Bewegungs- und Sporttherapie in der Rehabilitation des Long-/Post-COVID-Syndroms unter besonderer Berücksichtigung neuropsychiatrischer Symptomatik

Zusammenfassung

Die von dem Atemwegsvirus SARS-CoV-2 ausgelöste Erkrankung COVID-19 ist heute als Multiorganerkrankung anerkannt. Sub- und postakut können diverse Langzeitfolgen mit unterschiedlich starker Symptomlast auftreten. Als häufigste Symptome des Long-/Post-COVID-Syndroms (LPCS) gelten Fatigue und Dyspnoe. Zunehmend gewinnen die neurologischen/neuropsychiatrischen Manifestationen des postinfektiösen Syndroms an Bedeutung. Insbesondere diejenigen LPCS-Patienten, die auf psychophysische Überforderung mit lang andauernder postexertioneller Malaise (PEM) reagieren, bedürfen einer äußerst behutsamen, auf ihre individuelle Belastungssensibilität abgestimmten Rehabilitation, denn bei Belastungsintoleranz kann eine Symptomverschlimmerung nach Anstrengung den Allgemeinzustand und die Lebensqualität dauerhaft verschlechtern.

Die Diversität der Erscheinungsbilder des LPCS mag ein Grund für die teils inkonsistenten Ergebnisse empirischer Interventionsforschung sein. Während viele Patienten von körperlicher Aktivität profitieren, kann sie bei einer Subgruppe die LPCS-Symptome verstärken. Nach bisherigem Erkenntnisstand erweist sich die Kombination von Ausdauer- mit Krafttraining am effektivsten, um die funktionale Kapazität zu verbessern, die Lebensqualität zu fördern und Symptome wie Dyspnoe, Fatigue oder Depression zu lindern. Grundsätzlich sollte die Intervention indikationsgerecht, symptomspezifisch und individualisiert angepasst werden. Wenngleich Mind-Body-Exercise (MBE) für viele belastungsvulnerable Patientenkollektive als wirksam und sicher gelten kann, fehlt bislang ein evidenzbasiertes bewegungstherapeutisches Konzept für LPCS-Patienten mit PEM. Ein praktikabler Ansatz wird vorgeschlagen, der MBE sowie andere Methoden bewusster Körperarbeit mit Belastungssteuerung nach dem subjektiven Belastungsempfinden und mit präventivem Selbstmanagement (Pacing) verknüpft. Die partizipative Einbindung der Patientensicht in Therapie und Evaluation ist dabei zentral.

Summary

COVID-19 caused by the respiratory virus SARS-CoV-2 is nowadays being recognized as a multisystem disease. Sub- and post-acute many long-term effects with different symptoms and severity occur. Most common symptoms of the long/post-COVID syndrome (LPCS) are fatigue and dyspnea. Neurological and psychiatric manifestations of the post-infectious syndrome are gaining importance. Especially LPCS-patients that respond to mental and physical overload with post-exertional malaise (PEM) need a careful rehabilitation, which is tailored to their individual needs. For exercise intolerance can aggravate symptoms after exertion potentially deteriorating the general condition and Quality of Life (QoL) permanently.

The diversity of LPCS-manifestations may be one reason for inconsistent empirical evidence as a result of exercise interventions. While many patients benefit from physical activity, a subgroup of patients reacts with worsening symptoms. According to the preliminary state of knowledge combined endurance and strength training turns out to be most effective in enhancing functional capacity, QoL and attenuating symptoms like dyspnea, fatigue and depression. In principle, the intervention should be designed appropriately to indications, symptoms and individual requirements. Even though mind-body exercise (MBE) can be considered effective and safe for many load-sensitive LPCS-patients, an evidence-based concept of physical exercise and sports therapy for LPCS-patients with PEM is missing. A feasible approach is proposed integrating MBE and other mindful methods that work with subjective exercise perception and controlling as well as with the preventive self-management of pacing. Participatory inclusion of the patient’s point of view in therapy and evaluation appears crucial in this process.

Stichworte

Long-/Post-COVID - Bewegungstherapie - Belastungsintoleranz/PEM - Mind-Body-Exercise/MBE - Subjektive Belastungssteuerung

Keywords

long/post COVID - physical exercise and sports therapy - exercise intolerance/PEM - mind-body exercise/MBE - subjective exercise control

Publication History

Received: 28 February 2024

Accepted after revision: 12 June 2024

Article published online:
19 February 2025

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