ORIGINAL ARTICLE Open access and CC-BY licensed

Effects of physical
training on the quality
of life of patients with
Abstract
post-COVID-19 condition
Introduction: Post-COVID-19 condition has a significant
impact on the quality of life (QOL) of the affected indivi-
Efeitos do treinamento físico na duals. Objective: To describe the effects of a pulmonary
rehabilitation (PR) program on the health-related quality
qualidade de vida de pacientes of life (HRQOL) of patients with post-COVID-19 condition

com síndrome pós-COVID-19 and understand the aspects relevant to their quality of
life. Methods: This is a quasi-experimental study, using
an interrupted time series design, involving adult men
and women with a history of hospitalization due to
SARS-CoV-2 and post-COVID-19 condition who were
Andreane Daniele Barbosa de Lira 1,2*
referred for PR between February 2021 and December
Alexandra Ignes Bruni Tulio 1,2 2022. Participants were assessed pre- and post-PR for
Heloísa Rodrigues Alves Bobato 2 clinical information, quality of life (using the Nottingham
Regina Helena Senff Gomes 2 Health Profile - NHP), overall peripheral muscle strength
Arlete Ana Motter 1 (dynamometry), and dyspnea during activities of daily
living (ADLs) (mMRC scale). Results: Thirty-nine indivi-
duals participated in the study, 22 (56.4%) of whom
1
Universidade Federal do Paraná (UFPR), Programa de Pós-Graduação em
Saúde Coletiva, Curitiba, PR, Brazil
were women, with a mean age of 55.8 (± 9.98) years.
2
Complexo do Hospital de Clínicas, Universidade Federal do Paraná (UFPR) The most common persistent symptoms were fatigue
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Curitiba, PR, Brazil (64.1%), dyspnea (59%), memory impairment (30.8%),
and pain (28.2%). Of the six NHP domains, five showed
significant improvement after the intervention. The me-
dian total NHP score decreased from 11 points pre-
PR to 6 points post-PR (p < 0.001). Dynamometry and
mMRC scores also exhibited statistically significant im-
provements after PR. Conclusion: Individuals with post-
COVID-19 condition experience important impairments
in HRQOL, across physical, emotional, social, and sleep-
related domains. Pulmonary rehabilitation, through phy-
sical training, produced positive effects by improving
Date of first submission: June 13, 2024
Last received: March 3, 2025 QOL, increasing overall peripheral muscle strength, and
Accepted: March 27, 2025 reducing dyspnea during ADLs.
Associate editor: Ana Paula Cunha Loureiro
Keywords: Physiotherapy. COVID-19. SARS-CoV-2. Long
*Correspondence: andreane.daniele@gmail.com COVID. Rehabilitation.

