Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220048-en
Brazilian Journal of Pain
Review Article

Physical exercise in the control of pain or fatigue associated with viral infections: systematic review

Exercícios físicos no controle de dor ou fadiga associadas às infecções virais: revisão sistemática

Mônica Andrade Rios; Bruno Teixeira Goes; Abrahão Fontes Baptista; Leonardo Santana Ramos de Oliveira; Katia Nunes Sá

http://dx.doi.org/10.5935/2595-0118.20220048-en BrJP, vol.5, n3, p.248-257, 2022
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Abstract

BACKGROUND AND OBJECTIVES: Individuals after viral infections remain with persistent symptoms such as pain and fatigue. Physical exercises have been described as a promising alternative for the control of these symptoms, but there are no systematic reviews that verify the effectiveness of this therapy and that assess the quality of these studies. The aim of this study was to investigate the effect of physical exercise on pain or fatigue associated with viral infections.

METHODS: Systematic review registered with PROSPERO (CRD42021265174). Data collection was carried out between July 2021 and January 2022. Randomized clinical trials that addressed the practice of exercises, in individuals over 18 years of age, diagnosed with viral infection associated with the presence of pain or fatigue for more than 3 months were included. The search was carried out in the Pubmed, EMBASE, LILACS and Scielo databases, and the paired selection was carried out in the software (rayyan.ai); risk of bias analysis was assessed using the Cochrane risk-of-bias tool for randomized trials 2; certainty of evidence through GRADE; and for the construction of the meta-analysis, the Review Manager software.

RESULTS: Eleven clinical trials were selected in populations with acquired immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), chikungunya and poliomyelitis. For both pain and fatigue, the combination of aerobic exercise with resistance training, lasting 40 to 60 minutes, two to three times a week, was effective and safe. The methodological quality of the studies showed a high risk of bias in six studies due to the following domains: bias due to deviations from the intended interventions, bias due to lack of outcome data and bias in the selection of the reported outcome; rated as some concerns in one study due to the domain bias due to deviations from intended interventions; and the others were assessed as low risk of bias. The meta-analysis showed a result in favor of the intervention group on pain intensity in the studies for Chikungunya and in a study for HTLV, which points to a positive effect in favor of the active groups.

CONCLUSION: Exercises for the treatment of fatigue have very low evidence, while resistance exercises have moderate evidence for pain outcome. These are low-risk, low-cost resources with promising effects that should be better tested in people after viral infections.

HIGHLIGHTS

  • Aerobic training combined with resistance training shows promising results for reducing pain and fatigue in this population after viral infection.
  • Pilates is a method that significantly reduces pain intensity after HTLV-1 and Chikungunya infections.
  • Exercise can benefit people with persistent pain and fatigue symptoms after viral infections.

Keywords

Pain, Physical exercise, Fatigue, Viral infections

Resumo

JUSTIFICATIVA E OBJETIVOS: Indivíduos após infecções virais permanecem com sintomas persistentes, como a dor e a fadiga. Exercícios físicos têm sido descritos como alternativa promissora para o controle desses sintomas, porém não há revisões sistemáticas que verifquem a eficácia dessa terapêutica e que avaliem a qualidade destes estudos. O objetivo deste estudo foi investigar o efeito de exercícios físicos na dor ou fadiga associados a infecções virais.

MÉTODOS: Revisão sistemática registrada na PROSPERO (CRD42021265174). A coleta de dados foi realizada entre julho de 2021 a janeiro de 2022. Foram incluídos ensaios clínicos randomizados que abordaram a prática de exercícios, em indivíduos com idade superior a 18 anos, com diagnóstico de infecção viral associada à presença de dor ou fadiga por mais de três meses. A busca foi realizada nas bases de dados Pubmed, EMBASE, LILACS e Scielo e, a seleção por pares foi realizada no software (rayyan.ai); a análise de risco de viés foi avaliada através da ferramenta Cochrane risk-of-bias tool for randomized trials 2; a certeza da evidência por meio da GRADE; e para a construção da meta-análise, o software Review Manager.

