Effect of Pulmonary Rehabilitation Approaches on Dyspnea, Exercise Capacity, Fatigue, Lung Functions, and Quality of Life in Patients With COVID-19: A Systematic Review and Meta-analysis

Arch Phys Med Rehabil. 2022 Oct;103(10):2051-2062. doi: 10.1016/j.apmr.2022.06.007. Epub 2022 Jul 29.


Objective: To qualitatively synthesize and quantitatively evaluate the effect of pulmonary rehabilitation (PR) on dyspnea, lung functions, fatigue, exercise capacity, and quality of life (QoL) in patients with COVID-19.

Data sources: PubMed, Web of Science, and Cochrane databases were searched from January 2020 to April 2022.

Data selection: Randomized controlled trials (RCTs) assessing the effect of PR on dyspnea, lung functions, fatigue, exercise capacity, and QoL in patients with COVID-19.

Data extraction: The mean difference (MD) and a 95% CI were estimated for all the outcome measures using random effect models. The following data were extracted by 2 independent reviewers: (1) first author; (2) publication year; (3) nationality; (4) number of patients included (5) comorbidities; (6) ventilatory support; (7) length of inpatient stay; (8) type of PR; (9) outcome measures; and (10) main findings. The risk of bias was evaluated using the cochrane risk of bias tool.

Data synthesis: A total of 8 RCTs involving 449 participants were included in the review. PR was found to be significantly effective in improving dyspnea (5 studies, SMD -2.11 [95% CI, -2.96 to -1.27; P<.001]) and exercise capacity (MD 65.85 m [95% CI, 42.86 to 88.83; P<.001]) in patients with both acute and chronic COVID-19 with mild to severe symptoms, whereas fatigue (MD -2.42 [95% CI, -2.72 to -2.11, P<.05]) and lung functions (MD 0.26 L [95% CI, 0.04 to 0.48, P<.05]) were significantly improved in acute COVID-19 patients with mild symptoms. The effect of PR on QoL was inconsistent across studies. PR was found to be safe and feasible for patients with COVID-19.

Conclusion: Evidence from studies indicates that PR program is superior to no intervention in improving dyspnea, exercise capacity, lung functions, and fatigue in patients with COVID-19. PR appears to be safe and beneficial for both acute and chronic COVID-19 patients.

Keywords: COVID-19; Dyspnea; Exercise capacity; Pulmonary rehabilitation; Rehabilitation; SARS-COV-2.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • COVID-19*
  • Dyspnea / rehabilitation
  • Exercise Tolerance
  • Fatigue
  • Humans
  • Lung
  • Quality of Life*