DOI: 10.

4149/BLL_2021_052 Bratisl Med J 2021; 122 (5)

310 – 314

COVID-19 AND REHABILITATION

Rehabilitation and physical activity for COVID-19 patients in

the post infection period
Liska D, Andreansky M

Matej Bel University, Faculty of Arts, Department of Physical Education and Sports, Banska Bystrica,
Slovakia. [email protected]

ABSTRACT
The first cases of COVID-19 were initially recorded in December 2019 in Wuhan, the capital of China’s Hubei
Province. The situation quickly escalated and turned into a global pandemic. COVID-19 is a highly infectious
respiratory disease that leads to decreased respiratory, physical, and psychological function of affected
patients (2). Patients’ symptoms widely vary; from asymptomatic course to severe symptoms. Decrease
in physical function, and, in some cases, a persistence of symptoms may be observed in patients, who
overcame the infection period. Rehabilitation represents a potential treatment option for COVID-19 patients in
post-infection period. Rehabilitation therapies may help to restore physical function in patients and to reduce
the long-term effects of COVID19 infection (Ref. 37). Text in PDF www.elis.sk
KEY WORDS: COVID19, rehabilitation, post-infection syndrome.

Introduction due to muscle weakness. It may also result in walking problems

potentially affecting patients’ daily activities. In post infection
The first cases of COVID-19 were reported in December 2019 in period, patients may experience persistent pulmonary, musculo-
Wuhan, the capital of China’s Hubei Province. The situation quick- skeletal, neurological, cardiac, and psychological problems (7).
ly turned into a global pandemic (1). Since the pandemic continues, These long-term effects can negatively affect patient’s ability to
there are limited data on clinical and prognostic factors in patients perform daily activities and can also lead to social limitations.
with COVID-19. COVID-19 is a highly infectious respiratory dis- Rehabilitation treatment constitutes a potential treatment option
ease that leads to decreased respiratory, physical, and psychological for these patients. Rehabilitation therapies are based on individual
function in affected patients (2). Patients’ symptoms widely vary; needs of each patient (8). In order to determine the optimal reha-
from asymptomatic to severe (3). As the COVID-19 is highly infec- bilitation approaches, the potential or existing effects of functional
tious, the patients are isolated in order to limit the spread of SARS- deficit in the post infection period patients should be assessed.
CoV-2. This leads to a significant reduction in social interactions, Rehabilitation treatment is managed by a multidisciplinary team
as a consequence of which the patients feel lonely and isolated (4). consisting of a physiatrist, physiotherapist, psychologist, and oc-
Mechanism causing pneumonia is particularly complex. It seems cupational therapist. Depending on the particular case, this reha-
that the infection can elicit an excessive immune response in the bilitation therapy may be provided in several organizational mo-
host. COVID19 in some cases elicits a response generally known dalities; in inpatient setting, outpatient setting, or home setting.
as ‘cytokine storm’, (5). In some cases, moreover, patients suffer Within the context of the COVID-19 pandemic, the use of remote
from an extensive lung tissue inflammation. The main cytokine in monitoring and mobile intelligence technologies with wearable
this ‘storm’ is interleukin 6 (IL-6). IL-6 is produced by activated devices may enable the practice of intelligent, digital and remote
leukocytes and acts on a large number of cells and tissues. IL-6 rehabilitation (9–11).
assists in B cells differentiation. Rehabilitation exercises may also prevent the occurrence of
Many patients remain lying in the intensive care unit for a further complications (12). The elderly population is expected to
longer period of time. Patients often remain in one position for be at risk of serious COVID-19-related complications. There is
several hours, which may lead, due to critical illness, to dyspha- also an increased risk of serious complications in chronically ill
gia, muscle weakness, myopathy and neuropathy, as well as to re- and immunocompromised patients. An increased risk of mortality
duced mobility (6). In rare cases, the risk of falling may increase was found in patients with diabetes mellitus, chronic respiratory
diseases, hypertension, and oncological diseases. A more severe
Matej Bel University, Faculty of Arts, Department of Physical Education course of the disease has been reported in the patients with un-
and Sports, Banska Bystrica, Slovakia derlying comorbidities, such as obesity (13). The most frequent
Address for correspondence D. Liska, Mgr, Matej Bel University, triggers of serious complications in patients are respiratory failure,
Faculty of Arts, Department of Physical Education and Sports, Banska septic shock, or multiple organ dysfunction. A particularly seri-
Bystrica, Slovakia. ous complication is acute respiratory distress syndrome (ARDS).