RESULTADOS: Foram selecionados 11 ensaios clínicos nas populações com Vírus da Imunodeficiência Adquirida (HIV), Virus Linfotrópico da Célula T Humana (HTLV), Chikungunya e Poliomielite. Tanto para dor quanto para a fadiga, a conjunção de exercícios aeróbicos com treino resistido, com duração de 40 a 60 minutos, de duas a três vezes por semana, foram eficazes e seguros. A qualidade metodológica dos estudos demonstrou em seis estudos alto risco de viés, devido aos domínios: viés devido a desvios das intervenções pretendidas, viés devido à falta de dados de resultado e viés na seleção do resultado relatado; classificado como algumas preocupações em um estudo devido o domínio viés devido a desvios das intervenções pretendidas; e os demais foram avaliados como baixo risco de viés. Na meta-análise foi demonstrado resultado a favor do grupo intervenção sobre a intensidade da dor nos estudos para Chikungunya e em um estudo para HTLV, o que aponta para efeito positivo a favor dos grupos ativos.

CONCLUSÃO: Os exercícios físicos no tratamento da fadiga apresentam evidências muito baixas, enquanto para o desfecho dor os exercícios resistidos apresentam moderada evidência. São recursos de baixo risco e custo, com efeitos promissores, que devem ser melhor testados em pessoas após infecções virais.

DESTAQUES

  • O treinamento aeróbico combinado com o treinamento de resistência mostra resultados promissores para reduzir a dor e a fadiga nesta população após a infecção viral.
  • O Pilates é um método que reduz significativamente a intensidade da dor após infecções por HTLV-1 e Chikungunya.
  • O exercício pode beneficiar pessoas com sintomas persistentes de dor e fadiga após infecções

Palavras-chave

Dor, Exercício físico, Fadiga, Infecções Virais

References

Silva LA, Soares JPA, Silva LF, Silva RR, Araújo MS, Silva MVG, Oliveira ES, Mesquita LMF, Alencar IF, Dutra VCA, Silveira MB, Norbiato VNP, Silveira MLFG, Souza MGG, Barbosa ISF, Mendonça CFS, Duque ES, Oliveira JVE, Silva SFM. Pandemias e suas repercussões sociais ao longo da história associado ao novo SARS-COV-2: um estudo de revisão. Res Soc Dev. 2021;10(3).

Zappa A, Amendola A, Romanò L, Zanetti A. Emerging and re-emerging viruses in the era of globalisation. Blood Transfus. 2009;7(3):167-71.

Grubaugh ND, Ladner JT, Lemey P, Pybus OG, Rambaut A, Holmes EC, Andersen KG. Tracking virus outbreaks in the twenty-first century. Nat Microbiol. 2019;4(1):10-9.

Roychoudhury S, Das A, Sengupta P, Dutta S, Roychoudhury S, Choudhury AP, Ahmed ABF, Bhattacharjee S, Slama P. Viral pandemics of the last four decades: pathophysiology, health impacts and perspectives. Int J Environ Res Public Health. 2020;17(24):9411.

UNAIDS Brasil. 2022.

COVID-19 Data Explorer [Internet]. Our World in Data. .

Azagew AW, Woreta HK, Tilahun AD, Anlay DZ. High prevalence of pain among adult HIV-infected patients at University of Gondar Hospital, Northwest Ethiopia. J Pain Res. 2017;10:2461-9.

Mendes SMD, Baptista AF, Sá KN, Andrade DCA, Otero GG, Cavalcanti JZ, Isensee MF, Souza I, Kruschwsky RA, Galvão-castro B. Pain is highly prevalent in individuals with tropical spastic paraparesis. Health Care. 2013;1(3):47-53.

