and exercise to improve quality of life • Maintaining results achieved with pulmonary rehabilitation (follow-up plan) • Advantages/importance of smoking cessation and risk of comorbidities (e.g., diabetes, etc.) • Importance of adhering to medical prescriptions in terms of management of comorbidities and vaccinations • Achieving an optimal healthy life style	• Structured and comprehensive educational programmes • Age specific, gender-sensitive, delivered in the local language and extended to family and/or care-givers • Individual or group sessions • 15–60 min. • Importance of physical activity and exercise to improve quality of life • Maintaining results achieved with pulmonary rehabilitation (follow-up plan) • Advantages/importance of smoking cessation and risk of comorbidities (e.g., diabetes, etc.) • Importance of adhering to medical prescriptions in terms of management of comorbidities and vaccinations • Achieving an optimal healthy life style
Psychological support (limited evidence on COVID)1, 31, 78, 80, 81, 105, 105	Depression, anxiety and cognitive dysfunction	• Psychological assessment • Psychological support • Relaxation technique • Consider self-help group	• Psychological assessment • Psychological support • Relaxation technique • Consider Self-help group
Airway clearance techniques (limited evidence on COVID)1, 31, 78, 97	Difficult to remove secretions or mucous plugs. Frequent bronchial exacerbations (≥2/year). Concomitant diagnosis of bronchiectasis.	• Choose the technique suitable for the subject among those available, based on respiratory capacity, mucus rheology, collaboration and patient preferences • 15–30 minutes one or more times/day • Choose the duration of treatment based on chronic (long term) or acute problem (short term) • Suggest maintenance program when needed	• Choose the technique suitable for the subject among those available, based on respiratory capacity, mucus rheology, collaboration and patient preferences • 15–30 minutes one or more times/day choose the duration of treatment based on chronic (long term) or acute problem (short term) • Suggest maintenance program when needed
Long term oxygen therapy (limited evidence on TB and COVID)1, 78, 98, 99	Resting hypoxemia despite stable condition and optimal medical therapy (partial pressure of oxygen < 7.3 kPa (<55 mmHg) or ≤8 kPa (≤60 mmHg) with evidence of peripheral oedema, polycythaemia (haematocrit ≥55%) or pulmonary hypertension).	Titrate oxygen flow that maintain oxygen saturation >92–93%. • Long term oxygen therapy should be initiated on a flow rate of 1 L/min and titrated up in 1 L/min increments until oxygen saturation >90%. An arterial blood gas analysis should then be performed to confirm that a target partial pressure of oxygen ≥8 kPa (60 mm Hg) at rest has been achieved. • Ambulatory and nocturnal oximetry may be performed to allow more accurate flow rates to be ordered for exercise and sleep, respectively during rest, sleep and exertion. • Provide formal education to patients referred to home • Schedule periodic re-assessment at 3 months	Titrate oxygen flow that maintain oxygen saturation > 92–93%. • Long term oxygen therapy should be initiated on a flow rate of 1 L/min and titrated up in 1 L/min increments until oxygen saturation > 90% at rest has been achieved. • Non-hypercapnic patients initiated on long term oxygen therapy should increase their flow rate by 1 L/min during sleep in the absence of any contraindications. • Ambulatory oximetry may be performed to allow more accurate flow rates to be ordered for exercise • Provide formal education to patients referred to home • Schedule periodic re-assessment at 3 months
Long-term nocturnal non invasive mechanical ventilation (limited evidence on TB and COVID)1, 77, 100	Chronic stable hypercapnia (partial pressure of carbon dioxide >6–8 kPa (45–60 mmHg)), despite optimal medical therapy. non-invasive ventilation could be applied during aerobic training in case of severe breathlessness or reduced exercise resistance.	• Not initiating long-term non-invasive ventilation during an admission for acute on-chronic hypercapnic respiratory failure, favoring reassessment at 2–4 weeks after resolution • Titrate non-invasive ventilation setting • Titrate mask • Plan education • Consider non-invasive ventilation during exercise • Schedule an educational meeting and verifies the ability of the subject and/or a caregiver to manage the non-invasive ventilation at home	• Probably not applicable
Nutritional support (limited evidence on COVID)1, 78, 101, 102, 103	Body composition abnormalities	• Nutritional assessment • Tailored treatment from foods and medical supplements	• Nutritional assessment • Tailored treatment from foods and medical supplements • Need for financial incentives and transportation access should be evaluated