Indexed and abstracted in Science Citation Index Expanded and in Journal Citation Reports/Science Edition
 Liska D, Andreansky M. Rehabilitation and physical activity for COVID-19 patients…
xx

Mild disease is characterized by mild symptoms and absence Fitness Test Battery (21). The chair stand test is used to assess
of pneumonia signs. Rehabilitation after a mild disease can be a functional lower extremity strength, transitional movements,
provided on an outpatient basis by the means of telerehabilitation. balance, and a fall risk in older adults (22). Scoring is based on
Post-COVID19 patients may experience a persistence of symptoms the amount of time (to the nearest decimal in seconds). During
even in the post-infection period. Chronic respiratory symptoms af- the test, patient transfers from a seated to a standing position and
ter the recovery from COVID-19 may include: shortness of breath back to sitting five times. The equipment needed in performing
on exertion, persistence of cough and wheezing, and chest pres- test includes stopwatch and a standard height chair with a straight
sure. However, these may or may not be related to exertion (14). back. In order to execute the test correctly, the test taker sits on the
The negative effects associated with long-term intensive unit chair with their straight back resting against the chair back. The
care are well described (15). Many patients suffer from post- test taker is also instructed to fold their arms across their chest.
intensive care syndrome (PICS) after hospitalization in the in- Then the test taker should be instructed to do five sit-to-stands as
tensive care unit. This syndrome causes a significant decline in quickly as possible. Another variant is the 30-second chair stand
muscle strength, physical performance, myopathy, and in indi- test. It is performed in the same design as the first variant, but it
vidual cases neuropathy, loss of muscle mass, lack of nutrition, involves recording the number of stands a person can complete
as well as an impaired emotional and physical health (16, 17). In in 30 seconds.
addition to the post-intensive care syndrome, in the post-infection
period patients also experience adverse symptoms. These include Step Test
neuromuscular weakness, fatigue, decreased mobility, recurrent The test was developed at Harvard University in 1942. It is
falls, deconditioning, as well as psychological disorders, such as also known as Harvard cardiac stress test (23). Step test is one of
anxiety, depression, poor concentration. Symptoms may persist the oldest and most widely used cardiac stress tests. This test is
for several months. Family members of patients may be similarly also used in cardiac rehabilitation. The test is used to measure and
affected. There is a significant need in rehabilitation during the assess an individual’s circulatory and aerobic fitness and is based
post-infection period (18, 19). on the measurements of cardiac activity. One of the main indica-
Rehabilitation treatment aims at improving patient’s func- tors of cardiac activity is a change in heart rate. The measurement
tional condition, resulting in an improved quality of life and a re- is based on the principle of a directly proportional relationship
duced physical disability. Physiatrists and physiotherapists play a between cardiovascular fitness and the recovery rate of the heart
key role in improving the functional effects of critical conditions, rate to the initial values after a strenuous exercise. The metabolic
including long-term mechanical ventilation failure. They also demands of muscle tissue increase during a physical exercise,
play a key role in helping patients to recover from neuropathies which leads to an increased cardiac activity as well. The better
and myopathies. Amid the COVID-19 pandemic, many physiat- the individual’s cardiovascular fitness, the sooner their heart rate
rists and physiotherapists are preparing for a substantial increase values return to normal.
of patients with critical disease and respiratory-related functional There are several versions of Harvard step test. In the most
disorders. widely used version of the test, an individual steps up and down
on the box at a rate of 30 steps per minute. Height of the box is
Functional examination of patients in the post-infection period 40 cm for men and 30 cm for women. Duration of the exercise
is 5 minutes or until exhaustion. After finishing the exercise, the
Six Minute Walk Test test taker lies down on their back and the total number of their
The 6 minute walk test is a sub-maximal exercise test used to heart beats are counted 1, 2, and finally 3 minutes after finishing
assess aerobic capacity and endurance in various chronic condi- the exercise. The patient immediately sits down on completion
tions. The distance covered in 6 minutes is used as a result to com- of the test, and the total number of their heart beats are counted
pare the changes in patients’ functional capacity. This test can be from 1 to 1½ minutes after finishing and from 2 to 2½ minutes
used in patients of all ages. The test was initially designed to help after finishing and finally from 3 to 3½ minutes after finishing.
in the assessment of patient with cardiopulmonary issues. Gradu- By using the measured data in formula, we subsequently obtain a
ally, it was introduced in numerous other conditions. It also plays certain index of physical proficiency, the fitness index. Calcula-
a potential role in the assessment of patients with COVID-19 in tion of fitness index:
post-infection period. It assesses the functional capacity of an in- (te) = 300 seconds - time until exhaustion (in seconds)
dividual and provides valuable information on all systems during (hb) = sum of heartbeats after 1, 2, and 3rd minute
physical activity, including pulmonary and cardiovascular systems.
To perform the test, it is necessary to measure the circle in which Timed up and go test (TUG)
will patients perform the test. Another necessary equipment is a This test is used predominantly in elderly population. It is de-
stopwatch. Sporttesters may be used to measure a pulse frequency. signed to assess the functional ability of patients and determine
the risk of falling. It may be beneficial in determining the physi-
The Chair Stand Test cal impairment caused by the infection in elderly patients with
Chair stand test is used for testing lower limb strength and COVID-19 after the resolution of the infectious period. Equip-
endurance in older adults. It is a part of the Fullerton Functional ment needed to perform the test: chair and stopwatch. In order to

