Early mobilization and physical exercise in patients with COVID-19: A narrative literature review.
Veronica Lourenço Wittmer, Flavia Marini Paro, Halina Duarte and 2 others
PMID 33743391WHAT IT FOUND
No randomized trials of early mobilization or exercise in hospitalized COVID-19 patients were found.
Published guidance recommends low-intensity activity for mild and stable cases, with stopping rules for oxygen saturation drop, fever, breathlessness, chest pain, or instability.
Key findings
01No randomized controlled trial investigating early mobilization and exercises in COVID-19 patients was found.
02For mild to moderate hospitalized patients, guidance generally recommends low intensity, often Borg CR 10 below 3 or METs below 3, and stopping if SpO2 decreased by 4% points or symptoms such as severe dyspnea, chest pain, arrhythmia, dizziness or inability to maintain balance occur.
03Telerehabilitation was described as an alternative for selected patients, including four hospitalized patients who used a tablet, a Bluetooth pulse oximeter and a 20 minute exercise program.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
No randomized controlled trial investigating early mobilization and exercises in COVID-19 patients was found, so the review reports expert recommendations rather than tested effects. Most included papers were opinion, letters, editorials, guidelines or reviews, not primary clinical trials. Many recommendations were drawn from studies in other diseases, because evidence specific to COVID-19 was limited. The search stopped on June 30, 2020, and was limited to English, Portuguese and Spanish. The text says 32 papers were included, while Table 2 says 34, so the included evidence base is unclear. The only study reporting improvement from a combined program was a pilot, and the contribution of each component cannot be separated.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not treat early mobilization, exercise or telerehabilitation as proven treatments for COVID-19. This review found no randomized controlled trial in hospitalized COVID-19 patients, and most recommendations come from expert opinion, guidelines or studies in other conditions.