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Longobardi I, Prado DMLD, Goessler KF, Meletti MM, de Oliveira Júnior GN, de Andrade DCO, Gualano B, Roschel H. Oxygen uptake kinetics and chronotropic responses to exercise are impaired in survivors of severe COVID-19. Am J Physiol Heart Circ Physiol 2022; 323:H569-H576. [PMID: 35984763 PMCID: PMC9448283 DOI: 10.1152/ajpheart.00291.2022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The post-acute phase of coronavirus disease 2019 (COVID-19) is often marked by several persistent symptoms and exertional intolerance, which compromise survivors’ exercise capacity. This was a cross-sectional study aiming to investigate the impact of COVID-19 on oxygen uptake (V̇o2) kinetics and cardiopulmonary function in survivors of severe COVID-19 about 3–6 mo after intensive care unit (ICU) hospitalization. Thirty-five COVID-19 survivors previously admitted to ICU (5 ± 1 mo after hospital discharge) and 18 controls matched for sex, age, comorbidities, and physical activity level with no prior history of SARS-CoV-2 infection were recruited. Subjects were submitted to a maximum-graded cardiopulmonary exercise test (CPX) with an initial 3-min period of a constant, moderate-intensity walk (i.e., below ventilatory threshold, VT). V̇o2 kinetics was remarkably impaired in COVID-19 survivors as evidenced at the on-transient by an 85% (P = 0.008) and 28% (P = 0.001) greater oxygen deficit and mean response time (MRT), respectively. Furthermore, COVID-19 survivors showed an 11% longer (P = 0.046) half-time of recovery of V̇o2 (T1/2V̇o2) at the off-transient. CPX also revealed cardiopulmonary impairments following COVID-19. Peak oxygen uptake (V̇o2peak), percent-predicted V̇o2peak, and V̇o2 at the ventilatory threshold (V̇o2VT) were reduced by 17%, 17%, and 12% in COVID-19 survivors, respectively (all P < 0.05). None of the ventilatory parameters differed between groups (all P > 0.05). In addition, COVID-19 survivors also presented with blunted chronotropic responses (i.e., chronotropic index, maximum heart rate, and heart rate recovery; all P < 0.05). These findings suggest that COVID-19 negatively affects central (chronotropic) and peripheral (metabolic) factors that impair the rate at which V̇o2 is adjusted to changes in energy demands. NEW & NOTEWORTHY Our findings provide novel data regarding the impact of COVID-19 on submaximal and maximal cardiopulmonary responses to exercise. We showed that V̇o2 kinetics is significantly impaired at both the onset (on-transient) and the recovery phase (off-transient) of exercise in these patients. Furthermore, our results suggest that survivors of severe COVID-19 may have a higher metabolic demand at a walking pace. These findings may partly explain the exertional intolerance frequently observed following COVID-19.
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Affiliation(s)
- Igor Longobardi
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Karla Fabiana Goessler
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Matheus Molina Meletti
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, São Paulo, Brazil.,Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, São Paulo, Brazil.,Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
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Rocco IS, Viceconte M, Pauletti HO, Matos-Garcia BC, Marcondi NO, Bublitz C, Bolzan DW, Moreira RSL, Reis MS, Hossne NA, Gomes WJ, Arena R, Guizilini S. Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery. Disabil Rehabil 2017; 41:534-540. [PMID: 29279000 DOI: 10.1080/09638288.2017.1401673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting. METHODS Fifty-two patients aged 60.9 ± 7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model. Oxygen uptake at steady state, constant time, and mean response time corrected by work rate were analysed. Short-term clinical outcomes were evaluated during the early post-operative of off-pump coronary artery bypass surgery. RESULTS Multivariate analysis showed body mass index, surgery time, and mean response time corrected by work rate as independent predictors for short-term outcomes. The optimal mean response time corrected by work rate cut-off to estimate short-term clinical outcomes was 1.51 × 10-3 min2/ml. Patients with slower mean response time corrected by work rate demonstrated higher rates of hypertension, diabetes, EuroSCOREII, left ventricular dysfunction, and impaired 6-min walk test parameters. The per cent-predicted distance threshold of 66% in the pre-operative was associated with delayed oxygen uptake kinetics. CONCLUSIONS Pre-operative oxygen uptake kinetics during 6-min walk test predicts short-term clinical outcomes after off-pump coronary artery bypass surgery. From a clinically applicable perspective, a threshold of 66% of pre-operative predicted 6-min walk test distance indicated slower kinetics, which leads to longer intensive care unit and post-surgery hospital length of stay. Implications for rehabilitation Coronary artery bypass grafting is a treatment aimed to improve expectancy of life and prevent disability due to the disease progression; The use of pre-operative submaximal functional capacity test enabled the identification of patients with high risk of complications, where patients with delayed oxygen uptake kinetics exhibited worse short-term outcomes; Our findings suggest the importance of the rehabilitation in the pre-operative in order to "pre-habilitate" the patients to the surgical procedure; Faster oxygen uptake on-kinetics could be achieved by improving the oxidative capacity of muscles and cardiovascular conditioning through rehabilitation, adding better results following cardiac surgery.