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perform the test correctly, patient starts in a seated position with bic exercises are gait, swimming, cycling, and nordic walking. In
their back resting against the chair back. Patient positions their the post-infection period, it is important to start walking with a
feet on a place marked by a line. Patient stands up upon therapist’s moderate gait, and then to increase the intensity. Interval exercises
command and walks 3 meters. Therapist records the time needed may also be applied, providing that the patient’s health condition
to walk 3 meters and back to the chair. A longer distance can be has sufficiently improved.
used as a variation of the test.
Graded exercise
The post-COVID-19 functional status (PCFS) After respiratory symptoms resolved, a potential problem
It is a simple tool to monitor the course of symptoms and the for patients may be deconditioning and a reduced lung function.
impact of symptoms of COVID-19 infection. PCFS scale may Graded exercise is based on a gradual increase of the intensity of
help to assess patients, who need a rehabilitation treatment after physical activity. It has to be used accordingly to patient’s indivi-
recovery from COVID-19 infection. It covers the full spectrum of dual physical ability. Exercise begins with a moderate intensity and
functional outcomes and focuses on patients’ limitations. Grade 0 is important in terms of improving cardiovascular function. One
reflects the absence of any functional limitation. Grade 1 reflects of the most basic types of exercise is gait. Gait should be initially
that the symptoms, pain or anxiety are present to an increasing taught at patient’s natural pace and should not exceed 40–50%
degree. Grade 2 and 3 account for patient’s impaired ability in of patient’s maximum heart rate (COVID-19). The increase of in-
performing various daily activities (24). Finally, grade 4 accounts tensity must not occur before the infectious period has resolved.
for patients with severe functional limitations. Physical activity should be performed at least 5 times a week for
30 minutes. If patient tolerates the load and an adequate physical
Rehabilitation options activity leads to an improvement in symptoms, the intensity and
duration of physical activity may be prolonged.
Early active mobilization is important for improving muscle
strength, which results in a better mobility in patients discharged Rehabilitation methods
from hospital, as well as in the improvement in patients’ quality
of life outside the hospital. An important part of rehabilitation To improve patients’ health, we can use also other rehabili-
includes a neuromotor mobilization together with a passive mobi- tation methods. These exercises are most frequently applied to
lization and an active exercises to maintain or improve the range improve the posture and alleviate pain in patients. The most com-
of motion. Rehabilitation therapies may also help with algic mani- monly used ones are yoga and pilates. Other rehabilitation methods
festations in the post-infection period patients. may be used to improve musculoskeletal problems. Several forms
When determining the functional fitness of patient, it is impor- of manual therapy might be used to reduce pain manifestations in
tant to take into account the level of physical activity in the home the post-infection patients.
environment and to determine the preferred type of movement. Another potential treatment option is occupational therapy.
Occupational therapy can be suitable especially for elderly people,
Type of exercise: e.g. gait, cycling, swimming, yoga, pilates, nor- who have lost their autonomy and have limitations in performing
dic walking, housework, gardening etc. (25, 26). their daily activities. It may speed up the homecoming and help
Duration: Duration of daily physical activity. to stimulate the need for independence. Another important reha-
Frequency: Physical activity during the week. bilitation component is psychological care. Psychological care is
Exercise Intensity: (light, moderate, or intense exercise). provided for patients with mental disorders, such as anxiety, de-
pression, and post-traumatic stress disorder.
Types of exercises
Pulmonary rehabilitation
Muscle weakness may be present in post-COVID19 patients. Pulmonary rehabilitation focuses at improving functional
Strength training is a physical exercise that uses resistance in order condition in patients with lung diseases (29). An important part
to stimulate muscle contraction. Strength training also leads to an of treatment is pulmonary therapy. The aim of pulmonary reha-
improved joint mobility, as well as to an increased strength of mus- bilitation in patients with COVID-19 is to improve the symptoms
cles, tendons and ligaments (27). During the strength training, it is of dyspnoea, alleviate anxiety, reduce complications, minimize
important to maintain a slow controlled movement. When it comes physical disability, as well as to maintain functioning and improve
to resistance exercise, it is possible to regulate the load, taking the quality of life.
into account the patient’s health condition. Strength training in- Pulmonary rehabilitation involves breathing exercises based
cluding both concentric and eccentric muscle contraction is a safe, on assessment and monitoring of exercise tolerance with the aim
simple, and effective way to induce and increase muscle strength. of improving breathing control (30). Breathing exercises are used
to improve the tidal volume and reduce psychological effects
Aerobic exercise (stress, anxiety, and depression) (31, 32). Exercise training is the
It is the most common type of physical activity (28). Aerobic most important component of pulmonary rehabilitation. It can
exercise is performed with a moderate intensity. The basic aero- be initially performed by a lying patient, in case of significantly

