Eficácia de programas de exercícios físicos na condição pós-covid caracterizada por fadiga e dispneia, com impacto na funcionalidade e qualidade de vida: uma revisão sistemática e metanálise

Abstract

Background: Previous studies have indicated better overall benefits of physical training compared to recommendations for self-management of symptoms. However, the effectiveness of training specifically on dyspnea and fatigue, the most frequently reported symptoms associated with post-COVID conditions, still needs to be clarified. Objective: To compare the available scientific evidence on the effectiveness of inspiratory muscle training and multicomponent physical training in adults with symptoms of fatigue and dyspnea, at least 12 weeks after COVID-19. To analyze the changes promoted by training in lung function, cardiopulmonary fitness, peripheral muscle strength, functionality, and health-related quality of life. Method: Systematic review and meta-analysis according to the Cochrane methodology and reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. A systematic electronic search was conducted, without language or time restrictions, until August 2023, updated in September 2024, in the following databases: Cochrane Library; Embase; Epistemonikos; PEDro; PubMed/MEDLINE; LILACS/BVS; Web of Science; Scopus and OpenGrey. Two reviewers independently selected the articles, extracted the data according to a standardized extraction form, and assessed the included studies' methodological quality and the evidence quality, according to the RoB 2 and GRADE tools, respectively. Results: Of the 2,045 articles found, only 7 met the inclusion criteria. The total number of participants was 485. The mean age ranged from 30 to 70 years, with 332 (68%) females and 153 (32%) males. Three studies exclusively evaluated inspiratory muscle training or multicomponent physical training and only one study evaluated both training alone and in combination. Inspiratory muscle training significantly improved inspiratory muscle strength, MIP (MD = 22.70; 95% IC: 13.78 to 31.62), and VO2 max (MD = 4.49; 95% IC: 3.35 to 5.62). Multicomponent training significantly improved handgrip strength (MD = 3.05; 95% IC: 1.68 to 4.42), sit-to-stand test (MD = 3.55; 95% IC: 1.61 to 5.49), timed up-and-go test (MD = -1.13; 95% IC: -1.49 to -0.77), post-COVID-19 functional status scale (MD= -0.64; 95% IC: -1.13 to -0.16) and health-related quality of life (SMD = 0.75; 95% IC: 0.39 to 1.10). There were no reports of adverse events among physical training participants and treatment adherence ranged from 78% to 100%. Conclusion: Inspiratory muscle training improved cardiorespiratory outcomes, while multicomponent muscle training improved muscle strength, functionality, and fatigue. Inspiratory muscle training and multicomponent muscle training improved health-related quality of life. The quality of evidence for the outcomes evaluated was low.