Comparison of the effectiveness of pulmonary telerehabilitation and physical activity recommendations in patients with pulmonary fibrosis due to COVID-19

Aim: This study aimed to compare the effects of telerehabilitation and physical activity recommendations on exercise capacity, peripheral muscle strength, symptoms, activity, and participation in patients with pulmonary fibrosis due to COVID-19. Methods: Thirty-two patients were included in the study and randomised into two groups: telerehabilitation and physical activity. The telerehabilitation group completed the program online, supervised by a physiotherapist, two days a week, and unsupervised one day. The physical activity group received physical activity recommendations. Exercise capacity was assessed with a six-minute, incremental and endurance shuttle walk tests, and peripheral muscle strength was assessed with a dynamometer. Physical activity was assessed with activity monitor and pedometer, body composition with bioelectrical impedance analysis, physical fitness with One Minute Sit-to-Stand Test, dyspnea with mMRC, functional status with Post COVID Functional Status Scale, fatigue with Fatigue Severity Scale and Modified Borg scale, quality of life with European Quality of Life Questionnaire, dyspnea in activities of daily living with London Chest Activities of Daily Living Scale, anxiety-depression with Hospital Anxiety Depression Scale and clinical status change with Global Rating of Change Scale. Program adherence rate and usability of the system were questioned for the telerehabilitation group. Results: Thirty patients completed the study. Significant improvements were obtained in the telerehabilitation group in terms of six-minute and incremental shuttle walking distance, muscle strength, physical activity, muscle mass and basal metabolic rate, physical fitness, dyspnea, functional status, fatigue, quality of life and activities of daily living compared to the physical activity group (p<0.05). In the physical activity group, endurance walking time, lower extremity muscle strength, weekly step count, perceived dyspnea after exercise and in daily life, and quality of life were significantly improved (p<0.05). There was a similar change between the groups in terms of endurance shuttle walking time, sedentary time, anxiety-depression and body fat percentage (p>0.05). The adherence rate was 92% in the telerehabilitation group. The telerehabilitation group evaluated the usability of the system as high. Conclusion: Patients with pulmonary fibrosis due to COVID-19 should be included in rehabilitation programs. With appropriate patient selection and patient education, telerehabilitation can be used as a safe option.