Systematic review of changes and recovery in physical function and fitness following Severe Acute Respiratory Syndrome-related Coronavirus (SARS-CoV) infection: Implications for COVID-19 rehabilitation

Objectives: 1) Compare physical function and fitness outcomes in people infected with SARS-CoV to healthy controls; 2) quantify the recovery of physical function and fitness following SARS-CoV infection; 3) determine the effects of exercise following SARS-CoV infection.
Methods: Four databases (CINAHL, MEDLINE, ProQuest, and Web of Science Core Collections) were searched in April 2020 using keywords relating to SARS-CoV, physical function, fitness, and exercise. Observational studies or randomised controlled trials were included if they involved people following SARS-CoV infection and either assessed the change or recovery in physical function/fitness or evaluated the effects exercise post-infection.
Results: 10 articles were included in this review. Evidence from nine articles demonstrated that SARS-CoV patients had reduced levels of physical function and fitness post-infection in comparison to healthy controls. Furthermore, patients demonstrated incomplete recovery of physical function, with some experiencing residual impairments 1-2 years post-infection. Evidence from one randomised controlled trial found that a combined aerobic and resistance training intervention significantly improved physical function and fitness post-infection in comparison to a control group.
Conclusions: Physical function and fitness are impaired following SARS-CoV infection, and impairments may persist up to 1-2 years post-infection. Researchers and clinicians can use these findings to understand the potential impairments and rehabilitation needs of people recovering from the current COVID-19 outbreak. While one study demonstrated that exercise can improve physical function and fitness post-infection, further research is required to determine the effectiveness of exercise in people recovering from similar infections (e.g. COVID-19).
Impact statement: Considering the similarities in pathology and clinical presentation of SARS-CoV and COVID-19, it is likely that COVID-19 patients will present with similar impairments to physical function. Accordingly, research is required to measure the extent of functional impairments in COVID-19 cohorts. In addition, research should evaluate whether rehabilitation interventions such as exercise can promote post-infection recovery.