Fisioter. Mov., 2025, v. 38, e38115 DOI: 10.1590/fm.2025.38115

 FISIOTERAPIA EM MOVIMENTO Physical Therapy in Movement

Resumo Post-COVID-19 condition, also referred to as long

COVID, is characterized by a set of symptoms that per-
Introdução: A síndrome pós-COVID-19 tem impacto signi- sist or emerge for the first time after the SARS-CoV-
ficativo na qualidade de vida dos indivíduos acometidos. 2 infection, and may last for weeks or months after
Objetivo: Descrever os efeitos de um programa de reabilita- the initial recovery phase.1-4 What differentiates long
ção pulmonar (RP) sobre a qualidade de vida relacionada à COVID from other post-viral syndromes is its conside-
saúde (QVRS) de pacientes com síndrome pós-COVID-19 e rably higher epidemiolo-gical burden, up to six times
compreender os aspectos pertinentes à qualidade de vida more prevalent than similar conditions resulting from
destes pacientes. Métodos: Trata-se de um estudo quase-ex- other viral infections.5
perimental, do tipo série de tempo interrompida, com adultos The lingering effects of SARS-CoV-2 infection can
de ambos os sexos, com histórico de internação pelo SARS- impact multiple organ systems, commonly leading to
CoV-2 e síndrome pós-COVID-19, encaminhados para RP en- fatigue or muscle weakness, dyspnea, chest pain, sleep
tre fevereiro/2021 e dezembro/2022. Os participantes foram and emotional disturbances, arthralgia, and a decline
avaliados quanto às informações clínicas, qualidade de vida in QOL.2,6-9 Multiple, potentially overlapping factors
(Perfil de Saúde de Nottingham - PSN), força muscular peri- are believed to contribute to post-COVID-19 condi-
férica global (dinamometria) e dispneia às atividades de vida tion. These include persistent SARS-CoV-2 reservoirs in
diária (escala mMRC) pré e pós-RP. Resultados: Participaram tissues, immune dysregulation, sustained inflammation,
do estudo 39 sujeitos, sendo 22 (56,4%) do sexo feminino, tissue dysfunction and damage resulting from exces-
com idade média de 55,8 (+ 9,98) anos. As principais quei- sive inflammation, nonspecific effects of hospitalization,
xas persistentes foram fadiga (64,1%), dispneia (59%), altera- sequelae of critical illness, comorbidity-related compli-
ção de memória (30,8%) e dor (28,2%). Dos seis domínios cations, and adverse effects of medications.10-12
do PSN, cinco apresentaram melhora significativa pós-inter- Prolonged symptoms are a significant burden on
venção. A mediana do escore total do PSN foi de 11 pontos the quality of life QOL of COVID-19 survivors, and may
no pré para 6 pontos no pós-RP (p < 0,001). Dinamometria persist for months following the acute infection.4,13
e mMRC também apresentaram diferença estatística signifi- Moreover, evidence suggests that post-COVID-19
cativas pós-RP. Conclusão: Indivíduos com síndrome pós- condition may become a major psychosocial and
COVID-19 apresentam alterações importantes na QVRS, evi- economic challenge.14
denciadas por alterações físicas, emocionais, sociais e do It is well established that the repercussions of a di-
sono. A RP, por meio do treinamento físico, demonstrou efei- sease extend beyond clinical outcomes such as morta-
tos positivos na melhoria da qualidade de vida e também lity and morbidity, encompassing subjective measures
sobre o ganho de força muscular periférica global, e redução including health-related quality of life (HRQOL). This
da dispneia às atividades de vida diária. multidimensional construct includes physical, mental,
social, and emotional domains and can be assessed
Palavras-chave: Fisioterapia. COVID-19. SARS-CoV-2. COVID through generic or specific instruments validated for
longa. Reabilitação. different populations.15
In public health research and practice, QOL mea-
sures are valid and appropriate indicators of interven-
tion outcomes, incorporating objective and subjective
Introduction evaluations. These HRQOL data help determine public
policies, planning strategies, and therapeutic interven-
Following the acute phase of the pandemic, it is tions.16
now understood that the impact of SARS-CoV-2 infec- Consequently, investigating HRQOL is crucial for e-
tion extends beyond the initial illness. Between 10 and valuating the impact of diseases, disorders, or impair-
20% of those who recover from the disease experience ments in physical, mental, and social domains.17 Thus,
symptoms that negatively affect their health and quality patient-reported QOL is also a significant parameter
of life (QOL), a condition known as post-COVID-19 for identifying individuals with a substantial burden of
condition.1 post-COVID-19 symptoms.14

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 FISIOTERAPIA EM MOVIMENTO Physical Therapy in Movement

