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Fagundes de Sousa TL, Kluser Sales AR, Martins Fagundes JG, Barbosa Botelho LF, Ribeiro de Souza F, Fonseca GW, Pereira de Albuquerque AL, Tavares de Melo MD, Alves MJDNN. Evaluation of myocardial work and exercise capacity in patients recovered from the severe form of COVID-19. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 23:200324. [PMID: 39258008 PMCID: PMC11382027 DOI: 10.1016/j.ijcrp.2024.200324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 09/12/2024]
Abstract
Background The impact of COVID-19 goes beyond its acute form and can lead to the persistence of symptoms and the emergence of systemic disorders, defined as long-term COVID. Methods We performed a cross-sectional study that included patients over 18 years of age who recovered from the severe form of COVID-19 at least 60 days after their discharge. Patients and controls were enrolled to undergo transthoracic echocardiography (TTE) using a more sensitive tool, myocardial work, in combination with cardiopulmonary exercise testing (CPET). Results A total of 52 patients and 31 controls were enrolled. Significant differences were observed in ejection fraction (LVEF; 62 ± 7 vs. 66 ± 6 %; p = 0.007), global longitudinal strain (LVGLS; -18.7 ± 2.6 vs. -20.4 ± 1.4 %; p = 0.001), myocardial wasted work (GWW; 152 ± 81 vs. 101 ± 54 mmHg; p = 0.003), and myocardial work efficiency (GWE; 93 ± 3 vs. 95 ± 2 %; p = 0.002). We found a significant difference in peak VO2 (24.4 ± 5.4 vs. 33.4 ± 8.8 mL/kg/min; p < 0.001), heart rate (160 ± 14 vs. 176 ± 11 bpm; p < 0.001), ventilation (84.6 ± 22.6 vs. 104.9 ± 27.0 L/min; p < 0.001), OUES% (89 ± 16 vs. 102 ± 22 %; p = 0.002), T ½ (120.3 ± 32 vs. 97.6 ± 27 s; p = 0.002) and HRR at 2 min (-36 ± 11 vs. -43 ± 13 bpm; p = 0.010). Conclusion Our findings revealed an increased wasted work, with lower myocardial efficiency, significantly reduced aerobic exercise capacity, and abnormal heart rate response during recovery, which may be related to previously described late symptoms. The reduction in functional capacity during physical exercise is partly associated with a decrease in resting myocardial work efficiency. These findings strongly indicate the need to determine whether these manifestations persist in the long term and their impact on cardiovascular health and quality of life in COVID-19 survivors.
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Affiliation(s)
- Thiago Lins Fagundes de Sousa
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
- Medical Sciences Center of the Federal University of Paraíba, Brazil
| | | | - Juliana Góes Martins Fagundes
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
- Medical Sciences Center of the Federal University of Paraíba, Brazil
| | - Luis Fábio Barbosa Botelho
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
- Medical Sciences Center of the Federal University of Paraíba, Brazil
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Deng S, Yin M, Chen Z, Deng J, Wang Z, Li Y, Lyu M, Zhang B, Zhu S, Hu S, Nassis GP, Li Y. SARS-CoV-2 infection decreases cardiorespiratory fitness and time-trial performance even two months after returning to regular training - Insights from a longitudinal case series of well-trained kayak athletes. J Exerc Sci Fit 2024; 22:350-358. [PMID: 39027081 PMCID: PMC11255366 DOI: 10.1016/j.jesf.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 07/20/2024] Open
Abstract
Objective The aims of this study were to examine the effect of SARS-CoV-2 infection on cardiorespiratory fitness (CRF) and time-trial performance in vaccinated well-trained young kayak athletes. Methods This is a longitudinal observational study. Sixteen (7 male, 9 female) vaccinated kayakers underwent body composition assessment, maximal graded exercise test, and 1000-m time-trial tests 21.9 ± 1.7 days before and 66.0 ± 2.2 days after the SARS-CoV-2 infection. The perception of training load was quantified with Borg's CR-10 scale before and after the infection return to sport period. Results There were significant decreases in peak oxygen uptake (-9.7 %; effect size [ES] = 1.38), peak oxygen pulse (-5.7 %; ES = 0.96), and peak heart rate (-1.9 %; ES = 0.61). Peak minute ventilation, and minute ventilation/carbon dioxide production slope were unchanged after infection compared to the pre-infection values. In the entire 1000-m, the impaired tendencies were found in completion time, mean power, and mean speed (-2.4 to 1.2 %; small ESs = -0.40 to 0.47) as well as significant changes in stroke rate and stroke length (-4.5 to 3.7 %; ESs = -0.60 to 0.73). Conclusion SARS-CoV-2 infection decreased CRF and time-trial performance even two months after return to regular training in vaccinated athletes.
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Affiliation(s)
- Shengji Deng
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
| | - Mingyue Yin
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Zhili Chen
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Jianfeng Deng
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
| | - Zhenyu Wang
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Yuxi Li
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Mengde Lyu
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Boyi Zhang
- Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, German
- Exercise and Health Technology Center, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
| | - Shaoqiang Zhu
- Jiangxi Water Sports Administration Center, Administration of Sports of Jiangxi, Nanchang, China
| | - Shenggui Hu
- Jiangxi Water Sports Administration Center, Administration of Sports of Jiangxi, Nanchang, China
| | - George P. Nassis
- Department of Physical Education, College of Education, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
| | - Yongming Li
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
- China Institute of Sport Science, Beijing, China
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Ahmad AM, Mohamed Awad Allah SA, Abd Elhaseeb GA, Elsharawy DE, Ahmed HS, Mohamed Abdelwahab MA. Effects of conventional versus virtual reality-simulated treadmill exercise on fatigue, cognitive function, and participant satisfaction in post-COVID-19 subjects. A randomized trial. J Exerc Sci Fit 2024; 22:316-321. [PMID: 38765321 PMCID: PMC11098941 DOI: 10.1016/j.jesf.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Background/objective Post-COVID-19 subjects typically experience symptoms of fatigue, cognitive impairment, and sleep difficulty, which can be relieved by conventional aerobic exercise. Virtual Reality (VR) technology to support conventional exercise has recently gained much attention. Therefore, this study aimed to assess the effects of traditional treadmill exercise compared to virtual reality-simulated treadmill exercise on fatigue, cognitive function, sleep quality, and participant satisfaction with the exercise program in post-COVID-19 subjects. Methods This single-centered, randomized, parallel-group intervention study was conducted between December 2021 and March 2022. Sixteen of twenty post-COVID-19 subjects completed this study (n1 = 8, n2 = 8). Inclusion criteria were persistent dyspnea/fatigue, mild cognitive problems, and age from 30-60 years. Exclusion criteria were previous severe COVID-19 infection and ICU admission, concomitant respiratory or cardiovascular disease, and musculoskeletal or neurological disease. Eligible subjects were assigned randomly to two groups: a non-VR group that received traditional treadmill aerobic exercise only and a VR group that received treadmill exercise with non-immersive VR. Both groups received moderate-intensity exercise on a treadmill at [50-60 % (peak HR-resting HR) + resting HR] for 30-45 min, three times per week, and for four weeks. The outcome measures were the Chalder Fatigue Scale, Montreal Cognitive Assessment (MoCA) questionnaire, Pittsburgh Sleep Quality Index (PSQI), and participant satisfaction with the exercise program rated on a 5-point Likert scale. Results Both groups showed significant improvements in the Chalder Fatigue Scale, the MoCA questionnaire, and the PSQI scores after training compared to baseline (p < 0.05), without significant differences between them (p > 0.05). However, participant satisfaction with the exercise program was significantly higher in the VR group than in the non-VR group (p = 0.037). Conclusion A moderate-intensity 4-week treadmill exercise program with and without non-immersive VR may improve fatigue, cognitive function, and sleep quality to the same extent in COVID-19 survivors. However, participant satisfaction with the exercise program could be greater after conventional treadmill training assisted by non-immersive VR than after conventional treadmill training alone in this cohort. Trial registration Pan African Clinical Trials Registry, PACTR202311561948428, retrospectively registered.
