The effects of pulmonary rehabilitation on frailty in patients with respiratory disease and post-COVID syndrome

1. Introduction: Frailty has emerged as a key concern in the management of chronic respiratory diseases (CRDs), including chronic obstructive pulmonary disease (COPD) and the relatively recent post-COVID syndrome (Long COVID). Defined as a decline in physiological reserves, frailty renders individuals vulnerable to acute stressors, leading to adverse clinical outcomes such as increased hospitalizations, reduced mobility, and overall diminished quality of life. While pulmonary rehabilitation (PR) has been widely recognized as an effective intervention for COPD, its role in addressing frailty, particularly within post-COVID populations, remains underexplored. The COVID-19 pandemic significantly impacted the progression of this research, necessitating modifications in methodology due to disruptions in healthcare services. Initially focused on frailty in COPD, the study expanded to include post-COVID syndrome as an emerging area of interest. The overarching hypothesis posits that frailty is a clinical symptom within the spectrum of post-COVID syndrome and that pulmonary rehabilitation can serve as an effective intervention. 1.1 Research Problem: Despite the well-documented benefits of pulmonary rehabilitation in improving exercise capacity and reducing hospital readmissions in COPD, its effectiveness in reversing or mitigating frailty remains uncertain. Frailty has been linked to higher hospitalisation rates, increased mortality risk, and functional decline in patients with chronic respiratory conditions. Given the recent emergence of post-COVID syndrome, there is an urgent need to explore whether frailty should be recognised as part of its clinical presentation and whether pulmonary rehabilitation can effectively mitigate frailty-related complications. 1.2 Objectives: The study aimed to: 1. Determine the prevalence of frailty among individuals with post-COVID syndrome. 2. Assess changes in frailty status following a six-week pulmonary rehabilitation program. 3. Evaluate alterations in standard clinical outcomes used in pulmonary rehabilitation. 4. Compare the clinical characteristics of individuals hospitalized for COVID-19 with those who managed their illness at home. [...] 6. Conclusion and Recommendations: This study highlights frailty as a prevalent concern in both COPD and post-COVID syndrome, emphasising pulmonary rehabilitation as a viable intervention. Key findings demonstrate that PR can reduce frailty, improve functional capacity, and enhance quality of life in both populations. However, long-term strategies must be developed to maintain these benefits. Future research should expand sample sizes and explore long-term rehabilitation models for frail populations. This thesis underscores the urgent need to integrate frailty assessments in clinical practice for COPD and post-COVID patients and recommends the wider implementation of tailored pulmonary rehabilitation programs.