Adapted Physical Activity Protocol Improves Health-Related Quality of Life and Psychological Outcomes in Long COVID: A Prospective Longitudinal Study

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Nadhir Hammami,1 Souad Karoui,2 Mehrzia Amani Khezami,2,3,* Halil İbrahim Ceylan,4,* Wissem Dhahbi,1,5 Emna Bahlouli,2,3 Imededdine Ben Jeddou,2 Ismail Dergaa,6,7 Sonia Lebib,2,3 Fatma-Zohra Ben Salah,2,3 Valentina Stefanica,8 Raul Ioan Muntean,9 Catherine Dziri2,3 1Research Unit (UR22JS01) “Sport Sciences, Health and Movement”, High Institute of Sport and Physical Education of Kef, University of Jendouba, Le Kef, Tunisia; 2Departement of Physical Medicine and Rehabilitation, Kassab Institute of Orthopedics, Tunis, Tunisia; 3Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; 4Department of Physical Education of Sports Teaching, Faculty of Sports Sciences, Atatürk University, Erzurum, Türkiye; 5Qatar Police Academy, Police College, Training Department, Doha, Qatar; 6High Institute of Sport and Physical Education of Ksar Saïd, University of Manouba, Manouba, Tunisia; 7Research Laboratory Education, Motricité, Sport Et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia; 8Department of Physical Education and Sport, Faculty of Sciences, Physical Education and Informatics, National University of Science and Technology Politehnica Bucharest, Pitesti University Center, Pitesti, Romania; 9Department of Physical Education and Sport, Faculty of Law and Social Sciences, University “ 1 Decembrie 1918” of Alba Iulia, Alba Iulia, Romania*These authors contributed equally to this workCorrespondence: Halil İbrahim Ceylan, Department of Physical Education of Sports Teaching, Faculty of Sports Sciences, Atatürk University, Yakutiye, Erzurum, Türkiye, 25240, Tel +90 442 231 2265, Fax +90 442 231 4288, Email halil.ibrahimceylan60@gmail.com Raul Ioan Muntean, Department of Physical Education and Sport, Faculty of Law and Social Sciences, University “ 1 Decembrie 1918” of Alba Iulia, Strada Unirii No. 15-17, Alba Iulia, 510009, Romania, Tel +40 258 813 994, Fax +40 258 806 126, Email muntean.raul@uab.roBackground: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has resulted in persistent symptoms in some individuals—referred to as long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC). Common symptoms such as fatigue, dyspnea, anxiety, and depression can markedly impair health-related quality of life (HRQOL). Conventional rehabilitation may be insufficient, raising interest in Adapted Physical Activity (APA) as a non-pharmacological strategy to improve physical and psychological outcome. Thus, this study aimed to evaluate the short- and medium-term effects of an APA protocol on HRQOL and psychological outcomes in patients with long COVID.Methods: Fifty non-hospitalized patients with long COVID (mean age 52.0 ± 15.3 years; 44% female) participated in in a prospective, longitudinal observational study. Each patient underwent a 6-week APA program consisting of two 30-minute individualized cardiorespiratory sessions per week. HRQOL (SF-12), anxiety, and depression (HADS) were evaluated at baseline (E1), immediately post-intervention (E2), and at 5– 7 months follow-up (E3).Results: Significant improvements were found in both physical and mental SF-12 scores across time points (p 

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