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Affiliation(s)
- Ahmad Mahdi Ahmad
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Sara Ali Mohamed Awad Allah
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Gehad Ali Abd Elhaseeb
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Hend Salem Ahmed
- Physical Therapy Department, National Heart Institute, Giza, Egypt
| | - Mona Ahmed Mohamed Abdelwahab
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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4
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Provenzale G, Barbieri L, Tumminello G, Carugo S, Guazzi M. Exercise response in post-acute coronary syndrome patients survived to COVID-19 infection. Int J Cardiol 2024; 411:132285. [PMID: 38901570 DOI: 10.1016/j.ijcard.2024.132285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024]
Abstract
AIMS Many studies evaluated the functional response in post-Covid-19 patients; however, they systematically excluded patients with concomitant acute coronary syndrome (ACS). We evaluated the long-term functional capacity assessed by cardiopulmonary exercise test (CPET) in patients hospitalized for ACS and concomitant SARS-CoV2 infection. The secondary aim was to investigate the functional response in patients with symptoms related to "long COVID-19 syndrome" (LCS). METHODS This cross-sectional case-control study compared 20 patients with ACS and concomitant SARS-COV2 infection with 20 patients without COVID-19. At the follow-up visit (between 6 and 12 months after revascularization procedure) all patients underwent a CPET. RESULTS Patients with previous ACS and concomitant COVID-19 showed a reduced O2 consumption than controls (predicted peak V̇O2 74.00% vs 86.70%; p = 0.01) with a high degree of ventilatory inefficiency (VE/ V̇CO2 slope 38.04 vs 30.31; p = 0.002). 50% of subjects with previous COVID-19 disease showed symptoms related to "LCS"; this subgroup demarcates the characteristic reduced exercise capacity found in the entire COVID + group. CONCLUSIONS This study is the first in literature having analyzed the long-term functional capacity phenotype in a population of ACS patients and concomitant SARS-CoV2 infection. Severe ventilatory inefficiency emerged as the functional signature of these patients. Moreover, the subset of patients with symptoms related to LCS has the most compromised long term reduced exercise capacity and an altered ventilation control.
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Affiliation(s)
| | - Lucia Barbieri
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy.
| | - Gabriele Tumminello
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy
| | - Marco Guazzi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Italy
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5
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Rasmussen IE, Løk M, Durrer CG, Lytzen AA, Foged F, Schelde VG, Budde JB, Rasmussen RS, Høvighoff EF, Rasmussen V, Lyngbæk M, Jønck S, Krogh-Madsen R, Lindegaard B, Jørgensen PG, Køber L, Vejlstrup N, Pedersen BK, Ried-Larsen M, Lund MAV, Berg RMG, Christensen RH. Impact of a 12-week high-intensity interval training intervention on cardiac structure and function after COVID-19 at 12-month follow-up. Exp Physiol 2024. [PMID: 39258503 DOI: 10.1113/ep092099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/30/2024] [Indexed: 09/12/2024]
Abstract
In patients previously hospitalised for COVID-19, a 12-week high-intensity interval training (HIIT) intervention has previously been shown to increase left ventricular mass (LVM) immediately after the intervention. In the present study, we examined the effects of the same HIIT scheme on LVM, pulmonary diffusing capacity, symptom severity and functional capacity at 12-month follow-up. In this investigator-blinded, randomised controlled trial, 12 weeks of a supervised HIIT scheme (4 × 4 min, three times a week) was compared to standard care (control) in patients recently discharged from hospital due to COVID-19. At inclusion and at 12-month follow-up, LVM was assessed by cardiac magnetic resonance imaging (cMRI, primary outcome), while pulmonary diffusing capacity for carbon monoxide (DLCOc, secondary outcome) was examined by the single-breath method. Symptom severity and functional status were examined by the Post-COVID-19 Functional Scale (PCFS) and King's Brief Interstitial Lung Disease (KBILD) questionnaire score. Of the 28 patients assessed at baseline, 22 completed cMRI at 12-month follow-up (12.4 ± 0.6 months after inclusion). LVM was maintained in the HIIT but not the standard care group, with a mean between-group difference of 9.68 [95% CI: 1.72, 17.64] g (P = 0.0182). There was no differences in change from baseline to 12-month follow-up between groups in DLCOc % predicted (-2.45 [-11.25, 6.34]%; P = 0.578). PCFS and KBILD improved similarly in the two groups. In individuals previously hospitalised for COVID-19, a 12-week supervised HIIT scheme resulted in a preserved LVM at 12-month follow-up but did not affect pulmonary diffusing capacity or symptom severity.
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Affiliation(s)
- Iben Elmerdahl Rasmussen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mathilde Løk
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Cody Garett Durrer
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Anna Agnes Lytzen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Frederik Foged
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Vera Graungaard Schelde
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Josephine Bjørn Budde
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Syberg Rasmussen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Emma Fredskild Høvighoff
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Villads Rasmussen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Mark Lyngbæk
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Simon Jønck
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, University Hospital Copenhagen - Hvidovre Hospital, Hvidovre, Denmark
| | - Birgitte Lindegaard
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Department of Pulmonary Medicine and Infectious Diseases, North Zealand Hospital, Hillerød, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Morten Asp Vonsild Lund
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Ronan M G Berg
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Regitse Højgaard Christensen
- Centre for Physical Activity Research, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, University Hospital Copenhagen - Herlev Hospital, Herlev, Denmark
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Haunhorst S, Dudziak D, Scheibenbogen C, Seifert M, Sotzny F, Finke C, Behrends U, Aden K, Schreiber S, Brockmann D, Burggraf P, Bloch W, Ellert C, Ramoji A, Popp J, Reuken P, Walter M, Stallmach A, Puta C. Towards an understanding of physical activity-induced post-exertional malaise: Insights into microvascular alterations and immunometabolic interactions in post-COVID condition and myalgic encephalomyelitis/chronic fatigue syndrome. Infection 2024:10.1007/s15010-024-02386-8. [PMID: 39240417 DOI: 10.1007/s15010-024-02386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND A considerable number of patients who contracted SARS-CoV-2 are affected by persistent multi-systemic symptoms, referred to as Post-COVID Condition (PCC). Post-exertional malaise (PEM) has been recognized as one of the most frequent manifestations of PCC and is a diagnostic criterion of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Yet, its underlying pathomechanisms remain poorly elucidated. PURPOSE AND METHODS In this review, we describe current evidence indicating that key pathophysiological features of PCC and ME/CFS are involved in physical activity-induced PEM. RESULTS Upon physical activity, affected patients exhibit a reduced systemic oxygen extraction and oxidative phosphorylation capacity. Accumulating evidence suggests that these are mediated by dysfunctions in mitochondrial capacities and microcirculation that are maintained by latent immune activation, conjointly impairing peripheral bioenergetics. Aggravating deficits in tissue perfusion and oxygen utilization during activities cause exertional intolerance that are frequently accompanied by tachycardia, dyspnea, early cessation of activity and elicit downstream metabolic effects. The accumulation of molecules such as lactate, reactive oxygen species or prostaglandins might trigger local and systemic immune activation. Subsequent intensification of bioenergetic inflexibilities, muscular ionic disturbances and modulation of central nervous system functions can lead to an exacerbation of existing pathologies and symptoms.