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Affiliation(s)
- Isadora Salvador Rocco
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Marcela Viceconte
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Hayanne Osiro Pauletti
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Bruna Caroline Matos-Garcia
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Natasha Oliveira Marcondi
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Caroline Bublitz
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Douglas William Bolzan
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Rita Simone Lopes Moreira
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Michel Silva Reis
- c Department of Physical Therapy , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Nelson Américo Hossne
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Walter José Gomes
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Ross Arena
- d Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences , University of Illinois at Chicago , Chicago , IL , USA
| | - Solange Guizilini
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
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Borghi-Silva A, Beltrame T, Reis MS, Sampaio LMM, Catai AM, Arena R, Costa D. Relationship between oxygen consumption kinetics and BODE Index in COPD patients. Int J Chron Obstruct Pulmon Dis 2012; 7:711-8. [PMID: 23118534 PMCID: PMC3484529 DOI: 10.2147/copd.s35637] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patients with chronic obstructive pulmonary disease (COPD) present with reduced exercise capacity due to impaired oxygen consumption (VO(2)), caused primarily by pulmonary dysfunction and deleterious peripheral adaptations. Assuming that COPD patients present with slower VO(2) and heart rate (HR) on-kinetics, we hypothesized that this finding is related to disease severity as measured by the BODE Index. In this context, the present study intends to evaluate the relationship between VO(2) uptake on-kinetics during high-intensity exercise and the BODE Index in patients with COPD. METHODS Twenty males with moderate-to-severe stable COPD and 13 healthy control subjects matched by age and sex were evaluated. COPD patients were screened by the BODE Index and then underwent an incremental cardiopulmonary exercise test and a constant speed treadmill session at 70% of maximal intensity for 6 minutes. The onset of the exercise (first 360 seconds) response for O(2) uptake and HR was modeled according to a monoexponential fit. RESULTS Oxygen consumption and HR on-kinetics were slower in the COPD group compared with controls. Additionally, VO(2) on-kinetic parameters revealed a strong positive correlation (r = 0.77, P < 0.05) with BODE scores and a moderate negative correlation with walking distance (r = -0.45, P < 0.05). CONCLUSION Our data show that moderate-to-severe COPD is related to impaired oxygen delivery and utilization during the onset of intense exercise.
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Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, SP, Brazil.
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Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus. Arch Phys Med Rehabil 2010; 91:1402-9. [PMID: 20801259 DOI: 10.1016/j.apmr.2010.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/28/2010] [Accepted: 06/02/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether oxygen consumption (V o(2)) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls. DESIGN Exploratory case-control study. SETTING Medical school exercise physiology laboratory. PARTICIPANTS Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10). INTERVENTION None. MAIN OUTCOME MEASURES V o(2) on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs). RESULTS Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE. CONCLUSION V o(2) on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE.
