{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T07:55:58Z","timestamp":1762070158220,"version":"build-2065373602"},"reference-count":121,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Physiotherapy Program, Department of Health Sciences, Pontificia Universidad Cat\u00f3lica de Chile"},{"name":"Sandra Faire and Ivan Fecan Professorship in Rehabilitation Medicine (University Health Network\/University of Toronto)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biology"],"abstract":"<jats:p>The purpose of this narrative review is to highlight the oxidative stress induced in COVID-19 patients (SARS-CoV-2 infection), describe longstanding functional impairments, and provide the pathophysiologic rationale that supports aerobic eccentric (ECC) exercise as a novel alternative to conventional concentric (CONC) exercise for post-COVID-19 patients. Patients who recovered from moderate-to-severe COVID-19 respiratory distress demonstrate long\u2013term functional impairment. During the acute phase, SARS-CoV-2 induces the generation of reactive oxygen species that can be amplified to a \u201ccytokine storm\u201d. The resultant inflammatory and oxidative stress process causes organ damage, particularly in the respiratory system, with the lungs as the tissues most susceptible to injury. The acute illness often requires a long-term hospital stay and consequent sarcopenia. Upon discharge, muscle weakness compounded by limited lung and cardiac function is often accompanied by dyspnea, myalgia, anxiety, depression, and sleep disturbance. Consequently, these patients could benefit from pulmonary rehabilitation (PR), with exercise as a critical intervention (including sessions of strength and endurance or aerobic exercises). Unfortunately, conventional CONC exercises induce significant cardiopulmonary stress and increase inflammatory and oxidative stress (OS) when performed at moderate\/high intensity, which can exacerbate debilitating dyspnoea and muscle fatigue post-COVID-19. Eccentric training (ECC) is a well\u2013tolerated alternative that improves muscle mass while mitigating cardiopulmonary stress in patients with COPD and other chronic diseases. Similar benefits could be realized in post-COVID-19 patients. Consequently, these patients could benefit from PR with exercise as a critical intervention.<\/jats:p>","DOI":"10.3390\/biology11101446","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T00:07:43Z","timestamp":1665187663000},"page":"1446","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Eccentric Training in Pulmonary Rehabilitation of Post-COVID-19 Patients: An Alternative for Improving the Functional Capacity, Inflammation, and Oxidative Stress"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0674-7506","authenticated-orcid":false,"given":"Felipe","family":"Contreras-Brice\u00f1o","sequence":"first","affiliation":[{"name":"Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Cat\u00f3lica de Chile, Av. Vicu\u00f1a Mackenna #4860, Santiago 7820436, Chile"},{"name":"Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain"},{"name":"Advanced Center for Chronic Diseases (ACCDiS), Division of Cardiovascular Diseases, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Marcoleta #367, Santiago 8380000, Chile"},{"name":"Millennium Institute for Intelligent Healthcare Engineering, Av. Vicu\u00f1a Mackenna #4860, Santiago 7820436, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0840-1904","authenticated-orcid":false,"given":"Maximiliano","family":"Espinosa-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Cat\u00f3lica de Chile, Av. Vicu\u00f1a Mackenna #4860, Santiago 7820436, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8786-9152","authenticated-orcid":false,"given":"Dmitry","family":"Rozenberg","sequence":"additional","affiliation":[{"name":"Department of Medicine, Respirology, University of Toronto, Toronto, ON M5G 2C4, Canada"},{"name":"Toronto General Hospital, Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9980-8699","authenticated-orcid":false,"given":"W. Darlene","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada"},{"name":"KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamainternmed.2020.0994","article-title":"Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China","volume":"180","author":"Wu","year":"2020","journal-title":"JAMA Intern. 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