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Affiliation(s)
- Simon Haunhorst
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University Jena, Wöllnitzer Straße 42, 07749, Jena, Germany
- Center for Interdisciplinary Prevention of Diseases Related to Professional Activities, Jena, Germany
| | - Diana Dudziak
- Institute of Immunology, Jena University Hospital/ Friedrich-Schiller-University Jena, Jena, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Martina Seifert
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Franziska Sotzny
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Uta Behrends
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
- AGV Research Unit Gene Vectors, Helmholtz Munich (HMGU), Munich, Germany
| | - Konrad Aden
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Internal Medicine I, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Dirk Brockmann
- Center Synergy of Systems, TU Dresden University of Technology, Dresden, Germany
| | - Paul Burggraf
- mHealth Pioneers GmbH, Körtestraße 10, 10967, Berlin, Germany
| | - Wilhelm Bloch
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Claudia Ellert
- , Landarztnetz Lahn-Dill, Wetzlar, Germany
- Initiative Long COVID Deutschland, Lemgo, Germany
| | - Anuradha Ramoji
- Institute of Physical Chemistry (IPC) and Abbe Center of Photonics (ACP), Member of the Leibniz Centre for Photonics in Infection Research (LPI), Friedrich-Schiller-University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Member of the Leibniz Centre for Photonics in Infection Research (LPI), Jena, Germany
| | - Juergen Popp
- Institute of Physical Chemistry (IPC) and Abbe Center of Photonics (ACP), Member of the Leibniz Centre for Photonics in Infection Research (LPI), Friedrich-Schiller-University Jena, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Member of the Leibniz Centre for Photonics in Infection Research (LPI), Jena, Germany
| | - Philipp Reuken
- Department for Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena Center for Mental Health, Jena University Hospital, Jena, Germany
- German Center for Mental Health (DZPG), Partner Site Jena, Jena, Germany
| | - Andreas Stallmach
- Department for Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University Jena, Wöllnitzer Straße 42, 07749, Jena, Germany.
- Department for Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany.
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany.
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7
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Zhai X, Wu W, Zeng S, Miao Y. Advance in the mechanism and clinical research of myalgia in long COVID. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2024; 13:142-164. [PMID: 39310121 PMCID: PMC11411160 DOI: 10.62347/txvo6284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 07/18/2024] [Indexed: 09/25/2024]
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve, mortality rates of coronavirus disease 2019 (COVID-19) have significantly decreased. However, a variable proportion of patients exhibit persistent prolonged symptoms of COVID-19 infection (long COVID). This virus primarily attacks respiratory system, but numerous individuals complain persistent skeletal muscle pain or worsening pre-existing muscle pain post COVID-19, which severely affects the quality of life and recovery. Currently, there is limited research on the skeletal muscle pain in long COVID. In this brief review, we review potential pathological mechanisms of skeletal muscle pain in long COVID, and summarize the various auxiliary examinations and treatments for skeletal muscle pain in long COVID. We consider abnormal activation of inflammatory response, myopathy, and neurological damages as pivotal pathological mechanisms of skeletal muscle pain in long COVID. A comprehensive examination is significantly important in order to work out effective treatment plans and relieve skeletal muscle pain. So far, rehabilitation interventions for myalgia in long COVID contain but are not limited to drug, nutraceutical therapy, gut microbiome-targeted therapy, interventional therapy and strength training. Our study provides a potential mechanism reference for clinical researches, highlighting the importance of comprehensive approach and management of skeletal muscle pain in long COVID. The relief of skeletal muscle pain will accelerate rehabilitation process, improve activities of daily living and enhance the quality of life, promoting individuals return to society with profound significance.
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Affiliation(s)
- Xiuyun Zhai
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Weijun Wu
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Siliang Zeng
- Department of Rehabilitation Therapy, School of Health, Shanghai Normal University Tianhua CollegeNo. 1661, North Shengxin Road, Shanghai 201815, China
| | - Yun Miao
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
- Department of Rehabilitation, School of International Medical Technology, Shanghai Sanda UniversityNo. 2727, Jinhai Road, Shanghai 201209, China
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8
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Baldi F, De Rose C, Mariani F, Morello R, Raffaelli F, Valentini P, Buonsenso D. Cardiopulmonary Exercise Testing in Children With Long COVID: A Case-controlled Study. Pediatr Infect Dis J 2024; 43:795-802. [PMID: 38713816 PMCID: PMC11250093 DOI: 10.1097/inf.0000000000004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is a noninvasive and nonexpensive diagnostic tool, that provides a comprehensive evaluation of the pulmonary, cardiovascular, and skeletal muscle systems' integrated reactions to exercise. CPET has been extensively used in adults with Long COVID (LC), while the evidence about its role in children with this condition is scarce. METHODS Prospective, case-controlled observational study. Children with LC and a control group of healthy children underwent CPET. CPET findings were compared within the 2 groups, and within the LC groups according to main clusters of persisting symptoms. RESULTS Sixty-one children with LC and 29 healthy controls were included. Overall, 90.2% of LC patients (55 of 61) had a pathologic test vs 10.3% (3/29) of the healthy control. Children with LC presented a statistically significant higher probability of having abnormal values of peak VO2 ( P = 0.001), AT% pred ( P <0.001), VO2/HR % ( P = 0.03), VO2 work slope ( P = 0.002), VE/VCO2 slope ( P = 0.01). The mean VO2 peak was 30.17 (±6.85) in LC and 34.37 (±6.55) in healthy patients ( P = 0.007). CONCLUSIONS Compared with healthy controls, children with LC have objective impaired functional capacity (expressed by a low VO2 peak), signs of deconditioning and cardiogenic inefficiency when assessed with CPET. As such, CPET should be routinely used in clinical practice to objectify and phenotype the functional limitations of children with LC, and to follow-up them.
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Affiliation(s)
- Fabiana Baldi
- From the Pulmonary Medicine Unit, Department of Medical and Surgical Sciences
| | | | | | - Rosa Morello
- Department of Woman and Child Health and Public Health
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Holdsworth DA, Barker-Davies RM, Chamley RR, O'Sullivan O, Ladlow P, May S, Houston AD, Mulae J, Xie C, Cranley M, Sellon E, Naylor J, Halle M, Parati G, Davos C, Rider OJ, Bennett AB, Nicol ED. Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19. BMJ Mil Health 2024; 170:308-314. [PMID: 36442889 PMCID: PMC11287624 DOI: 10.1136/military-2022-002193] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-COVID-19 syndrome presents a health and economic challenge affecting ~10% of patients recovering from COVID-19. Accurate assessment of patients with post-COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings. METHODS 113 consecutive military patients were assessed in a comprehensive clinical pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CT pulmonary angiography and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease. RESULTS 7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V̇O2 26.7 (±5.1) vs 34.6 (±7.0) mL/kg/min; p=0.002) and functional capacity (peak power 200 (±36) vs 247 (±55) W; p=0.026) compared with those without significant disease. Simple CPET criteria (oxygen uptake (V̇O2) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V̇CO2) slope <30.0 or VE/V̇CO2 slope <35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83%, respectively (area under the receiver operating characteristic curve (AUC) 0.89). The addition of capillary blood gases to estimate alveolar-arterial gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease. CONCLUSIONS In a population recovering from SARS-CoV-2, there is reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, permit the exclusion of clinically significant disease.
