Monitored Exercise and Supplemental Oxygen Improve Exercise Tolerance, Heart Rate Response and Symptoms in Three Females with Post-COVID Syndrome: A Case Series

Abstract Background: It is now recognized that a significant proportion of previously healthy young and middle-aged adults who contract COVID-19 will develop protracted post-viral symptoms including fatigue, dyspnea, cough, post-exertional malaise and autonomic dysfunction. Effective treatment approaches for this post-COVID syndrome (PCS) are crucially needed.Methods: Three previously healthy females (ages 34, 39, and 38) who contracted COVID-19 in Spring 2020 and subsequently developed PCS received monitored aerobic exercise combined with supplemental oxygen beginning seven or eight months following acute-illness. Pre- and post-treatment exercise tolerance was tested using the Bensen treadmill protocol. Treatment consisted of 22 sessions of graduated treadmill exercise during which 6 liters of continuous oxygen was delivered via nasal canula. Findings: All patients demonstrated ~54% improvement in exercise tolerance, improvement in heart rate and systolic blood pressure response during exercise, and remission or improvement of symptoms, including cough, dyspnea on exertion, laryngeal inflammation, chest discomfort, fatigue, and/or post-exertional malaise. Interpretation: We show that measured, monitored exercise combined with supplemental oxygen improved lingering symptoms in three female PCS patients. Supplemental oxygen may reduce post-exercise inflammation, therefore providing the benefits of exercise while reducing the likelihood of PCS symptom exacerbation. Due to the variable nature of PCS, it is crucial to individualize treatment protocols and to continually evaluate and modify each protocol based upon individual patient response. Funding: This work was funded by the Pulmonary Wellness Foundation.