-Case Reports-

Rapid Recovery in a Patient with Severe COVID-19 after a Low-Load, High-Frequency Rehabilitation Program Using an Ergometer in the Supine Position

Akira Saito¹, Motomichi Masuyama¹, Daisuke Ishiyama¹, Kenta Shigeta², Tsunemi Kitagawa^1,3 and Yoichiro Aoyagi^1,3

¹Department of Rehabilitation, Nippon Medical School Hospital, Tokyo, Japan
²Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
³Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan

Background: Rehabilitation therapy for patients with severe coronavirus disease 2019 (COVID-19) is crucial; however, studies regarding rehabilitation strategies for intensive care unit (ICU) patients with COVID-19 are limited. We report a case of severe COVID-19 in an ICU patient whose physical function and basic movement ability rapidly improved after the initiation of active aerobic exercise in the supine position.
Case: A 70-year-old man with hypertension and obesity was admitted to the ICU and managed with a ventilator because of severe COVID-19. Physical therapy started on postadmission day 34. Problems encountered during physical therapy included low saturation of percutaneous oxygen (SpO₂; <90%), dyspnea with a light exercise load, advancing muscle weakness, and endurance decline. The rehabilitation program included getting out of bed and resistance training of the upper and lower limbs twice daily while maintaining SpO₂ at ≥90%. After ventilator weaning, we initiated aerobic training using a supine ergometer with varying load volume. On discharge from the ICU on postadmission day 45, the patient's physical function (handgrip strength, Medical Research Council score, and Borg scale) and basic movement ability (Functional Status Score for ICU) rapidly improved.
Conclusion: Rehabilitation therapy involving aerobic cycling training based on a quantitative load setting may be effective in treating COVID-19.

J Nippon Med Sch 2023; 90: 414-418

Keywords
coronavirus disease 2019, cycling ergometer in the supine position, physiotherapy, intensive care unit

Correspondence to
Yoichiro Aoyagi, MD, PhD, Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
yyy@rc5.so-net.ne.jp

Received, February 18, 2022
Accepted, August 24, 2022