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Year : 2021  |  Volume : 21  |  Issue : 1  |  Page : 30-32

Rehabilitation for cardiovascular endurance in COVID-19 patient

1 Department of Physiotherapy, School of Applied Medical Sciences, Lovely Professional University, Phagwara, Punjab, India
2 Department of Rehabilitation Sciences, SNSAH, Jamia Hamdard, New Delhi, India

Date of Submission20-Dec-2020
Date of Acceptance17-Feb-2021
Date of Web Publication07-Jun-2021

Correspondence Address:
Dr. Suresh Mani
Associate Professor, Department of Physiotherapy, School of Applied Medical Sciences, Lovely Professional University, Phagwara, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjsm.sjsm_41_20

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In recent times, pneumonia associated with a novel coronavirus named severe acute respiratory syndrome coronavirus 2 has engulfed majority of the world population. Despite the fact reported that children and young adults are at lower risk from the infection of the COVID-19 than the population of other age groups, young-aged individuals have chances of getting infected which may lead to several complications either in mild or moderate or severe forms. It shows an effect on cardiovascular endurance along with many adverse effects even in a previously healthy young individual. Necessity of assessing the cardiac endurance in post-COVID-19–affected patients is at most as this makes them analyze their cardiac fitness. Here, we report a case of a 30-year-old COVID-19 recovery patient who had faced cardiovascular endurance problems. Cardiac rehabilitation and self-cardiovascular endurance evaluation were coached. After 2 weeks, the patient reported moderate improvement regarding cardiovascular endurance.

Keywords: Cardiovascular endurance, COVID-19, rehabilitation

How to cite this article:
Datla LS, Siddiqui ZA, Mani S. Rehabilitation for cardiovascular endurance in COVID-19 patient. Saudi J Sports Med 2021;21:30-2

How to cite this URL:
Datla LS, Siddiqui ZA, Mani S. Rehabilitation for cardiovascular endurance in COVID-19 patient. Saudi J Sports Med [serial online] 2021 [cited 2022 Aug 10];21:30-2. Available from: https://www.sjosm.org/text.asp?2021/21/1/30/317858

  Introduction Top

The COVID-19 pandemic which started as an outbreak from Wuhan, China, has affected more than 60 million across the world.[1],[2] Pneumonia associated with severe acute respiratory syndrome coronavirus 2 was declared a pandemic in February 2020.[3] It has affected nearly 218 countries.[4] India is one of the countries hardest hit, with more than 9 million infected and 141,000 deaths.[4] It is salient to highlight the COVID-19 effects on cardiovascular endurance. Coronaviruses are known to be associated with a high-level inflammatory burden which will induce many adverse effects on cardiovascular system. Systemic inflammation and cardiovascular complications may result in significant morbidity and mortality.[5],[6]

  Case Report Top

In our report, we present the case of a patient who recovered from COVID-19 with no history of any past physical and mental illness and presenting to our center with symptoms of decreased cardiovascular endurance.

A 30-year-old male patient who is a computer professional by occupation approached for physiotherapy after his recovery from COVID-19. No history of allergies, past physical illness, and mental illness was reported. No other relevant family history was reported. The patient approached with complaints of chest tightness and breathlessness on performing usual activities of daily living such as grocery shopping and climbing up and downstairs, along with doing daily chores, which was used to be very normal with no above-mentioned clinical symptoms in the past, i.e., before COVID-19 attack. The patient had been self-quarantined for a month and took medications prescribed by the authorized government medical practitioner of their locality. He was put on medication as per the prescribed protocol. The clinical response was good, and he did not take any assisted medical support. After 3 weeks, the patient got tested and was found to be negative for COVID-19 test; then, he took a week rest and started doing his past regular activities with no discomfort. The only remarkable finding he experienced was some sort of breathlessness and mild chest tightness while walking even for shorter distances (1.6 km) and in stair climbing (10–15 steps). Then again, he took COVID-19 test and necessary scans and revealed no clinical problems. Following the tests, he was advised to consult a physiotherapist. We had taken his complete medical and personal history, the details of his COVID-19 attack, and the symptoms he experienced during those times.

As the previous necessary reports were not available with the patient, an interview was conducted through a questionnaire comparing the subject's cardiovascular endurance in pre- and post-COVID-19 times, which revealed decrease in cardiovascular endurance as compared with pre-COVID-19 time. A 3-min step test was done for the assessment of cardiovascular endurance as it is the most simple and handy and can be self-assessed even with no much equipment as they are unavailable at that time. However, a 3-min step is valid and reliable for measuring endurance.[7] The maximum rate of oxygen consumption (VO2 max) as recorded with a 3-minute step test was 35.7 ml/kg/min, thus indicating an average cardiovascular endurance.