Oliveira ASB, Maynard FM. Síndrome pós-poliomielite. Rev Neurocienc. 2002;10(1):31-4.

Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603-5.

Orrù G, Bertelloni D, Diolaiuti F, Mucci F, Di Giuseppe M, Biella M, Gemignani A, Ciacchini R, Conversano C. Long-COVID syndrome? A study on the persistence of neurological, psychological and physiological symptoms. Healthcare. 2021;9(5):575.

Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes Metab Syndr. 2021;15(3):869-75.

Soumahoro MK, Gérardin P, Boëlle PY, Perrau J, Fianu A, Pouchot J, Malvy D, Flahault A, Favier F, Hanslik T. Impact of Chikungunya virus infection on health status and quality of life: a retrospective cohort study. PLoS One. 2009;4(11).

Marimoutou C, Ferraro J, Javelle E, Deparis X, Simon F. Chikungunya infection: self-reported rheumatic morbidity and impaired quality of life persist 6 years later. Clin Microbiol Infect. 2015;21(7):688-93.

Garip Y, Eser F, Bodur H, Baskan B, Sivas F, Yilmaz O. Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning. Rev Bras Reumatol Engl Ed. 2017;57(1):1-7.

Fontes LCDSF, Costa PJR, Fernandes JCJ, Vieira TS, Reis NC, Coimbra IMM, Paiva JAOC. The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective. Rev Bras The r Intensiva. 2022;34(1):141-6.

Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as treatment for anxiety: systematic review and analysis. Ann Behav Med. 2015;49(4):542-56.

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;4(4).

Bricca A, Harris LK, Jäger M, Smith SM, Juhl CB, Skou ST. Benefts and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. Ageing Res Rev. 2020;63:101166.

Palermo PCG, Feijó OG. Exercício físico e infecção pelo HIV: atualização e recomendações. Rev Bras Fisiol Exe. 2003;2:218-46.

Wittmer VL, Paro FM, Duarte H, Capellini VK, Barbalho-Moulim MC. Early mobilization and physical exercise in patients with COVID-19: A narrative literature review. Complement Ter Clin Pract. 2021;43:101364.

Macêdo MC, Mota RS, Patrício NA, Baptista AF, Andrade Filho AS, Sá KN. Pain and quality of life in human t-cell lymphotropic virus type 1-associated myelopathy or tropical spastic paraparesis after home-based exercise protocol: a randomized clinical trial. Rev Soc Bras Med Trop. 2019;52.

Patrício NA, Vidal DG, Pinto EB, Sá KN, Baptista AF. Efectiveness of virtual reality games for falls, postural oscillations, pain and quality of life of individual HAM/TSP: a randomized, controlled, clinical trial. J Neurovirol. 2020;26(5):676-86.

Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;20(5):13.

Maharaj SS, Yakasai AM. Does a rehabilitation program of aerobic and progressive resisted exercises influence HIV-induced distal neuropathic pain?. Am J Phys Med Rehabil. 2018;97(5):364-9.

Hand GA, Phillips KD, Dudgeon WD, William Lyerly G, Larry Durstine J, Burgess SE. Moderate intensity exercise training reverses functional aerobic impairment in HIV-infected individuals. AIDS Care. 2008;20(9):1066-74.

Facchinetti LD, Araújo AQ, Silva MT, Leite ACC, Azevedo MF, Chequer GL, Oliveira RV, Ferreira AS, Lima MA. Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study. Arq Neuro-Psiquiatr. 2017;75(4):221-7.

Nosrat S, Whitworth JW, Dunsiger SI, SantaBarbara NJ, Ciccolo JT. Acute effects of resistance exercise in a depressed HIV sample: The exercise for people who are immunocompromised (EPIC) study. Ment Health Phys Act. 2017;12:2-9.

Voorn EL, Koopman FS, Brehm MA, Beelen A, de Haan A, Gerrits KHL, Nollet F. Aerobic exercise training in post-polio syndrome: process evaluation of a randomized controlled trial. PLoS One. 2016;11(7).