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xx

depressed patient even in an inpatient setting (patient lying on a hospitalisation. Patient’s gait distance, gait speed, heart rate vari-
hospital bad), and subsequently advance to gait in an outpatient ability, and oxygen saturation showed improvements.
setting. Patients with COVID-19 are more likely to suffer from preva-
Pulmonary rehabilitation is based on a comprehensive assess- lent anxiety and depression. This can lead to sleep problems. The
ment of patient’s health and various individualized techniques de- effectiveness of progressive muscle relaxation in patients with CO-
signed to prevent complications that may cause or worsen respi- VID-19 was tested by Liu et al. (35). Progressive muscle relaxation
ratory symptoms. Pulmonary rehabilitation also helps to recover is a method of deep muscle relaxation based on the notion that
from infectious diseases of the respiratory system. Additionally, muscle tension is a physiological response of the human body to
it includes general exercises aimed at improving the physical fit- thinking. This technique was described by Jacobsen. Progressive
ness. Exercises to improve the function of the inspiratory muscles muscle relaxation is easy to learn. It does not require a specific
are an important part of the therapy. Pulmonary rehabilitation also time and place, nor special technology or equipment. The aim of
focuses on the practice of coughing and the removal of airway se- the study by Liu et al. (37) was to test the effectiveness of pro-
cretions. Another important part of the therapy is a psychological gressive muscle relaxation in patients with COVID-19 in regards
component that includes the education of the patient. Pulmonary to sleep quality and anxiety. A total of 51 patients were randomly
rehabilitation is a simple, effective, safe, and timesaving approach divided into experimental and control groups. The experimental
that leads to faster reconvalescence of patient. Within the assess- group underwent a progressive muscle relaxation for 30 minutes
ment, it is important to focus on patient’s functional ability, mo- per day for 5 consecutive days. The control group did not undergo
bility, cardiovascular function, and on the assessment of breathing the therapy. In comparison to the control group, the anxiety and
stereotype (frequency, amplitude). sleep quality scores of the experimental group after an interven-
Another type of exercise is an active cycle of breathing tech- tion were statistically significant (P < 0.001).
niques. The active cycle of breathing techniques utilises the com-
binations and cycles of airway clearance techniques in order to Conclusion
clear the obstructed parts of lungs. Another option is autogenic
drainage. Autogenous drainage is a common technique based on a Rehabilitation represents a potential treatment option for pa-
combination of manoeuvres to mobilize and centralize secretions tients after recovery from COVID-19 infection. Rehabilitation
by short breaths in order to capture secretions in the peripheral therapies can help to restore physical function in patients and al-
airways. This is followed by normal breathing to capture secretions leviate the effects of COVID-19 infection.
