Background: Exercise tolerance and quadriceps strength (QF) are reduced in patients with long COVID-19 syndrome several months after the acute phase of the disease. The effect of pulmonary rehabilitation (PR) on exercise tolerance and QF is inconclusive.

Aim: To investigate the effect of a hybrid PR program, combining outpatient and home-based PR, on exercise capacity and QF in long COVID-19 syndrome.

Methods: 38 patients (age (mean±SD): 57±12 yrs.) with excessive fatigue due to long COVID-19 syndrome (FACIT score (26±10) were allocated to PR (n=24) or usual care (UC) (n=14) groups, 132±75 days from hospital discharge. PR consisted of 8 outpatient sessions (twice weekly for 4 weeks), and 24 home- based sessions (3 times/week for 8 weeks). Patients in the UC were instructed to be physically active. Exercise tolerance was assessed by a ramp incremental CPET to the limit of tolerance. QF was assessed via an isometric strength test.

Results: Exercise tolerance was increased in the PR group (by 18±9 Watt, p<0.05) leading to greater oxygen consumption (by 2.3±1.6 ml/min/kg, p<0.05) following the completion of the PR programme. Leg fatigue at peak exercise was reduced by a clinically significant margin (1.0±3.0, Borg). Finally, QF was increased in the PR group (by 4.3±4.6 kg, p<0.05). There were no significant differences in the UC group. The change in exercise tolerance and oxygen consumption were positively associated with the change in QF when all patients were included in the analysis (r=0.315 (p=0.054) and r=0.353 (p=0.041), respectively).

Conclusions: A hybrid PR programme improves exercise tolerance and QF in patients with long COVID-19 syndrome.