Effects Of Exercise On Quality Of Life In Pediatric Covid-19 Patients: A Randomized Controlled Trial

PURPOSE: This study assessed the impact of a 12-week, home-based exercise training (HBET) on health-related quality of life (HRQOL), cardiovascular and metabolic parameters in pediatric COVID-19 patients. METHODS: In this single center, randomized controlled trial (RCT) conducted in Sao Paulo, Brazil, from October 2020 to January 2022, 32 patients from a tertiary hospital were randomly assigned to the HBET or standard of care (CONTROL) in a 2:1 ratio. The HBET group underwent supervised and unsupervised sessions 3 times/week for 12 weeks emphasizing aerobic and bodyweight exercises, while CONTROL received standard care and no exercise intervention. The HRQOL (Pediatric Quality of Life Inventory [PedsQL], cardiopulmonary exercise test (CPET), brachial flow-mediated dilation (b-FMD) and echocardiography were assessed. Data were analyzed using an intention-to-treat (ITT) and a complete-case approach. Dependent variables were analyzed by a mixed model with repeated measures using group (HBET and CONTROL) and time (PRE and POST) as fixed factors, and subjects as random factors. RESULTS: Average compliance to HBET was 50% (58% in supervised and 46% in unsupervised online sessions). Eighty one percent of participants (median age 12 years, 35% males) had preexisting chronic conditions, and COVID-19 severity was classified as mild in 78%, moderate in 12% and severe in 10% of the cases. There was no difference in HQROL between groups in the ITT analysis. The HBET group demonstrated an increase in peak heart rate (EMD: 14.1, 95%CI 3.3 to 25, p = 0.05) and chronotropic reserve (EMD: 15.5, 95%CI 3.1 to 27.9, p = 0.07). No other difference was detected for CPET, b-FMD and echocardiography variables (all p > 0.05). CONCLUSION: In this RCT, a 12-week HBET intervention did not impact HRQOL in pediatric COVID-19 patients. Although adherence was low, HBET showed greater improvements in peak heart rate and chronotropic reserve, with no changes in other cardiovascular parameters.Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP (grants # 2021/02742-0 and 2022/16147-0 to C.A., #2019/15231-4 to S.M.S., and #2017/13552-2 to B.G.).