in the intermediate airways, then by a deep breath and a strong
cough to induce excretion. References

1. El Hassoun O, Valaskova Z, Polak S, Hulin I. Few insights on the

The effectiveness of rehabilitation in regards to an improve-
problem of COVID-19. Bratisl Med J 2020; 121 (7): 471–474.
ment of patients’ functional condition
2. Hatala R. Proposal for complementary targeted public health antiepi-
demic measures during the pandemics of COVID-19. Bratisl Med J 2020;
Exercise has a positive effect on systemic endothelial function
121 (7): 459–461.
and the inflammatory response (33). Regular exercises lead to sig-
nificant strengthening of the immune system. Exercise have also a 3. Zhu Y, Wang Z, Zhou Y, Onoda K, Maruyama H, Hu C et al. Sum-
mary of respiratory rehabilitation and physical therapy guidelines for pa-
positive effect on apoptosis after the recovery from the infection.
tients with COVID-19 based on recommendations of World Confederation
Community-acquired pneumonia in the elderly population
for Physical Therapy and National Association of Physical Therapy. J Phys
leads to decrease in daily activities (ADL) and quality of elderly Ther Sci 2020; 32 (8): 545–549.
patients’ lives. It is accompanied with a decreased physical and
4. Liska D, Poljak J. Possibilities of rehabilitation in corona virus disease
mental functions. In elderly patients, who overcame COVID-19, it
(COVID-19). Rehabilitacia 2020; 57 (2): 78–90.
is important to improve pulmonary function, as it is an important
factor in maintaining ADL and QoL. 5. Yormaz B, Ergun D, Tulek B, Ergun R, Korez KM, Suerdem M et
al. The evaluation of prognostic value of acute phase reactants in the CO-
The effect of pulmonary rehabilitation on pulmonary function
VID-19. Bratisl Med J 2020; 121 (9): 628–633.
and quality of life in older adults with COVID-19 was tested by Liu
et al. (35). A total of 72 patients were randomly divided into experi- 6. Smondack P, Gravier F-É, Prieur G, Repel A, Muir J-F, Cuvelier
A et al. [Physiotherapy and COVID-19. From intensive care unit to home
mental and control groups. The experimental group underwent a
care-An overview of international guidelines]. Rev Mal Respir 2020; 10.
pulmonary rehabilitation and the control group did not. Patients un-
derwent the pulmonary rehabilitation that lasted six weeks. After six 7. Barker-Davies RM, O’Sullivan O, Senaratne KPP, Baker P, Cran-
ley M, Dharm-Datta S et al. The Stanford Hall consensus statement for
weeks, there was recorded, based on comparison with control group,
post-COVID-19 rehabilitation. Br J Sports Med 2020; 54 (16): 949–959.
a significant improvement in respiratory function, a 6-minute walk
test, and quality of life SF-36 score. The effectiveness of respi- 8. Asly M, Hazim A. Rehabilitation of post-COVID-19 patients. Pan Afr
ratory rehabilitation in an 80-year-old patient was testes out by Med J 2020; 36: 168.
Shan et al. (36). Patient required an intubation for 14 days in the 9. Nakayama A, Takayama N, Kobayashi M, Hyodo K, Maeshima N,
intensive care unit. Patient underwent 1 month rehabilitation after Takayuki F et al. Remote cardiac rehabilitation is a good alternative of