Among multiple treatments, physiotherapy through “yes” response is scored as one (1) point, and each “no”
exercise-based pulmonary rehabilitation (PR) programs response as zero (0), resulting in a maximum score of
is effective in improving functional capacity, dyspnea, 38, where higher scores indicate poorer QOL.21
and HRQOL, as demonstrated by studies related to Overall peripheral muscle strength was also eva-
other pulmonary diseases.18,19 luated using the handgrip strength test, based on the
Given the above, the present study aimed to des- maximum value recorded by dynamometry, a simple
cribe the effects of a PR program on the HRQoL of yet valid measure of overall muscle strength.22 Partici-
patients with post-COVID-19 condition and understand pants were seated with the dominant upper limb fle-
the aspects relevant to their quality of life. xed at the elbow at a 90° angle, and the forearm close
to the body. They were instructed to apply maximum
grip force for approximately three seconds using a
Methods hydraulic hand dynamometer (Saehan Medical, model
SH5001), with a 15-second rest period. Three measure-
This is a quasi-experimental study using an inter- ments were obtained, and the highest value was used
rupted time series design, and a convenience sample for analysis.
of adults with post-COVID-19 condition referred for Dyspnea experienced during ADLs was assessed
PR between February 2021 and December 2022. using the Modified Medical Research Council Dysp-
The research was conducted at the Physiotherapy nea Scale (mMRC). Participants reported their percei-
Outpatient Clinic of the Hospital de Clínicas Complex ved level of dyspnea by selecting a score ranging
at the Federal University of Paraná, following approval from 0 to 4, where 0 = dyspnea only with strenuous
by the Research Ethics Committee (CAAE: 47158821. exercise; 1 = breathlessness when walking quickly on
6.0000.0096, protocol number 4.805.035). All partici- level ground or up a gentle slope; 2 = walking slower
pants who agreed to take part in the study gave their than others the same age due to breathless or stop-
written informed consent. ping for breath when walking at own pace on level
Inclusion criteria were history of hospitalization with ground; 3 = short of breath after walking a few minu-
a positive COVID-19 test, age > 18 years, both sexes, tes or 90 to 120 meters on level ground; 4 = too breath-
not currently engaged in physical activity, and a me- less to leave the house or breathless when dressing or
dical referral for PR. Exclusion criteria included pre- undressing.²³
existing motor/functional impairments, severe cardio- All participants were evaluated before and after
vascular diseases, cognitive impairments, pregnant and the intervention by one of the study’s physiothera-
puerperal women, peripheral oxygen saturation < 80% pists, who had been previously trained in the proto-
at rest, resting heart rate above the maximum recom- col, and assessed HRQOL (NHP), overall peripheral
mended for age, and any limitation and/or contraindi- muscle strength (dynamometry), and dyspnea during
cation to aerobic training. ADLs (mMRC).
For data collection, a standardized evaluation form To determine the appropriate aerobic training load,
developed by the researchers, encompassing socio- all participants underwent an incremental lower-limb
demographic, anthropometric, and clinical information, exercise test on a treadmill or stationary bicycle du-
was used. Body mass index (BMI) was calculated using ring the initial assessment. The test began with a 3-
weight and height, and individuals with a BMI exceed- minute warm-up at zero incline, to allow participants
ing 30 kg/m² were classified as obese, and those be- to establish a comfortable walking or cycling speed.
low as non-obese.20 Following the warm-up, the treadmill incline was in-
The Nottingham Health Profile (NHP) was used creased by 1% per minute, while monitoring heart rate,
to assess HRQOL. This is a generic QOL assessment oxygen saturation, and the Borg scale (ranging from
instrument comprising 38 items based on the World 0, indicating no effort to 10, indicating maximal effort)
Health Organization's disability classification, with “yes” for both dyspnea and lower-limb fatigue. The test was
or “no” response options. The items are categorized terminated based on the participants’ perception of
into six domains: energy level (3 items), pain (8 items), dyspnea or fatigue (Borg scale), pain, or if their heart
emotional reactions (9 items), sleep (5 items), social rate exceeded the predicted maximum. The test (ex-
interaction (5 items), and physical skills (8 items). Each cluding warm-up) lasted between 8 and 12 minutes.

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 FISIOTERAPIA EM MOVIMENTO Physical Therapy in Movement

If the test duration fell outside this range, it could be The proposed intervention consisted of eight weeks
repeated on a subsequent day with adjustments to of PR involving physical training, at a frequency of two
the initial speed. For participants unable to use the to three individual one-hour sessions per week. These
treadmill, the test was administered on a stationary sessions were conducted under the direct supervi-
bike, with workload increments measured in watts. For sion of a physiotherapist, with continuous monitoring of
rehabilitation, 80% of the maximum load achieved maximum heart rate, oxygen saturation, and perceived
during the test was prescribed, while maintaining the exertion. The PR protocol used in this study is presented
established speed.24 in Table 1.

Table 1 - Proposed rehabilitation program

Protocol Exercises Time (minutes)

Warmup Active upper limb exercises, static gait 5
Aerobic training Treadmill or stationary bicycleat 80% of incremental test load 30
Muscle strengthening Upper and lower limbs,3 sets of 8 to 12 repetitions 5
Functional training Balance and gait training, functional exercises 5
Muscle stretching Global 8
Breathing exercises Ventilatory patterns, broncheal hygiene (if needed) 5
Educational guidance on the diseases, preventive 2
Guidance
easures and at-home exercises
If peripheral oxygen saturation (SpO2) < 88%, Time required to adapt SpO2
Oxygen supplementation
follow the same incremental test parameters