Cardiac rehabilitation was started with breathing exercises as it is a great way to increase coordination and strength along with the endurance of breathing muscles. Father more, the patient was advised to do aerobic exercises as per his convenience which includes regular walking initially covering a mile and progress gradually up to 3 miles per for two weeks.[8] At the end of two weeks of interventions, the patient underwent a 3-minute step test and VO2 max was calculated. The calculated value of VO2 max was 48.3 ml/kg/min which indicated the cardiac rehabilitation and aerobic physical activity resulted in moderate improvement in cardiovascular endurance..

  Discussion Top

Cardiovascular endurance is an important component of an individual's overall well-being. Improving cardiovascular endurance enhances oxygen intake in the lungs and heart and will help an individual to endure physical activity for longer. Evaluating the cardiovascular endurance of an individual involves examining the oxygen intake and its utilization by the body. An individual's cardiovascular endurance level shows its direct effect on their physical activity. A 2017 study had suggested that people with more levels of cardiovascular endurance have less chances to develop higher blood pressure than those with lesser levels of cardiovascular endurance.[9] A 2015 study suggested that improvement of cardiovascular endurance has chances of minimizing the risk of coronary heart disease.[10] As the coronavirus affects the cardiovascular system, it is very crucial to assess one's cardiovascular endurance. Massive lockdown and quarantine during the COVID-19 pandemic have disrupted the overall cardiopulmonary fitness of an individual. Hence, performing a simple 3-minutes steps test may aid in self-assessment of cardio-respiratory endurance level and set up a plan of action if it is compromised.

In our case, a young adult reported with symptoms of decreased cardiovascular endurance who faced difficulty in performing his normal physical activities which he used to do with ease in the past before the coronavirus attack. Reduced VO2 at the baseline in our subject indicates a decrease in cardiovascular endurance levels hence cardiac rehabilitation was given along with the regular aerobic physical activity. After 4 weeks of intervention, the VO2 max value was improved, and declined episodes of chest tightness and breathlessness which he experienced earlier during his physical activity.

  Conclusion Top

Cardiovascular endurance shows its impact on an individual's level of overall well-being. It is very important to self-evaluate one's endurance which can be made easy through the 3-min step test. Regaining and sustaining cardiovascular endurance during these pandemic times are very crucial. Aerobic physical activity plays a key role in maintaining and improving cardiovascular endurance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. (2020). Risk communication and community engagement readiness and response to coronavirus disease (COVID-19): interim guidance, 19 March 2020. World Health Organization. License: CC BY-NC-SA 3.0 IGO. Available from: https://apps.who.int/iris/handle/10665/331513. [Last accessed on 2020 Sep 25].  Back to cited text no. 1
World Health Organization. Naming the Coronavirus Disease (COVID-19) and the Virus That Causes It. World Health Organization; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus 2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it. [Last accessed on 2020 Oct 30].  Back to cited text no. 2
Salvatore PP, Sula E, Coyle JP, Caruso E, Smith AR, Levine RS, et al. Recent increase in COVID-19 cases reported among adults aged 18-22 years – United States, May 31-September 5, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1419-24.  Back to cited text no. 3
Nicola M, O'Neill N, Sohrabi C, Khan M, Agha M, Agha R. Evidence based management guideline for the COVID-19 pandemic-Review article. Int J Surg 2020;77:206-16.  Back to cited text no. 4
Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiol 2020;5:831-40.  Back to cited text no. 5
Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med 2020;38:1504-7.  Back to cited text no. 6
Kieu NT, Jung SJ, Shin SW, Jung HW, Jung ES, Won YH, et al. The validity of the YMCA 3-minute step test for estimating maximal oxygen uptake in healthy Korean and Vietnamese adults. J Lifestyle Med 2020;10:21-9.  Back to cited text no. 7
Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: An American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005;111:369-76.  Back to cited text no. 8
Sui X, Sarzynski MA, Lee DC, Lavie CJ, Zhang J, Kokkinos PF, et al. Longitudinal patterns of cardiorespiratory fitness predict the development of hypertension among men and women. Am J Med 2017;130:469-76.e2.  Back to cited text no. 9
Gander JC, Sui X, Hébert JR, Hazlett LJ, Cai B, Lavie CJ, et al. Association of cardiorespiratory fitness with coronary heart disease in asymptomatic men. Mayo Clin Proc 2015;90:1372-9.  Back to cited text no. 10


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