313
Bratisl Med J 2021; 122 (5)
310 – 314

outpatient cardiac rehabilitation in the COVID-19 era. Environ Health 24. Siegerink B, Boon D, Barco S, Klok E. The Post-COVID-19 Func-
Prev Med 2020; 25 (1): 48. tional Status (PCFS) Scale: a tool to measure functional status over time
after COVID-19. 06. máj 2020 [cit 25. október 2020]; Available at: https:
10. Salawu A, Green A, Crooks MG, Brixey N, Ross DH, Sivan M. A
//osf.io/qgpdv/
Proposal for Multidisciplinary Tele-Rehabilitation in the Assessment and
Rehabilitation of COVID-19 Survivors. Int J Environ Res Public Health 25. Petríková Rosinová I, Shtin Banarpvá P, Korcová J. Nordic Walk-
2020; 17 (13). ing als geeignete Heilaktivität bei den Patienten mit der Diagnose Diabetes
Mellitus. Rehabilitacia 2018; 55 (2): 128–133.
11. Urban M, Kádě O, Pavlík V, Šafka V, Lašák P, Pravdová L et al.
Telemedicína v léčbě obezity. MMSL 2020; 89 (2): 74–79. 26. Novák J. The importance of gait as the most natural physical activity
in the human life style. Prakt Lek 2018; 98 (4): 158–165.
12. Wang C-C, Chao J-K, Wang M-L, Yang Y-P, Chien C-S, Lai W-Y et
al. Care for Patients with Stroke During the COVID-19 Pandemic: Physical 27. Roman-Belmonte JM, De la Corte-Rodriguez H, Rodriguez-Mer-
Therapy and Rehabilitation Suggestions for Preventing Secondary Stroke. chan EC, Muñoz-De la Torre E, Vazquez-Sasot A. Strengthening with
J Stroke Cerebrovasc Dis 2020; 29 (11): 105182. Blood Flow Restriction: Can it be a Useful Option in the Rehabilitation
of Patients with Coronavirus? Arch Bone Jt Surg 2020; 8 (4): 553–536.
13. Hainer V, Kunešová M, Taxová-Braunerová R, Zamrazilová H,
Aldhoon-Hainerová I. Two current pandemics: Obesity and covid-19. 28. Michalicka V, Pohnan R. Brain energetic demands during cogni-
Prakt Lek 2020; 100 (4): 159–163. tive activities in relation to aerobic load. Military Med Sci Lett 2019; 88
(4): 159–165.
14. Wilson M, Hull J, Rogers J, Pollock N, Dodd M, Haines J et al.
Cardiorespiratory considerations for return-to-play in elite athletes after 29. Sciriha A, Lungaro-Mifsud S, Fsadni P, Scerri J, Montefort S.
COVID-19 infection: a practical guide for sport and exercise medicine Pulmonary Rehabilitation in patients with Interstitial Lung Disease: The
physicians. Brit J Sport Med 2020; 54. effects of a 12-week programme. Respir Med 2019; 146: 49–56.
15. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL 30. Polastri M, Nava S, Clini E, Vitacca M, Gosselink R. COVID-19
et al. Physiotherapy management for COVID-19 in the acute hospital set- and pulmonary rehabilitation: preparing for phase three. Eur Respir J [In-
ting: clinical practice recommendations. J Physiother 2020; 66 (2): 73–82. ternet]. 25. jún 2020 [cit 25. október 2020]; 55 (6). Available at: https: //
www.ncbi.nlm.nih.gov/pmc/articles/PMC7401308/
16. Kim SY, Kumble S, Patel B, Pruski AD, Azola A, Tatini AL et al.
Managing the Rehabilitation Wave: Rehabilitation Services for COVID-19 31. Demeco A, Marotta N, Barletta M, Pino I, Marinaro C, Petrar-