Statistical analysis relation Coefficient). For all statistical tests, the signifi-
cance level was set at p < 0.05.
The collected data were tabulated and analyzed
using Jamovi statistical software (version 2.5.0). Results
are presented as means with standard deviations, and Results
absolute and relative frequencies, according to the na-
ture of the variable. The Shapiro-Wilk test was used to During the study period, a total of 71 individuals
assess the normality of data distribution. To determine visited the physiotherapy clinic for PR due to post-
statistical significance, different tests were applied, ba- COVID-19 condition, 46 of whom met the inclusion cri-
sed on the type of variable. For quantitative variables teria and were subsequently recruited. Among the eli-
exhibiting a normal distribution, the parametric paired gible paricipants, seven were lost to follow-up (Figure 1).
Student’s t-test was used. For quantitative variables lack- The final sample consisted of 39 participants with
ing a normal distribution or ordinal qualitative variables, post-COVID-19 condition, 22 (56.4%) of whom were
the Wilcoxon non-parametric test was applied. women, with a mean age of 55.8 years (± 9.98), a
To conduct a multivariate analysis of the effect of mean BMI of 32 kg/m2 (± 4.52), and mean hospital
time on the NHP score, a linear mixed-effects model stay due to COVID-19 of 25.5 days (± 15.9). The pri-
was constructed using REML (Restricted Maximum Li- mary comorbidities were obesity, present in 27 indivi-
kelihood Estimation). The dependent variable was the duals (69.2%), and hypertension, in 22 (56.4%). The most
NHP score, and predictor variables were selected based frequently reported persistent symptoms included fa-
on their theoretical relevance. The model’s goodness tigue, reported by 25 participants (64.1%), dyspnea by
of fit was assessed using quality metrics such as AIC 23 (59%), memory impairment by 12 (30.8%), and pain
(Akaike Information Criterion), BIC (Bayesian Informa- by 11 (28.2%) Additional epidemiological data for the
tion Criterion), R-squared (R2) and ICC (Intraclass Cor- sample are presented in Table 2.

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 FISIOTERAPIA EM MOVIMENTO Physical Therapy in Movement

Visited the physiotherapy clinic

Selection

for post-COVID-19 pulmonary

rehabilitation (n = 71) Declined to participate in the study (n = 15)

Excluded (n = 10)
Severe cardiovascular disease (n = 3)
Previous motor/functional impairment (n = 3)
Pregnant/puerperal women (n = 2)
Contraindication to aerobic training (n = 1)
Cognitive impairment (n = 1)
Eligibility

Individuals with post-COVID-19

condition recruited (n = 46)

Sample losses (n = 7)
Deviation from the aerobic protocol (n = 3)
Interrupted the rehabilitation program (n = 4)
Inclusion

Data analysis (n = 39)

Figure 1 - Flowchart of data collection.

Table 2 - Overall study participant data (n = 39) In the initial QOL assessment, conducted using the
NHP, all participants reported a certain level of impair-
Overall Data n (%) ment in some of the items evaluated, with a minimum
Women 22 (56.4) of 1 and maximum of 30 affirmative responses. Among
Men 17 (43.6) the 38 items comprising the NHP questionnaire, five
Age (years)* 55.80 ± 9.98 exhibited the highest affirmative response frequencies
Body mass index* 32.00 ± 4.52 before the intervention, with significant percentages, as
Days hospitalized* 25.50 ± 15.90 follows: Item 26 – "I lose my energy quickly" (energy level
Days in the intensive care unit* 14.50 ± 16.20 domain) was reported by 64.1% of participants; Item 17
Days on invasive mechanical ventilation* 9.59 ± 12.10 – "I have difficulty climbing up and down stairs or steps"
Comorbidities (physical abilities domain) by 61.5% of participants; Item
Obesity 27 (69.2) 11 – "I have difficulty bending down" (physical abilities
Hypertension 22 (56.4) domain) by 59%; Item 27 – "I have difficulty standing
Dyslipidemia 9 (23.1) for long periods (at the kitchen sink or waiting for the
Diabetes 8 (20.5) bus)" (physical abilities domain) by 59%; and Item 3 –
Hypothyroidism 7 (17.9) "Things are making me feel discouraged/depressed"
Complaints (emotional reactions domain) by 51.3%.
Fatigue 25 (64.1) Following the intervention protocol, all these items
Dyspnea 23 (59.0) showed improvement, with affirmative response fre-
Memory impairment 12 (30.8) quencies decreasing to 25.6% for items 26, 17, and
Pain 11 (28.2) 11, 51.3% for item 27 and 10.3% for item 3. For the re-
Others 17 (43.6) maining items, the affirmative response frequencies
varied from 0 to 48.7% before and 0 to 35.9% after the
Note: *Data shown as mean and standard deviation. intervention.