Lee KA, Jong S, Gay CL. Fatigue management for adults living with HIV: a randomized controlled pilot study. Res Nurs Health. 2020;43(1):56-67.

Daynes E, Gerlis C, Chaplin E, Gardiner N, Singh SJ. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition - a cohort study. Chron Respir Dis. 2021;18:14799731211015691.

Smith BA, Neidig JL, Nickel JT, Mitchell GL, Para MF, Fass RJ. Aerobic exercise: effects on parameters related to fatigue, dyspnea, weight and body composition in HIV-infected adults. AIDS. 2001;15(6):693-701.

Oncu J, Durmaz B, Karapolat H. Short-term effects of aerobic exercise on functional capacity, fatigue, and quality of life in patients with post-polio syndrome. Clin Rehabil. 2009;23(2):155-63.

Jaggers JR, Hand GA, Dudgeon WD, Burgess S, Phillips KD, Durstine JL, Blair SN. Aerobic and resistance training improves mood state among adults living with HIV. Int J Sports Med. 2015;36(2):175-81.

Koopman FS, Voorn EL, Beelen A, Bleijenberg G, de Visser M, Brehm MA, Nollet F. No reduction of severe fatigue in patients with postpolio syndrome by exercise therapy or cognitive behavioral therapy: results of an RCT. Neurorehabil Neural Repair. 2016;30(5):402-10.

Borges J, Baptista AF, Santana N, Souza I, Kruschewsky RA, Galvão-Castro B, Sá KN. Pilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: a randomized crossover clinical trial. J Bodyw Mov Ter. 2014;18(1):68-74.

Parker R, Jelsma J, Stein DJ. Managing Pain in Women living with HIV/AIDS: a randomized controlled trial testing the effect of a six-week peer-led exercise and education intervention. J Nerv Ment Dis. 2016;204(9):665-72.

de Oliveira BFA, Carvalho PRC, de Souza Holanda AS, Dos Santos RISB, da Silva FAX, Barros GWP, de Albuquerque EC, Dantas AT, Cavalcanti NG, Ranzolin A, Duarte ALBP, Marques CDL. Pilates method in the treatment of patients with Chikungunya fever: a randomized controlled trial. Clin Rehabil. 2019;33(10):1614-24.

Neumann IL, de Oliveira DA, de Barros EL, da S Santos G, de Oliveira LS, Duarte AL, Marques CD, Dantas AT, Dantas D, de Siqueira GR, da Silva Tenório A. Resistance exercises improve physical function in chronic Chikungunya fever patients: a randomized controlled trial. Eur J Phys Rehabil Med. 2021;57(4):620-9.

Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29(12):1155-67.

Miyamoto GC, Costa LOP, Cabral CMN. Eficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis. Braz J Phys Ter. 2013;17(6):517-32.

Maher CG, Saragiotto BT, Hancock MJ, Ostelo RW, Cabral CM, Menezes Costa LC, Costa LO. Pilates for low back pain. Cochrane Database Syst Rev. 2015.

Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017.

Heine M, Verschuren O, Hoogervorst EL, van Munster E, Hacking HG, Visser-Meily A, Twisk JW, Beckerman H, de Groot V, Kwakkel G. Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial. Mult Scler. 2017;23(11):1517-26.

Nakano J, Hashizume K, Fukushima T, Ueno K, Matsuura E, Ikio Y, Ishii S, Morishita S, Tanaka K, Kusuba Y. Efects of aerobic and resistance exercises on physical symptoms in cancer patients: a meta-analysis. Integr Cancer Ter. 2018;17(4):1048-58.

Wilson KC. Consensus-based recommendations in respiratory medicine. Eur Respir J. 2020;56:2002889.

Submitted date:
07/08/2022

Accepted date:
09/23/2022

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