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Affiliation(s)
- D A Holdsworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Royal Centre for Defence Medicine, Birmingham, UK
| | - R M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R R Chamley
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Clincal Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - S May
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - A D Houston
- Academic Department of Military Rehabilitation, Defence Medical Services, Loughborough, UK
| | - J Mulae
- Royal Centre for Defence Medicine, Birmingham, UK
| | - C Xie
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Cranley
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - E Sellon
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Royal Centre for Defence Medicine, Birmingham, UK
| | - J Naylor
- Royal Centre for Defence Medicine, Birmingham, UK
| | - M Halle
- Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany
| | - G Parati
- Università degli Studi di Milano-Bicocca, Milano, Italy
| | - C Davos
- Academy of Athens Biomedical Research Foundation, Athens, Greece
| | - O J Rider
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Clincal Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - A B Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - E D Nicol
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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10
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Mavroudis I, Petridis F, Petroaie AD, Ciobica A, Kamal FZ, Honceriu C, Iordache A, Ionescu C, Novac B, Novac O. Exploring Symptom Overlaps: Post-COVID-19 Neurological Syndrome and Post-Concussion Syndrome in Athletes. Biomedicines 2024; 12:1587. [PMID: 39062160 PMCID: PMC11274969 DOI: 10.3390/biomedicines12071587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The COVID-19 pandemic has introduced new challenges in managing neurological conditions, particularly among athletes. This paper explores the intersection of post-COVID-19 neurological syndrome (PCNS/PASC) and post-concussion syndrome (PCS), focusing on their implications in sports medicine. Our analysis covers the symptomatology, pathophysiology, and management strategies for PCNS/PASC and PPCS, with special attention paid to the unique challenges faced by athletes recovering from these conditions, including the risk of symptom exacerbation and prolonged recovery. Key findings reveal that both PCNS/PASC and PPCS present with overlapping symptoms such as cognitive difficulties, exercise intolerance, and mental health issues, but differ in specific manifestations like anosmia and ageusia, unique to COVID-19. Pathophysiological analysis reveals similarities in blood-brain barrier disruption (BBB) but differences in the extent of immune activation. Management strategies emphasize a gradual increase in physical activity, close symptom monitoring, and psychological support, with a tailored approach for athletes. Specific interventions include progressive aerobic exercises, resistance training, and cognitive rehabilitation. Furthermore, our study highlights the importance of integrating neurology, psychiatry, physical therapy, and sports medicine to develop comprehensive care strategies. Our findings underscore the dual challenge of COVID-19 and concussion in athletes, necessitating a nuanced, interdisciplinary approach to effective management. Future research should focus on the long-term neurological effects of both conditions and optimizing treatment protocols to improve patient outcomes. This comprehensive understanding is crucial for advancing the management of athletes affected by these overlapping conditions and ensuring their safe return to sports.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK;
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Antoneta Dacia Petroaie
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Centre of Biomedical Research, Romanian Academy, Bd. Carol I, no. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Str. Splaiul Independentei no. 54, Sector 5, 050094 Bucharest, Romania
- “Ioan Haulica” Institute, Apollonia University, Pãcurari Street 11, 700511 Iasi, Romania
| | - Fatima Zahra Kamal
- Higher Institute of Nursing Professions and Health Techniques, Marrakesh 40000, Morocco
- Laboratory of Physical Chemistry of Processes and Materials, Faculty of Sciences and Techniques, Hassan First University, B.P. 539, Settat 26000, Morocco
| | - Cezar Honceriu
- Faculty of Physical Education, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania;
| | - Alin Iordache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Cătălina Ionescu
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Clinical Department, Apollonia University, Păcurari Street 11, 700511 Iasi, Romania
| | - Bogdan Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Otilia Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
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11
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Vontetsianos A, Chynkiamis N, Gounaridi MI, Anagnostopoulou C, Lekka C, Zaneli S, Anagnostopoulos N, Oikonomou E, Vavuranakis M, Rovina N, Papaioannou AI, Kaltsakas G, Koulouris N, Vogiatzis I. Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome. J Clin Med 2024; 13:4144. [PMID: 39064183 PMCID: PMC11278210 DOI: 10.3390/jcm13144144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Cardiorespiratory complications are commonly reported among patients with long COVID-19 syndrome. However, their effects on exercise capacity remain inconclusive. We investigated the impact of long COVID-19 on exercise tolerance combining cardiopulmonary exercise testing (CPET) with resting echocardiographic data. Methods: Forty-two patients (55 ± 13 years), 149 ± 92 days post-hospital discharge, and ten healthy age-matched participants underwent resting echocardiography and an incremental CPET to the limit of tolerance. Left ventricular global longitudinal strain (LV-GLS) and the left ventricular ejection fraction (LVEF) were calculated to assess left ventricular systolic function. The E/e' ratio was estimated as a surrogate of left ventricular end-diastolic filling pressures. Tricuspid annular systolic velocity (SRV) was used to assess right ventricular systolic performance. Through tricuspid regurgitation velocity and inferior vena cava diameter, end-respiratory variations in systolic pulmonary artery pressure (PASP) were estimated. Peak work rate (WRpeak) and peak oxygen uptake (VO2peak) were measured via a ramp incremental symptom-limited CPET. Results: Compared to healthy participants, patients had a significantly (p < 0.05) lower LVEF (59 ± 4% versus 49 ± 5%) and greater left ventricular end-diastolic diameter (48 ± 2 versus 54 ± 5 cm). In patients, there was a significant association of E/e' with WRpeak (r = -0.325) and VO2peak (r = -0.341). SRV was significantly associated with WRpeak (r = 0.432) and VO2peak (r = 0.556). LV-GLS and PASP were significantly correlated with VO2peak (r = -0.358 and r = -0.345, respectively). Conclusions: In patients with long COVID-19 syndrome, exercise intolerance is associated with left ventricular diastolic performance, left ventricular end-diastolic pressure, PASP and SRV. These findings highlight the interrelationship of exercise intolerance with left and right ventricular performance in long COVID-19 syndrome.
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Affiliation(s)
- Angelos Vontetsianos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Nikolaos Chynkiamis
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
- Thorax Research Foundation, 11521 Athens, Greece
| | - Maria Ioanna Gounaridi
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.I.G.); (E.O.); (M.V.)
| | - Christina Anagnostopoulou
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Christiana Lekka
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Stavroula Zaneli
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Nektarios Anagnostopoulos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.I.G.); (E.O.); (M.V.)