Survivors. Arch Phys Med Rehabil [Internet]. 22. september 2020 [cit 25. oli A et al. Rehabilitation of patients post-COVID-19 infection: a litera-
október 2020]; Available at: https: //www.ncbi.nlm.nih.gov/pmc/articles/ ture review. J Int Med Res [Internet]. 25. august 2020 [cit 25. október
PMC7506328/ 2020]; 48 (8). Available at: https: //www.ncbi.nlm.nih.gov/pmc/articles/
PMC7450453/
17. Li Z, Zheng C, Duan C, Zhang Y, Li Q, Dou Z et al. Rehabilitation
needs of the first cohort of post-acute COVID-19 patients in Hubei, China. 32. Celko J, Guth A, MaSan J, Malay M. Effects of slow diaphragmatic
Eur J Phys Rehabil Med 2020; 56 (3): 339–344. breathing. Rehabilitacia 2019; 56 (4): 275–287.
18. Sheehy LM. Considerations for Postacute Rehabilitation for Survi- 33. Heffernan KS, Ranadive SM, Jae SY. Exercise as medicine for CO-
vors of COVID-19. JMIR Public Health Surveill [Internet]. 08. máj 2020 VID-19: On PPAR with emerging pharmacotherapy. Med Hypotheses
[cit 25. október 2020]; 6 (2). Available at: https: //www.ncbi.nlm.nih.gov/ 2020; 143: 110197.
pmc/articles/PMC7212817/
34. da Silveira MP, da Silva Fagundes KK, Bizuti MR, Starck É, Rossi
19. Li J. Rehabilitation management of patients with COVID-19: lessons RC, de Resende E Silva DT. Physical exercise as a tool to help the im-
learned from the first experience in China. Eur J Phys Rehab Med 2020; mune system against COVID-19: an integrative review of the current lit-
56 (3): 335–338. erature. Clin Exp Med 2020.
20. Brugliera L, Spina A, Castellazzi P, Cimino P, Tettamanti A, Hou- 35. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory re-
dayer E et al. Rehabilitation of COVID-19 patients. J Rehabil Med 2020; habilitation in elderly patients with COVID-19: A randomized controlled
52 (4): jrm00046. study. Complement Ther Clin Pract 2020; 39: 101166.
21. Kováčiková Z, Neumannová K, Sarvestan J, Zemková E, Janura 36. Shan MX, Tran YM, Vu KT, Eapen BC. Postacute inpatient reha-
M. Sit-to-stand test in fall prediction in elderly adults: What are the options bilitation for COVID-19. BMJ Case Rep [Internet]. 18. august 2020 [cit
of use in clinical practice? Prakt Lek 2020; 100 (2): 78–82. 24. október 2020]; 13 (8). Available at: https: //www.ncbi.nlm.nih.gov/
pmc/articles/PMC7437681/
22. Michalčíková T, Neumannová K. The occurrence of balance disor-
ders in patients with chronic obstructive pulmonary disease. Rehab Fyzik 37. Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive
Lek 2019; 26 (2): 61–67. muscle relaxation on anxiety and sleep quality in patients with COVID-19.
Complement Ther Clin Pract 2020; 39: 101132.
23. Benuš P, Kovác J, Gurin B, Líška D. Effect of special breathing
exercises on performance and their potential use in rehabilitation. Reha-
Received November 30, 2020.
bilitacia 2019; 56 (3): 175–185.
Accepted January 7, 2021.

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