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In regard to HRQOL, with respect to NHP domains, by the total NHP score, which decreased from a median of
while the “social interaction” domain showed a trend 11 points pre-rehabilitation to 6 points post-rehabilitation
toward improvement, this change was not statistically (p < 0.001). With respect to global peripheral muscle
significant (p = 0.086). However, all the other domains, strength (assessed by dynamometry) and dyspnea
namely, energy le-vel, pain, emotional reactions, sleep, during ADLs (assessed by the mMRC scale), which were
and physical skills, improved substantially, as shown in also investigated in this study, the intervention improved
Table 3. This posi-tive impact on QOL is also supported muscle strength and reduced dyspnea (Table 3).

Table 3 - Measures of the variables before and after the pulmonary rehabilitation protocol (PRP)

Variables Pre-PRP Post-PRP p-value*

Quality of life
Energy level domain 1 [0.0 – 1.0] 0 [0.0 – 1.0] 0.001
Pain domain 2 [1.0 – 5.0] 1 [0.0 – 3.0] 0.014
Emotional reaction domain 4 [0.0 – 4.0] 1 [0.0 – 2.0] < 0.001
Sleep domain 1 [0.5 – 3.5] 1 [0.0 – 2.0] 0.001
Social interaction domain 0 [0.0 – 2.0] 0 [0.0 – 1.0] 0.086
Physical skills domain 3 [2.0 – 4.0] 1 [0.0 – 2.0] < 0.001
Total NHP score 11 [7.0 – 16.5] 6 [3.0 – 11.0] < 0.001
Overall peripheral muscle strength
Dynamometry 28 [22.0 – 32.0] 30 [24.0 – 35.0] < 0.001
Dyspnea during ADLs
mMRC 2 [1.0 – 3.0] 1 [0.0 – 1.0] < 0.001

Note: NHP = Nottingham Health Profile; ADLs = activities of daily living; mMRC = Modified Medical Research Council Dyspnea Scale.

Regression analysis using a mixed linear model con- the NHP score was explained by the model, and mo-
firmed that the difference between pre- and post-in- derate data reliability, as indicated by the ICC of 0.58.
tervention NHP scores had an estimated effect of -4.94,
with a standard error of 0.82 and 95% confidence in-
terval ranging from -6.57 to -3.32. This effect was statis- Discussion
tically significant (t = -5.96; p < 0.001), indicating an
improvement in QOL, independent of other variables. The demographic profile of the study sample indi-
The model also revelead that age had a significant cated that 56.4% were women. This suggests a po-
negative effect (t = -2.48; p = 0.019), with an estimate tential tendency for women to require referral for pul-
of -0.25 and a standard error of 0.10, suggesting that monary rehabilitation due to post-COVID-19 condition.
older age is associated with a smaller change in the Several authors have reported a higher risk for long-
total NHP score. The significant interaction between the term symptoms, such as persistent dyspnea and fati-
difference in post- and pre-intervention scores and age gue, in women.25 It is well-established that post-COVID-
(t = 2.25; p = 0.03) indicates that the change in NHP 19 condition can manifest in patients who experienced
scores resulting from the rehabilitation program varied both severe and mild or moderate forms of the disease.
according to age. The other variables included in the However, evidence suggests that 30% of hospitalized
mixed linear model showed no significant effects (Table patients with SARS-CoV-2 develop the chronic form.26
4). The model demonstrated a good overall fit, eviden- Hospitalization for COVID-19 was an inclusion criterion
ced by the high R² value (coefficient of determination for this study, with an average stay of 25.5 days, corro-
= 0.75), demonstrating that 75% of the variability in borating literature findings.