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.I.G.); (E.O.); (M.V.)
| | - Nikoletta Rovina
- 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Andriana I. Papaioannou
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Georgios Kaltsakas
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
- Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Centre of Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
| | - Nikolaos Koulouris
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Ioannis Vogiatzis
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne NE1 8ST, UK
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12
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Gomes-Neto M, Almeida KDO, Correia HF, Santos JC, Gomes VA, Serra JPC, Durães AR, Carvalho VO. Determinants of cardiorespiratory fitness measured by cardiopulmonary exercise testing in COVID-19 survivors: a systematic review with meta-analysis and meta‑regression. Braz J Phys Ther 2024; 28:101089. [PMID: 38936313 PMCID: PMC11259933 DOI: 10.1016/j.bjpt.2024.101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/28/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The relationship between cardiorespiratory fitness and its possible determinants in post-COVID-19 survivors has not been systematically assessed. OBJECTIVES To identify and summarize studies comparing cardiorespiratory fitness measured by cardiopulmonary exercise testing in COVID-19 survivors versus non-COVID-19 controls, as well as to determine the influence of potential moderating factors. METHODS We conducted a systematic search of MEDLINE/PubMed, Cochrane Library, EMBASE, Google Scholar, and SciELO since their inceptions until June 2022. Mean differences (MD), standard mean differences (SMD), and 95% confidence intervals (CI) were calculated. Subgroup and meta-regression analyses were used to evaluate potential moderating factors. RESULTS 48 studies (3372 participants, mean age 42 years, and with a mean testing time of 4 months post-COVID-19) were included, comprising a total of 1823 COVID-19 survivors and 1549 non-COVID-19 controls. After data pooling, VO2 peak (SMD=1.0 95% CI: 0.5, 1.5; 17 studies; N = 1273) was impaired in COVID-19 survivors. In 15 studies that reported VO2 peak values in mL/min/kg, non-COVID-19 controls had higher peak VO2 values than COVID-19 survivors (MD=6.2, 95% CI: 3.5, 8.8; N = 905; I2=84%). In addition, VO2 peak was associated with age, time post-COVID-19, disease severity, presence of dyspnea, and reduced exercise capacity. CONCLUSION This systematic review provides evidence that cardiorespiratory fitness may be impaired in COVID-19 survivors, especially for those with severe disease, presence of dyspnea, and reduced exercise capacity. Furthermore, the degree of reduction of VO2 peak is inversely associated with age and time post-COVID.
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Affiliation(s)
- Mansueto Gomes-Neto
- Physical Therapy Department, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil; Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
| | - Katna de Oliveira Almeida
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Helena França Correia
- Physical Therapy Department, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Juliana Costa Santos
- Physical Therapy Department, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Vinicius Afonso Gomes
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil; Hospital Especializado Otávio Mangabeira, Salvador, BA, Brazil
| | | | - André Rodrigues Durães
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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13
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Amput P, Poncumhak P, Konsanit S, Wongphon S. Comparison of cardiorespiratory parameters between 6-minute walk test and 1-minute sit to stand test in young adults with post-COVID-19: follow-up 3 months. J Thorac Dis 2024; 16:3085-3095. [PMID: 38883677 PMCID: PMC11170376 DOI: 10.21037/jtd-24-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/12/2024] [Indexed: 06/18/2024]
Abstract
Background The investigation of cardiorespiratory fitness in young adults post-coronavirus disease 2019 (COVID-19) is interesting because this information may help in understanding cardiorespiratory function in these populations. Moreover, it helps to know that these impairments possibly interfere with study, learning, and the activities of daily life in young adults post-COVID-19. This study aims to investigate and compare the cardiorespiratory parameters between 6-minute walk test (6MWT) and 1-minute sit-to-stand test (1-min-STST) in healthy young adults and post-COVID-19 and at a 3-month follow-up. Methods Forty-six young adults were recruited and divided into two groups including healthy young adults in one group (n=23) and post-COVID-19 patients in the other group (n=23). The young adults were assessed for cardiorespiratory parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (SpO2), rate of perceived exertion (RPE), and leg fatigue before and after performing a 6MWT and a 1-min STST at baseline and the 3-month follow-up. Test sequences were randomly assigned using the website randomizer.org. Results Post-COVID-19 had significantly decreased post-HR, post-SBP, post-SpO2, post-RPE, post-leg fatigue, and increased the distance of 6MWT, and number of steps of 1-min-STST when compared with the baseline (P<0.05). However, all parameters of cardiorespiratory could recover and return to the values of healthy young adults by the follow-up at 3 months. Conclusions Post-COVID-19 who recovered from mild-COVID-19 for about 6 months recovered their cardiorespiratory parameters to the values of healthy young adults.
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Affiliation(s)
- Patchareeya Amput
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao, Thailand
| | - Puttipong Poncumhak
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao, Thailand
| | - Saisunee Konsanit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Sirima Wongphon
- Department of Traditional Chinese Medicine, School of Public Health, University of Phayao, Phayao, Thailand
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14
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Lytzen AA, Helt TW, Christensen J, Lund TK, Kalhauge A, Rönsholt FF, Podlekavera D, Arndal E, Lebech A, Hanel B, Katzenstein TL, Berg RMG, Mortensen J. Pulmonary diffusing capacity for carbon monoxide and nitric oxide after COVID-19: A prospective cohort study (the SECURe study). Exp Physiol 2024; 109:652-661. [PMID: 38532277 PMCID: PMC11061629 DOI: 10.1113/ep091757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
Many patients exhibit persistently reduced pulmonary diffusing capacity after coronavirus disease 2019 (COVID-19). In this study, dual test gas diffusing capacity for carbon monoxide and nitric oxide (DL,CO,NO) metrics and their relationship to disease severity and physical performance were examined in patients who previously had COVID-19. An initial cohort of 148 patients diagnosed with COVID-19 of all severities between March 2020 and March 2021 had a DL,CO,NO measurement performed using the single-breath method at 5.7 months follow-up. All patients with at least one abnormal DL,CO,NO metric (n = 87) were revaluated at 12.5 months follow-up. The DL,CO,NO was used to provide the pulmonary diffusing capacity for nitric oxide (DL,NO), the pulmonary diffusing capacity for carbon monoxide (DL,CO,5s), the alveolar-capillary membrane diffusing capacity and the pulmonary capillary blood volume. At both 5.7 and 12.5 months, physical performance was assessed using a 30 s sit-to-stand test and the 6 min walk test. Approximately 60% of patients exhibited a severity-dependent decline in at least one DL,CO,NO metric at 5.7 months follow-up. At 12.5 months, both DL,NO and DL,CO,5s had returned towards normal but still remained abnormal in two-thirds of the patients. Concurrently, improvements in physical performance were observed, but with no apparent relationship to any DL,CO,NO metric. The severity-dependent decline in DL,NO and DL,CO observed at 5.7 months after COVID-19 appears to be reduced consistently at 12.5 months follow-up in the majority of patients, despite marked improvements in physical performance.
