Practicalities for Exercise Prescription in Long-COVID-19 Rehabilitation. A Narrative Review

Many COVID-19 survivors worldwide suffer from persistent symptoms, impaired functional capacity and quality of life. Rehabilitation exercise interventions for the long-term physical consequences of coronavirus disease 2019 (COVID-19) are currently being reported. As a result, the clinical practice and research focus on interventions that support recovery from ongoing symptomatology, independently to hospitalization. To date, the outpatient rehabilitation programs offer various exercise modes and training intensities for people recovering from long-term symptomatology of COVID-19. This narrative review summarizes previous studies that used exercise training protocols at the outpatient rehabilitation setting, presents the effectiveness of training on the functional outcomes and provides practical issues of the application of exercise training which overcome possible respiratory and peripheral muscle limiting factors of exercise and functional capacity for patients with Long-COVID-19. To this end we make recommendations on how better to implement exercise training in future studies so as to maximize training effects. Due to lack of randomized trials, more research is needed in the field of the exercise training modalities that are more effective and in parallel more tolerable for patients with persistent post-COVID-19 symptoms. In this context, interval training mode with short exercise periods can prevent high lactate accumulation and allow more intense exercise stimuli to the deconditioned peripheral muscles with minimal cardiac strain and exercise-induced hyperventilation, thus improving exercise capacity in this patients’ population.