210 - Using combined physiologic and subjective intensity parameters in persons experiencing moderate to severe post-acute sequelae of SARS CoV-2 infection improves quality of life and stabilizes symptom exacerbation.

Create a protocol for replicable physical therapy intervention in the post-acute sequelae of SARsCoV-2 (PASC) population.

Design:

Historically, perceptions concerning post-exertional malaise or post exercise symptom exacerbation (PEM/PESE) posed supervised rehabilitation barriers. An alternative approach to traditional physical therapy approaches is indicated.

Common to PASC are dyspnea and fatigue symptoms resulting from chronotropic intolerance, autonomic dysfunction, ineffective pacing strategies, impaired hemodynamics and impaired respiratory mechanics when persons exceed their energy expenditure threshold.

 
Participants are placed into 1 of 5 programs based on severity of dyspnea, orthostatic intolerance and PEM. The Basic program’s goal of symptom stabilization utilized physiologic and subjective intensity parameters on 38 people. Conservative heart rate equations considering beta blocker use, age, and PEM/PESE established target intensity. The traditional heart rate calculation (220 bpm – age) was not commonly used. The program considers positioning, starting with supine movements, then progresses into anti-gravity movements and aerobic interval training over 9 sessions. Self-rated effort and therapist monitored physiologic stress achieve metabolic training effects in active recovery zones.

Results:

Upon completion of the program, participants reported improved quality of life. 90-day survey feedback indicates favorable findings for symptom improvement. Participants shared these perceptions:

“Before PT I was depressed, believing I was slowly dying of long term COVID because I had experienced so many medical setbacks since COVID.”

“I am in better physical and emotional health because you reached out to me with your pilot program.”

Vital sign monitoring indicates improved heart rate response and exercise capacity. No PEM/PESE was reported. All participants reported symptom improvement.

Conclusions:

Rehabilitative management of PASC is a safe and effective means of symptom stabilization. Respondents indicate the program positively influenced confidence with self-management and were more optimistic about long term recovery.