Effects of 12 weeks of Pilates on functional capacity, peripheral muscle function, dyspnea and quality of life in patients with post-COVID-19 syndrome: a controlled and randomized clinical trial

Abstract

Introduction: Severe acute respiratory syndrome (SARS) due to COVID-19 has direct and indirect consequences on several systems, especially the musculoskeletal system, in addition to the respiratory system. Some of these symptoms persist for a long time and are included in the scope of post-COVID-19 syndrome, directly interfering with the functional capacity and quality of life of these patients. Pilates exercises focus on breathing, postural symmetry, trunk stabilization, flexibility, joint mobility, and overall muscle strengthening. Objective: To evaluate the effects of a quarterly program of standardized Pilates exercises on the functional capacity of patients with post-COVID-19 syndrome. Methods: A randomized, controlled clinical trial that evaluated the clinical and functional effects of 12 weeks of Pilates. The protocol was approved by the CEP under number CAAE: 57259422.2.0000.5235 and registered in clinical trials: NCT05722730. Volunteers (n=68) were recruited three months after hospital discharge due to COVID-19 progression. Of these, 60 were included, and those who met the exclusion criteria (n=12) were subsequently excluded. These volunteers were then blindly randomized (n=48) into two groups: a control group that received usual pulmonary rehabilitation care twice a week; and an intervention group that, in addition to pulmonary rehabilitation care twice a week, performed specific and standardized Pilates exercises on the same day for 12 weeks (24 therapeutic sessions). Functional capacity (6-minute walk test), ventilatory muscle strength (manovacuometry), musculoskeletal performance (quadriceps muscle strength and endurance, handgrip strength), sensation of dyspnea (mMRC), post-COVID-19 functional status (PCFS), and health-related quality of life (SF-36) were assessed and compared before and after the intervention. Results: After 12 weeks, there was a significant improvement in the intervention group in the 6MWT (53.76m vs 12.04m, p < 0.001), in peripheral muscle strength of 7.7 kg (D0: 21.3 [2.94] vs 28.9 [3.88], p < 0.001 vs 1.3 kg in the control group (D0 20.9 [2.24] vs D3 22.2 [2.17] p = 0.03). This difference in increase in peripheral muscle strength represented a 6.5 kg greater gain in the group of participants who performed 12 weeks of Pilates when compared to the control group (6.52 [4.99 – 8.04]; p < 0.001, SMD 2.3 [1.57 – 3.03]). Similar clinical effects were observed in the maximum quadriceps load test (with mean gain of 7.6 [95% CI 4.88 - 10.31] kg; p < 0.001, effect size of 1.5) compared to patients in the control group, even with the observation of significant improvement in strength in patients in the control group who received only usual care (Pilates: mean difference: 10.4 (95% CI 8.4 - 12.4), p < 0.001 and Control: Mean difference: 3.04 (95% CI (0.96 - 5.13), p = 0.005). The quarterly Pilates intervention also improved quality of life and functional status (D SF-36: 2.17 [95% CI -0.45 - 4.79]; p = 0.102 in the control group and 17.8 [15.49 - 20.51]; p < 0.001 in the Pilates group and D PCFS: -0.3 [95% CI -0.52 - - 0.08]; p < 0.05 in the control group and -1.08 [-1.29 – -0.87]; p < 0.001 in the Pilates group). Conclusion: The Pilates program was clinically effective in improving cardiorespiratory and musculoskeletal fitness in volunteers after hospitalization due to COVID-19 progression.