Cardiac rehabilitation produces functional capacity gains and quality of life improvements in patients with coronary heart disease (CHD), and a history of COVID-19 does not blunt this effect, according to a study.
CHD patients with a history of COVID-19 who underwent a supervised cardiac rehabilitation program showed significant improvements from baseline in BMI (mean change, –0.74 kg/m2; p<0.001), abdominal circumference (mean change, –3.18 cm; p<0.001), maximal inspiratory pressure (mean change, –15.49 cmH2O; p<0.001), manual grip force (mean changes, 4.51 kg for the right hand and 4.74 kg for the left hand; p<0.001 for both), task metabolic equivalents (METs; mean change, 1.46 ml/kg/min; p<0.001), and exercise test duration (mean change, 2.09 min; p<0.001). [Respir Med 2026;doi:10.1016/j.rmed.2026.108983]
Improvements were also seen across all Short Form-36 (SF-36) subscales, such as physical functioning, physical role functioning, bodily pain, general health perceptions, vitality, social role functioning, emotional role functioning, mental health, and health transition (p<0.001 for all).
More importantly, post-rehabilitation changes observed for CHD patients with a history of COVID-19 did not significantly differ from those seen for CHD patients who had not been exposed to COVID-19, except for vitality and health transition domains of the SF-36.
Vitality scores were substantially higher in the non-COVID group (between-group difference, 7.76; p=0.023), whereas the perceived health transition was significantly greater in the COVID group (between group difference, 12.37; p=0.013).
“To our knowledge, this is the first study to explore the potential influence of prior COVID-19 infection on outcomes of CR programmes in patients with CHD,” the authors noted.
The findings suggest that a history of COVID-19 was not associated with a modified response to the cardiac rehabilitation program in patients with CHD, they added.
The authors proposed several mechanisms that may explain the results observed in the study.
“Our study was conducted with mild COVID-19 patients, [so] residual impairments in pulmonary and cardiovascular systems may be limited, allowing for a similar baseline functional status compared to patients without prior infection,” the authors pointed out.
“In addition, exercise-based cardiac rehabilitation programs promote central and peripheral adaptations, including improved oxygen delivery and use, mitochondrial efficiency, and neuromuscular function. These mechanisms, together with the inclusion of inspiratory muscle training in selected patients with reduced maximal inspiratory pressure, may contribute to overcoming subtle post-viral limitations and support comparable improvements in both [COVID and non-COVID] groups,” they said.
Nevertheless, the authors advised careful interpretation of the results, given the observational design of the study and the limited clinical characterization of COVID-19 in the COVID group.
The study included 77 CHD patients enrolled in a supervised cardiac rehabilitation program, of which 39 had a previous COVID-19 infection (mean time since infection 7.5 months). Baseline characteristics were generally similar between the COVID and non-COVID groups. In the respective groups, the mean age was 54.95 vs 56.6 years, the mean BMI was 28.4 vs 30.3 kg/m2, more than 80 percent were male, and more than half had no atrial hypertension.
A total of 32 patients required additional inspiratory muscle training, of whom 13 belonged to the post-COVID-19 group and 19 to the non-COVID-19 group (p=0.138).