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Affiliation(s)
- Anna Agnes Lytzen
- Centre for Physical Activity ResearchCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Thora Wesenberg Helt
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Jan Christensen
- Department of Occupational Therapy and PhysiotherapyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Thomas Kromann Lund
- Department of Cardiology, Section for Lung TransplantationCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Anna Kalhauge
- Department of RadiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | | | - Daria Podlekavera
- Department of Respiratory Medicine and Infectious DiseasesCopenhagen University Hospital—Bispebjerg HospitalCopenhagenDenmark
| | - Elisabeth Arndal
- Department of OtorhinolaryngologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Anne‐Mette Lebech
- Department of Infectious DiseasesCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Birgitte Hanel
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Terese L. Katzenstein
- Department of Infectious DiseasesCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Ronan M. G. Berg
- Centre for Physical Activity ResearchCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Biomedical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Jann Mortensen
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of MedicineThe National HospitalTorshavnFaroe Islands
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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15
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Kavalcı Kol B, Boşnak Güçlü M, Baytok E, Yılmaz Demirci N. Comparison of the muscle oxygenation during submaximal and maximal exercise tests in patients post-coronavirus disease 2019 syndrome with pulmonary involvement. Physiother Theory Pract 2024:1-14. [PMID: 38469863 DOI: 10.1080/09593985.2024.2327534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Pulmonary involvement is prevalent in patients with coronavirus disease 2019 (COVID-19). Arterial hypoxemia may reduce oxygen transferred to the skeletal muscles, possibly leading to impaired exercise capacity. Oxygen uptake may vary depending on the increased oxygen demand of the muscles during submaximal and maximal exercise. OBJECTIVE This study aimed to compare muscle oxygenation during submaximal and maximal exercise tests in patients with post-COVID-19 syndrome with pulmonary involvement. METHODS Thirty-nine patients were included. Pulmonary function (spirometry), peripheral muscle strength (dynamometer), quadriceps femoris (QF) muscle oxygenation (Moxy® device), and submaximal exercise capacity (six-minute walk test (6-MWT)) were tested on the first day, maximal exercise capacity (cardiopulmonary exercise test (CPET)) was tested on the second day. Physical activity level was evaluated using an activity monitor worn for five consecutive days. Cardiopulmonary responses and muscle oxygenation were compared during 6-MWT and CPET. RESULTS Patients' minimum and recovery muscle oxygen saturation were significantly decreased; maximum total hemoglobin increased, heart rate, blood pressure, breathing frequency, dyspnea, fatigue, and leg fatigue at the end-of-test and recovery increased in CPET compared to 6-MWT (p < .050). Peak oxygen consumption (VO2peak) was 18.15 ± 4.75 ml/min/kg, VO2peak; percent predicted < 80% was measured in 51.28% patients. Six-MWT distance and QF muscle strength were less than 80% predicted in 58.9% and 76.9% patients, respectively. CONCLUSIONS In patients with post-COVID-19 syndrome with pulmonary involvement, muscle deoxygenation of QF is greater during maximal exercise than during submaximal exercise. Specifically, patients with lung impairment should be evaluated for deoxygenation and should be taken into consideration during pulmonary rehabilitation.
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Affiliation(s)
- Başak Kavalcı Kol
- Pilot Health Coordinatorship, Kırşehir Ahi Evran University, Kırşehir, Türkiye
| | - Meral Boşnak Güçlü
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Gazi University, Çankaya, Ankara, Türkiye
| | - Ece Baytok
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Gazi University, Çankaya, Ankara, Türkiye
| | - Nilgün Yılmaz Demirci
- Faculty of Medicine, Department of Pulmonology, Gazi University, Yenimahalle, Ankara, Türkiye
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16
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Faghy MA, Dalton C, Duncan R, Arena R, Ashton REM. Using cardiorespiratory fitness assessment to identify pathophysiology in long COVID - Best practice approaches. Prog Cardiovasc Dis 2024; 83:55-61. [PMID: 38417769 DOI: 10.1016/j.pcad.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
Cardio-respiratory fitness (CRF) is well-established in the clinical domains as an integrative measure of the body's physiological capability and capacity to transport and utilise oxygen during controlled bouts of physical exertion. Long COVID is associated with >200 different symptoms and is estimated to affect ∼150 million people worldwide. The most widely reported impact is reduced quality of life and functional status due to highly sensitive and cyclical symptoms that manifest and are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli, more commonly known as post-exertional symptom exacerbation (PESE) which prevents millions from engaging in routine daily activities. The use of cardiopulmonary exercise testing (CPET) is commonplace in the assessment of integrated physiology; CPET will undoubtedly play an integral role in furthering the pathophysiology and mechanistic knowledge that will inform bespoke Long COVID treatment and management strategies. An inherent risk of previous attempts to utilise CPET protocols in patients with chronic disease is that these are compounded by PESE and have induced a worsening of symptoms for patients that can last for days or weeks. To do this effectively and to meet the global need, the complex multi-system pathophysiology of Long COVID must be considered to ensure the design and implementation of research that is both safe for participants and capable of advancing mechanistic understanding.
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Affiliation(s)
- Mark A Faghy
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection Network, Chicago, IL, USA.
| | - Caroline Dalton
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Rae Duncan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Ross Arena
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection Network, Chicago, IL, USA
| | - Ruth E M Ashton
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection Network, Chicago, IL, USA
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17
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O'Sullivan O, Houston A, Ladlow P, Barker-Davies RM, Chamley R, Bennett AN, Nicol ED, Holdsworth DA. Factors influencing medium- and long-term occupational impact following COVID-19. Occup Med (Lond) 2024; 74:53-62. [PMID: 37101240 DOI: 10.1093/occmed/kqad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction ('fully deployable', FD) or with limitations ('medically downgraded', MDG). AIMS To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months. METHODS Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG. RESULTS Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading. CONCLUSIONS Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.
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Affiliation(s)
- O O'Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - A Houston
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - R M Barker-Davies
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - R Chamley
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK
- Royal Centre for Defence Medicine, Birmingham B15 2GW, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - E D Nicol
- Academic Department of Military Medicine, Birmingham B15 2GW, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - D A Holdsworth
- Royal Centre for Defence Medicine, Birmingham B15 2GW, UK
- Academic Department of Military Medicine, Birmingham B15 2GW, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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18
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Jamieson A, Al Saikhan L, Alghamdi L, Hamill Howes L, Purcell H, Hillman T, Heightman M, Treibel T, Orini M, Bell R, Scully M, Hamer M, Chaturvedi N, Montgomery H, Hughes AD, Astin R, Jones S. Mechanisms underlying exercise intolerance in long COVID: An accumulation of multisystem dysfunction. Physiol Rep 2024; 12:e15940. [PMID: 38346773 PMCID: PMC10861355 DOI: 10.14814/phy2.15940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
The pathogenesis of exercise intolerance and persistent fatigue which can follow an infection with the SARS-CoV-2 virus ("long COVID") is not fully understood. Cases were recruited from a long COVID clinic (N = 32; 44 ± 12 years; 10 (31%) men), and age-/sex-matched healthy controls (HC) (N = 19; 40 ± 13 years; 6 (32%) men) from University College London staff and students. We assessed exercise performance, lung and cardiac function, vascular health, skeletal muscle oxidative capacity, and autonomic nervous system (ANS) function. Key outcome measures for each physiological system were compared between groups using potential outcome means (95% confidence intervals) adjusted for potential confounders. Long COVID participant outcomes were compared to normative values. When compared to HC, cases exhibited reduced oxygen uptake efficiency slope (1847 (1679, 2016) vs. 2176 (1978, 2373) mL/min, p = 0.002) and anaerobic threshold (13.2 (12.2, 14.3) vs. 15.6 (14.4, 17.2) mL/kg/min, p < 0.001), and lower oxidative capacity, measured using near infrared spectroscopy (τ: 38.7 (31.9, 45.6) vs. 24.6 (19.1, 30.1) s, p = 0.001). In cases, ANS measures fell below normal limits in 39%. Long COVID is associated with reduced measures of exercise performance and skeletal muscle oxidative capacity in the absence of evidence of microvascular dysfunction, suggesting mitochondrial pathology. There was evidence of attendant ANS dysregulation in a significant proportion. These multisystem factors might contribute to impaired exercise tolerance in long COVID sufferers.