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 FISIOTERAPIA EM MOVIMENTO Physical Therapy in Movement

Table 4 - Multivariate analysis of the effect of time on the Nottingham Health Profile (NHP) score using a mixed
linear model regression

Variables Estimate (β) SE CI (95%) df t p-value

Intercept 10.05 0.89 8.29/11.81 30 11.19 < 0.010
Group 1 (NHP post-PR/pre-PR) -4.94 0.82 -6.57/-3.32 37 -5.96 < 0.001
Sex (Male/Female) -2.52 2.41 -7.26/2.22 30 -1.04 0.306
Age -0.25 0.10 -0.44/-0.05 30 -2.48 0.019
IMV duration (days) -8.68 0.06 -0.13/0.13 30 -0.01 0.990
Obesity (Yes/No) -3.32 2.15 -7.54/0.88 30 -1.54 0.132
mMRC pre-PR 0.87 1.19 -1.46/3.21 30 0.73 0.467
mMRC post-PR 1.37 1.34 -1.26/4.01 30 1.01 0.316
Dynamometry pre-PR -0.21 0.32 -0.86/0.42 30 -0.66 0.510
Dynamometry post-PR 0.05 0.33 -0.60/0.71 30 0.16 0,872
Group 1 (NHP post-PR/pre-PR) *Age 0.18 0.08 0.02/0.35 37 2.25 0.030

Note: Data presented as coefficient (β) and confidence interval (CI). SE = standard error; df = degrees of freedom; t = t-statistic; PR = pulmonary
rehabilitation; IMV = invasive mechanical ventilation; mMRC = modified Medical Research Council dyspnea scale.

With respect to the incidence of comorbidities, the The high pre-intervention frequencies of reported
high prevalence of obesity, present in 69.2% of the difficulties in performing simple daily tasks such as
subjects in this analysis, warrants attention. Thus, it can climbing up and down stairs, bending down, standing
be inferred that obese patients are more susceptible for extended periods, and feelings of low energy and
to the persistent symptoms of COVID-19. discouragement, reinforce the need and responsibility
In Latin America, studies have shown that indivi- of healthcare professionals to provide comprehensive
duals with obesity infected with SARS-CoV-2 are 113% and well-planned therapy for these individuals, consi-
more likely to require hospital care, 74% more likely to dering physical, emotional, and social aspects. Authors
need intensive care, and 48% more likely to die when report that integrative care is essential to address the
compared to normal weight individuals.27 multisystemic needs of this population.30
Among patients with post-COVID-19 condition, long- The data presented are consistent with other sci-
term symptoms vary. In this sample, the most frequent entific reports on impaired QOL due to post-COVID-19
complaints were fatigue, dyspnea, memory impairment, condition, where difficulties in performing daily activi-
and pain. Similarly, a study conducted 12 months after ties, such as washing and dressing, and an inability to
the viral infection also concluded that mainly fatigue maintain routine activities, were observed, contributing
and memory impairment persisted for more than one to feelings of frustration and guilt and generating a
year in these patients.28 high level of stress.29 Assessment of the clinical varia-
All participants in this study reported some level bles measured through the research protocols demons-
of QOL decline, as evidenced by at least one positi- trated that the eight-week PR program using physical
ve response on the NHP. The persistent symptoms re- training improved HRQOL.
ported (fatigue, dyspnea, memory impairment, pain) In this context, the "energy level," "pain," "emotional
alone could account for this alteration in HRQOL. Fur- reactions," "sleep," and "physical skills domains," exhibit-
thermore, the duration of hospitalization, and the po- ing significantly lower scores after the intervention, de-
tential post-traumatic stress and anxiety arising from monstrate that participants showed improvements in
post-illness uncertainties, may also have contributed to all these categories, which is also confirmed by the re-
this impairment. These assumptions are also supported duction in total NHP score. This is a significant finding
by existing literature on the topic.29 that, in conjunction with other studies, underscores the

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 FISIOTERAPIA EM MOVIMENTO Physical Therapy in Movement

impact of post-COVID-19 condition on physical and pulmonary rehabilitation as an effective strategy for
emotional function, participation in society, and, con- the recovery of patients with post-COVID-19 condition,
sequently, QOL.31 Pulmonary rehabilitation can be an contributing to restoring functionality and promoting
important strategy for healthcare management in this overall well-being.
population. Similarly, the other clinical variables stud-
ied also benefited from the intervention, with improve-
ments in peripheral muscle strength and a reduction in Authors’ contributions
dyspnea during ADLs in patients with post-COVID-19
condition. All the authors contributed to the study’s concep-
The findings presented above are consistent with tion, design, data analysis, and interpretation. ADBL and
other similar studies, where exercise programs based AIBT wrote and revised the manuscript, while HRAB,
on PR principles improved the QOL and functional ca- RHSG, and AAM critically reviewed its content. All the
pacity of patients following SARS-CoV-2 infection.32,33 authors approved the final version.
The indices suggesting that the change in NHP
scores resulting from the rehabilitation program varied
according to age, indicating that older age was asso- References
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