A Case Report of Long COVID with Pulmonary Fibrosis Patient after Receiving an Outpatient Pulmonary Rehabilitation Program


  • Napaporn Vaewthong Department of Physical Therapy, Central Chest Institute of Thailand


Lung fibrosis, Pulmonary rehabilitation, Exercise, Long COVID


COVID-19 survivors have developed pulmonary fibrosis and found that up to 44.9%, which caused dyspnea, decreased exercise capacity, and poor quality of life. Pulmonary rehabilitation is commonly used to reduce dyspnea, enhance exercise tolerance and improve quality of life. However, few studies of pulmonary rehabilitation in long COVID patients with pulmonary fibrosis have been conducted due to COVID-19 being an emerging disease. This report was a case study on a 60-year-old Thai male patient with long COVID and pulmonary fibrosis who received outpatient pulmonary rehabilitation for 3 months following the American College of Sports Medicine guidelines. The fact that the patient had limited exercise capacity caused by dyspnea and abnormal pulmonary function at the beginning of the rehabilitation program, meant that he first underwent low-intensity interval training to reduce dyspnea and familiarize himself with the prescribed training activities before progressing to moderate-intensity continuous training. After the rehabilitation 3 months, the patient experienced improved strength in the upper limbs (17.50%-17.86%), lower limbs (66.67%), respiratory muscles (inspiratory muscles 7.89%, expiratory muscles 9.62%), and pulmonary function (FEV1 8.87%, FVC 5.04% and FEF25-75% , 30.77%). (forced expiratory volume in one second (FEV1) 8.87%, forced vital capacity (FVC) 5.04% and peak expiratory flow (PEF) 25-75, 30.77%). As a result, improved exercise capacity (29.31%) and quality of life improved while dyspnea decreased. Thus, pulmonary rehabilitation should be recommended in patients with long COVID and pulmonary fibrosis to enhance their exercise capacity as well as their quality of life.


Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg Lond Engl 2020;76:71-6.

COVID-19 rapid guideline: managing the long-term effects of COVID-19 [Internet]. 2020 [cited 2023 Feb 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK567261/

Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV, WHO Clinical case definition working group on post-COVID-19 condition. A clinical case definition of post-COVID-19 condition by a delphi consensus. Lancet Infect Dis 2022;22(4):e102-7.

O’Mahoney LL, Routen A, Gillies C, Ekezie W, Welford A, Zhang A, et al. The prevalence and long-term health effects of long covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis. EClinicalMedicine 2023;55:101762.

Subramanian A, Nirantharakumar K, Hughes S, Myles P, Williams T, Gokhale KM, et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med 2022;28(8):1706-14.

Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023;21(3):133-46.

Hama Amin BJ, Kakamad FH, Ahmed GS, Ahmed SF, Abdulla BA, mohammed SH, et al. Post COVID-19 pulmonary fibrosis; a meta-analysis study. Ann Med Surg 2022;77:103590.

Tran S, Ksajikian A, Overbey J, Li P, Li Y. Pathophysiology of pulmonary fibrosis in the context of COVID-19 and implications for treatment: a narrative review. Cells 2022;11(16):2489.

Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American thoracic society/European respiratory society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188(8):e13-e64.

Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest 2007;131 (5 Suppl):4S-42S.

Dowman L, Hill CJ, May A, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev 2021;2(2):CD006322.

American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2014.

Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J 1999;14(2):270-4.

Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 1985;66(2):69-74.

Montes-Ibarra M, Oliveira CLP, Orsso CE, Landi F, Marzetti E, Prado CM. The impact of long COVID-19 on muscle health. Clin Geriatr Med 2022;38(3):545-57.

Reina-Gutiérrez S, Torres-Costoso A, Martínez-Vizcaíno V, Núñez de Arenas-Arroyo S, Fernández-Rodríguez R, PozueloCarrascosa DP. Effectiveness of pulmonary rehabilitation in interstitial lung disease, including coronavirus diseases: a systematic review and meta-analysis. Arch Phys Med Rehabil 2021;102(10):1989-97.

Huang LH, Chen YJ. The 6-minute walk test to assess exercise capacity of patients with chronic obstructive pulmonary disease. Eur Respir J 2016;48(suppl 60):PA1385.

de Torres JP, Pinto-Plata V, Ingenito E, Bagley P, Gray A, Berger R, et al. Power of outcome measurements to detect clinically significant changes in pulmonary rehabilitation of patients with COPD. Chest 2002;121(4):1092–8.

Oliveira A, Rebelo P, Paixão C, Jácome C, Cruz J, Valente C, et al. Minimal clinically important difference using one-repetition maximum in COPD. COPD 2021;18(1):35-44.

Wyrwich KW, Fihn SD, Tierney WM, Babu AN, Wolinsky FD, Kroenke K. Clinically important changes in health-related quality of life for patients with chronic obstructive pulmonary disease. J Gen Intern Med 2003;18(3):196-202.

Nyberg A, Carvalho J, Bui KL, Saey D, Maltais F. Adaptations in limb muscle function following pulmonary rehabilitation in patients with COPD - a review. Rev Port Pneumol 2016;22(6): 342-50.

Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012;185(4):435-52.




How to Cite

Vaewthong N. A Case Report of Long COVID with Pulmonary Fibrosis Patient after Receiving an Outpatient Pulmonary Rehabilitation Program. J DMS [Internet]. 2023 Dec. 15 [cited 2024 Apr. 15];48(4):138-44. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/250614