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Affiliation(s)
- Alexandra Jamieson
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial SciencesImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Lamis Alghamdi
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
- Department of Cardiac Technology, College of Applied Medial SciencesImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Lee Hamill Howes
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Helen Purcell
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Toby Hillman
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
- Respiratory MedicineUniversity College LondonLondonUK
| | - Melissa Heightman
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Thomas Treibel
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
- Barts Heart Centre, St Bartholomew's HospitalLondonUK
| | - Michele Orini
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Robert Bell
- Hatter Cardiovascular InstituteUniversity College LondonLondonUK
| | - Marie Scully
- Department of HaematologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Mark Hamer
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Hugh Montgomery
- Centre for Human Health and PerformanceUniversity College LondonLondonUK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC)LondonUK
| | - Alun D. Hughes
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Ronan Astin
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
- Centre for Human Health and PerformanceUniversity College LondonLondonUK
| | - Siana Jones
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
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19
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Holley AB, Fabyan KD, Haynes ZA, Holtzclaw AW, Huprikar NA, Shumar JN, Sheth PS, Hightower SL. Cardiopulmonary exercise testing in younger patients with persistent dyspnea following acute, outpatient COVID-19 infection. Physiol Rep 2024; 12:e15934. [PMID: 38320756 PMCID: PMC10846960 DOI: 10.14814/phy2.15934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
Studies using cardiopulmonary exercise testing (CPET) to evaluate persistent dyspnea following infection with COVID-19 have focused on older patients with co-morbid diseases who are post-hospitalization. Less attention has been given to younger patients with post-COVID-19 dyspnea treated as outpatients for their acute infection. We sought to determine causes of persistent dyspnea in younger patients recovering from acute COVID-19 infection that did not require hospitalization. We collected data on all post-COVID-19 patients who underwent CPET in our clinic in the calendar year 2021. Data on cardiac function and respiratory response were abstracted, and diagnoses were assigned using established criteria. CPET data on 45 patients (238.3 ± 124 days post-test positivity) with a median age of 27.0 (22.0-40.0) were available for analysis. All but two (95.6%) were active-duty service members. The group showed substantial loss of aerobic capacity-average VO2 peak (L/min) was 84.2 ± 23% predicted and 25 (55.2%) were below the threshold for normal. Spirometry, diffusion capacity, high-resolution computed tomography, and echocardiogram were largely normal and were not correlated with VO2 peak. The two most common contributors to dyspnea and exercise limitation following comprehensive evaluation were deconditioning and dysfunctional breathing (DB). Younger active-duty military patients with persistent dyspnea following outpatient COVID-19 infection show a substantial reduction in aerobic capacity that is not driven by structural cardiopulmonary disease. Deconditioning and DB breathing are common contributors to their exercise limitation. The chronicity and severity of symptoms accompanied by DB could be consistent with an underlying myopathy in some patients, a disorder that cannot be differentiated from deconditioning using non-invasive CPET.
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Affiliation(s)
- Aaron B. Holley
- Department of Pulmonary/Sleep and Critical Care MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Kimberly D. Fabyan
- Department of Pulmonary/Sleep and Critical Care MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Zachary A. Haynes
- Department of MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Arthur W. Holtzclaw
- Department of Pulmonary/Sleep and Critical Care MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Nikhil A. Huprikar
- Department of Pulmonary/Sleep and Critical Care MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - John N. Shumar
- Department of Pulmonary/Sleep and Critical Care MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | | | - Stephanie L. Hightower
- Department of Pulmonary/Sleep and Critical Care MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
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20
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D'Ávila LBO, Milani M, Le Bihan DCS, de Lima ACGB, Milani JGPO, Cipriano GFB, da Silva VZM, Cipriano G. Longitudinal strain and myocardial work in symptomatic patients having recovered from COVID-19 and possible associations with the severity of the disease. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-023-03042-2. [PMID: 38277026 DOI: 10.1007/s10554-023-03042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024]
Abstract
COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann-Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56 years (IQR: 43-63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104-212) versus 121 (74-163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91-95) versus 94 (93-96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r2 = 0.167; p = 0.009; GWE: r2 = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.
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Affiliation(s)
- Luciana Bartolomei Orru D'Ávila
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil.
- Medcor, CLSW 105 Bloco A salas 37 a 39 Sudoeste, Brasilia, DF, CEP: 70670431, Brazil.
| | - Mauricio Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Rehabilitation Sciences Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - David C S Le Bihan
- University of São Paulo | USP Heart Institute São Paulo (InCor), São Paulo, SP, Brazil
| | | | - Juliana Goulart Prata Oliveira Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
| | - Graziella França Bernardelli Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Sciences Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Gerson Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
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21
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Vonbank K, Nics H, Zwick RH, Maasz J, Sabic B, Potzmann M, Brandhofer G, Fuchs J, Yeghiazaryan L, Burtscher M, Paternostro-Sluga T. Decreased phrenic nerve compound muscle action potential, inspiratory muscle strength, and exercise capacity after COVID-19. Front Neurol 2024; 14:1308443. [PMID: 38292031 PMCID: PMC10824925 DOI: 10.3389/fneur.2023.1308443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Objectives Respiratory muscle weakness with higher ventilatory demands were reported even in patients recovering from only mild COVID-19 symptoms. Aim of this study was to assess the function of phrenic nerve and inspiratory respiratory muscle as well as cardiopulmonary exercise capacity in patients with prolonged exertional dyspnea after COVID-19 infection. Methods In this observational exploratory study, electrophysiological examination of the phrenic nerve, inspiratory muscle capacity as well as lung function test, 6-min walk distance (6MWD) and cardiopulmonary exercise test, have been performed in 22 patients post COVID-19 diagnosis (post-CoV). Results Exercise capacity (peak workload, Wpeak % predicted and peak oxygen uptake, VO2peak % predicted) were significantly affected in the post-CoV patients (61.8 ± 23.3 Wpeak % and 70.9 ± 22.3 VO2peak %). Maximum inspiratory pressure (MIP) was reduced (60.1 ± 25.5 mbar). In 6 of the 22 patients the electrophysiological response of the phrenic nerve was pathologically decreased (reduced compound muscle action potential, CMAP), while nerve conduction velocity (NCV) was normal, which corresponds to reduced muscle fiber contraction capacity. Positive relationships were demonstrated between 6MWD and MIP (rs = 0.88) as well as quality of life questionnaire (CRQ) and MIP (rs = 0.71) only in patients with reduced CMAP. Discussion Respiratory muscle weakness and exercise capacity is associated with reduced phrenic nerve CMAP without signs of neuropathy. This indicates that muscle fiber pathology of the diaphragm may be one pathophysiological factor for the prolonged respiratory symptoms after COVID-19 infections.