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Kemps HMC, De Vries WR, Hoogeveen AR, Zonderland ML, Thijssen EJM, Schep G. Reproducibility of onset and recovery oxygen uptake kinetics in moderately impaired patients with chronic heart failure. Eur J Appl Physiol 2007; 100:45-52. [PMID: 17277937 PMCID: PMC1914232 DOI: 10.1007/s00421-007-0398-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2007] [Indexed: 12/04/2022]
Abstract
Oxygen (O2) kinetics reflect the ability to adapt to or recover from exercise that is indicative of daily life. In patients with chronic heart failure (CHF), parameters of O2 kinetics have shown to be useful for clinical purposes like grading of functional impairment and assessment of prognosis. This study compared the goodness of fit and reproducibility of previously described methods to assess O2 kinetics in these patients. Nineteen CHF patients, New York Heart Association class II–III, performed two constant-load tests on a cycle ergometer at 50% of the maximum workload. Time constants of O2 onset- and recovery kinetics (τ) were calculated by mono-exponential modeling with four different sampling intervals (5 and 10 s, 5 and 8 breaths). The goodness of fit was expressed as the coefficient of determination (R2). Onset kinetics were also evaluated by the mean response time (MRT). Considering O2 onset kinetics, τ showed a significant inverse correlation with peak-
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$$ \ifmmode\expandafter\dot\else\expandafter\.\fi{V}{\text{O}}_{2} $$\end{document} (R = −0.88, using 10 s sampling intervals). The limits of agreement of both τ and MRT, however, were not clinically acceptable. O2 recovery kinetics yielded better reproducibility and goodness of fit. Using the most optimal sampling interval (5 breaths), a change of at least 13 s in τ is needed to exceed normal test-to-test variations. In conclusion, O2 recovery kinetics are more reproducible for clinical purposes than O2 onset kinetics in moderately impaired patients with CHF. It should be recognized that this observation cannot be assumed to be generalizable to more severely impaired CHF patients.
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Affiliation(s)
- Hareld M C Kemps
- Department of Sports Medicine, Máxima Medical Centre, Postbox 7777, 5500 MB, Veldhoven, The Netherlands.
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Drinkard BE, Hicks J, Danoff J, Rider LG. Fitness as a determinant of the oxygen uptake/work rate slope in healthy children and children with inflammatory myopathy. ACTA ACUST UNITED AC 2004; 28:888-97. [PMID: 14992126 DOI: 10.1139/h03-063] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED There is evidence that the slope of the change in oxygen uptake accompanying changes in work rate (delta VO2/delta W). during moderate incremental exercise is influenced by fitness (peak VO2). We set out to determine whether delta VO2/delta W was related to fitness in a group of healthy children and in children with juvenile dermatomyositis (JDM), a condition associated with decreased peak VO2. We also hypothesized that delta VO2/delta would be significantly decreased in children with JDM compared to healthy children. METHODS Twelve children (2 boys) with JDM, mean age 11.6 +/- 3.6 yrs, and 20 healthy children (4 boys), mean age 11.3 +/- 2.9 years, performed an incremental exercise test using a cycle ergometer. delta VO2/delta W below the anaerobic threshold was analyzed using linear regression. Correlations between peak VO2 and delta VO2/delta W were calculated, and differences between the JDM and healthy groups were analyzed using independent t-tests. RESULTS The delta VO2/delta W was significantly correlated with peak VO2 for children with JDM (r = 0.71, p < 0.01), healthy children (r = 0.53, p < 0.01), and all children combined (r = 0.78, p < 0.001). The delta VO2/delta W (7.4 +/- 1.4 vs. 10.8 +/- 1.2 ml O2.min-1.watt-1) and peak oxygen uptake (VO2peak) (19.2 +/- 5.0 vs. 31.4 +/- 7.2 ml O2.kg-1, min-1) were significantly lower in children with JDM than in healthy children, respectively (all p < or = 0.001). CONCLUSION Fitness is significantly related to delta VO2/delta W in healthy children and those with JDM. Children with JDM have a significantly lower delta VO2/delta W than healthy children. Further study is needed to identify specific factors influencing delta VO2/delta W.
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Affiliation(s)
- Bart E Drinkard
- Dept. of Rehabilitation Medicine, National Institute of Environmental Health Sciences, National Institutes of Health, 10 Center Dr., Bethesda, MD 20892-1604, USA
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Behnke BJ, McDonough P, Musch TI, Poole DC, Arena R. Comparison of oxygen uptake on-kinetics calculations in heart failure. Med Sci Sports Exerc 2003; 35:708-9; author reply 709. [PMID: 12673159 DOI: 10.1249/01.mss.0000058444.43322.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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