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Effects of a 16-week home-based exercise training programme on health-related quality of life, functional capacity, and persistent symptoms in survivors of severe/critical COVID-19: a randomised controlled trial
  1. Igor Longobardi1,
  2. Karla Goessler1,
  3. Gersiel Nascimento de Oliveira Júnior1,
  4. Danilo Marcelo Leite do Prado1,
  5. Jhonnatan Vasconcelos Pereira Santos1,
  6. Matheus Molina Meletti1,
  7. Danieli Castro Oliveira de Andrade2,
  8. Saulo Gil1,
  9. João Antonio Spott de Oliveira Boza1,
  10. Fernanda Rodrigues Lima2,
  11. Bruno Gualano1,2,
  12. Hamilton Roschel1,2
  1. 1 Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, SP, Brazil
  2. 2 Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
  1. Correspondence to Professor Hamilton Roschel, Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, 01246-903, SP, Brazil; hars{at}


Background Long-lasting effects of COVID-19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-related quality of life (HRQoL). We investigated the effects of a home-based exercise training (HBET) programme on HRQoL and health-related outcomes in survivors of severe/critical COVID-19.

Methods This was a single-centre, single-blinded, parallel-group, randomised controlled trial. Fifty survivors of severe/critical COVID-19 (5±1 months after intensive care unit discharge) were randomly allocated (1:1) to either a 3 times a week (~60–80 min/session), semi-supervised, individualised, HBET programme or standard of care (CONTROL). Changes in HRQoL were evaluated through the 36-Item Short-Form Health Survey, and physical component summary was predetermined as the primary outcome. Secondary outcomes included cardiorespiratory fitness, pulmonary function, functional capacity, body composition and persistent symptoms. Assessments were performed at baseline and after 16 weeks of intervention. Statistical analysis followed intention-to-treat principles.

Results After the intervention, HBET showed greater HRQoL score than CONTROL in the physical component summary (estimated mean difference, EMD: 16.8 points; 95% CI 5.8 to 27.9; effect size, ES: 0.74), physical functioning (EMD: 22.5 points, 95% CI 6.1 to 42.9, ES: 0.83), general health (EMD: 17.4 points, 95% CI 1.8 to 33.1, ES: 0.73) and vitality (EMD: 15.1 points, 95% CI 0.2 to 30.1, ES: 0.49) domains. 30-second sit-to-stand (EMD: 2.38 reps, 95% CI 0.01 to 4.76, ES: 0.86), and muscle weakness and myalgia were also improved in HBET compared with CONTROL (p<0.05). No significant differences were seen in the remaining variables. There were no adverse events.

Conclusion HBET is an effective and safe intervention to improve physical domains of HRQoL, functional capacity and persistent symptoms in survivors of severe/critical COVID-19.

Trial registration number NCT04615052.

  • Physical activity
  • Rehabilitation
  • Covid-19
  • Quality of life
  • Fatigue

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Contributors Designed research: IL, KG, DCOdA, SG, FRL, BG and HR. Conducted the research: IL and KG. Contributed to data collection: IL, KG, GNdOJ, DMLdP, JVPS, MMM and JASdOB. Analysed data/statistical analysis: IL and HR. Drafted the manuscript: IL, BG and HR. Guarantor: HR. All authors reviewed the manuscript critically and approved the final version. The corresponding author attests that all listed authors meet authorship criteria.

  • Funding This study was supported by grants from Fundação de Amparo à Pesquisa do Estado de São Paulo (#2021/13580-1, #2019/18039-7, #2020/15678-6, #2020/07540-4, #2020/08091-9 and #2017/13552-2 for IL, KG, MMM, GNOJ, SG and BG) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; #308307/2021-6 for HR).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.