Monitored Exercise and Oxygen Therapy Improves Aerobic and Autonomic Function in Post-Acute Sequelae of SARS-CoV-2 Infection (PASC): A Case Series

Abstract Case Description: Three females (ages 34, 38, and 38) who contracted COVID-19 in March or April 2020 were treated for post-acute sequelae of SARS-CoV-2 infection (PASC) associated cardiopulmonary and autonomic dysfunction seven to eight months following acute-illness. Exercise tolerance was tested using the Bensen protocol, followed by 22 treatment sessions of graduated treadmill exercise combined with supplemental oxygen two or three times a week, after which the exercise tolerance test was repeated. All patients demonstrated improvement in autonomic function and heart rate response during exercise and demonstrated ~54% improvement in exercise tolerance. Dyspnea remitted or improved in all patients, as did other PASC symptoms, including cough, dyspnea, larynx inflammation, chest tightness, fatigue, and post-exertional malaise. Discussion: It appears that PASC is a multisystemic, inflammation-mediated condition, that affects the respiratory, cardiac, neurologic, gastrointestinal and autonomic nervous systems, with high variability in symptomatology and course, both between patients and within individuals. Patient safety should be maximized by conducting thorough cardiac, respiratory, neurologic and pre-rehabilitation evaluations to rule out potential complications related to activity and exercise. Clinical course and comprehensive monitoring of heart rate and rhythm, blood pressure, and oxygen saturation should be evaluated before exercise time and intensity is increased, very conservatively.Summary: Due to the variable nature of PASC, it is crucial to individualize treatment protocols and to modify the protocol based on patient response; however, we show that gradual, monitored exercise combined with supplemental oxygen may improve lingering symptoms and autonomic function in some PASC patients.