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Affiliation(s)
- Karin Vonbank
- Klinik Pirawarth in Wien, Vienna, Austria
- Medical University of Vienna, Vienna, Austria
| | - Helena Nics
- Department of Physical Medicine and Rehabilitation, Klinik Floridsdorf, Vienna, Austria
| | - Ralf Harun Zwick
- Ludwig Boltzmann Institute for Rehabilitation Research, Therme Wien Med, Vienna, Austria
| | | | | | | | | | | | - Lusine Yeghiazaryan
- Medical University of Vienna, Center for Medical Data Science, Institute of Medical Statistics, Vienna, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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22
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Meda NS, Sherner JH, Holley AB. Dyspnea and Post-Pulmonary Embolism Syndrome after a Mild COVID-19 Infection. Ann Am Thorac Soc 2024; 21:151-157. [PMID: 38156895 DOI: 10.1513/annalsats.202304-332cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/08/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
| | | | - Aaron B Holley
- Department of Pulmonary/Sleep and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC
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23
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Mavronasou A, Asimakos A, Vasilopoulos A, Katsaounou P, Kortianou EA. Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment. Disabil Rehabil 2023:1-11. [PMID: 38156771 DOI: 10.1080/09638288.2023.2297928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To assess the inter-reliability of the Short Physical Performance Battery (SPPB), the 1-min Sit to Stand test (1-MSTS), and the Chester Step Test (CST) via remote assessment in post-COVID-19 patients after hospitalization. METHODS Twenty-five post-COVID-19 patients randomly performed the functional tests via remote assessment using a software platform at home and via face-to-face assessment at the rehabilitation center 24-72 h apart. One day before the remote assessment, all participants had a 1-h guidance session regarding the platform use, safety instructions, and home equipment preparation. RESULTS Participants completed all tests for both assessment procedures without experience of adverse events. The mean age was 53 (SD = 10) years old, and the median days of hospitalization were 23 (IQR = 10-33). The inter-reliability was moderate for the total score in the SPPB: Cohen's kappa = 0.545 (95% CI: 0.234 to 0.838), excellent for the number of repetitions in the 1-MSTS: ICC = 0.977 (95% CI: 0.948 to 0.990) and good for the total number of steps in the CST: ICC = 0.871 (95% CI: 0.698 to 0.944). CONCLUSION Remote functional assessments for SPPB, 1-MSTS, and CST indicated moderate to excellent inter-reliability in post-COVID-19 patients after hospitalization.
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Affiliation(s)
- Aspasia Mavronasou
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
| | - Andreas Asimakos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, Athens, Greece
| | - Aristeidis Vasilopoulos
- Health Assessment and Quality of Life Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
| | - Paraskevi Katsaounou
- Pulmonary & Respiratory Failure Department, First ICU, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni A Kortianou
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
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24
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Astley C, Prado DMLD, Sieczkowska SM, Esteves GP, Suguita P, Fink T, Lindoso L, Matsuo O, Martins F, Bain V, Badue Pereira MF, Marques HH, Malluf A, Leal GN, Silva CA, Roschel H, Gualano B. Impaired cardiorespiratory fitness and endothelial function after SARS-CoV-2 infection in a sample of mainly immunocompromised youth. J Appl Physiol (1985) 2023; 135:1323-1329. [PMID: 37916270 DOI: 10.1152/japplphysiol.00213.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
This study aimed to compare cardiopulmonary fitness and endothelial function 6 months after hospital diagnosis in a sample mainly comprising immunocompromised patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection versus noninfected controls. Youth (n = 30; age: 14 yr; 60% females) with confirmed SARS-CoV-2 seen in a tertiary hospital of Sao Paulo, Brazil, were matched by propensity score based on BMI, age, sex, and pre-existing diseases with a control group who had not been tested positive for SARS-CoV-2 infection (n = 30; age: 15 yr; 50% females). Cardiopulmonary fitness (by means of a cardiopulmonary exercise test: CPET) and brachial flow-mediated dilation (%b-FMD) were assessed 3-6 mo after diagnosis. Patients were matched by propensity score based on BMI, age, sex and pre-existing diseases, if any, with a control group who had not been tested positive for SARS-CoV-2. Compared with controls, patients with COVID-19 showed reduced ventilatory anaerobic threshold (VAT) and peak exercise time and minute ventilation/maximum voluntary ventilation (V̇e/MVV) (all P < 0.01). Brachial endothelial function variables were all adjusted for body surface area (BSA). Patients with COVID-19 had decreased %b-FMD (3.6 vs. 5.4; P = 0.03) mean and positive flow (P = 0.02 and P = 0.03, respectively) versus controls. Adjusted linear regression models exploring associations between CPET variables, %b-FMD and the potential predictors post-COVID-19 syndrome, number of symptoms, hospitalization, and COVID severity did not detect significant associations, except for total shear rate in hospitalization (coefficient: -65.07 [95%CI -119.5;-10.5], P = 0.02). Immunocompromised and previously healthy children and adolescents with COVID-19 presented with impaired exercise capacity and endothelial dysfunction when compared with their noninfected counterparts, but the mechanisms remain unknown.NEW & NOTEWORTHY COVID-19 appeared to impair recovery of exercise capacity and endothelial function in a sample mainly comprising immunocompromised patients, but the mechanisms are unknown. These findings support the need for preventive measures against COVID-19 in this vulnerable population and suggest the necessity of proper monitoring and treatment for these patients.
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Affiliation(s)
- Camilla Astley
- Center of Lifestyle Medicine, Applied Physiology & Nutrition Research Group, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Rheumatology Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Center of Lifestyle Medicine, Applied Physiology & Nutrition Research Group, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Sofia Mendes Sieczkowska
- Center of Lifestyle Medicine, Applied Physiology & Nutrition Research Group, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gabriel P Esteves
- Center of Lifestyle Medicine, Applied Physiology & Nutrition Research Group, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila Suguita
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Thais Fink
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Livia Lindoso
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Olivia Matsuo
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Martins
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Vera Bain
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Fernanda Badue Pereira
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Heloisa Helena Marques
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriana Malluf
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gabriela Nunes Leal
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Clovis Artur Silva
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Center of Lifestyle Medicine, Applied Physiology & Nutrition Research Group, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Rheumatology Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Center of Lifestyle Medicine, Applied Physiology & Nutrition Research Group, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Rheumatology Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Food Research Center, University of Sao Paulo, Sao Paulo, Brazil
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25
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Raza SS, Zafar U, Shehwar DE, Zafar H, Ullah F, Wazir M, Abbas SMH, Wazir H, Amin H, Varrassi G. Sex-Linked Differences in Pulmonary Functions of COVID-19 Patients After a Six-Minute Walk Test. Cureus 2023; 15:e50071. [PMID: 38186458 PMCID: PMC10769810 DOI: 10.7759/cureus.50071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) predominantly impacts the respiratory system. Historically, numerous lung diseases have shown sex-related differences throughout their progression. This study aimed to identify sex-linked disparities in pulmonary function tests (PFTs) among individuals who have recovered from COVID-19 when subjected to a six-minute walk test (6MWT). In this observational cross-sectional study, we analyzed 61 participants, consisting of 39 (64%) males and 22 (36%) females, all of whom previously contracted COVID-19 three months or more prior. We measured vitals such as blood pressure, pulse, oxygen saturation, and PFT values before and after the 6MWT. The post-6MWT evaluation revealed notable mean differences between males and females in parameters systolic blood pressure (SBP) (p = 0.003), diastolic blood pressure (DBP) (p = 0.026), forced expiratory volume in the first second (FEV1) (p = 0.038), forced vital capacity (FVC) (p = 0.041), and maximum voluntary ventilation (MVV) index (p = 0.011). PFT outcomes indicated sex-based variations among post-COVID-19 subjects. Specifically, post-stress values for FEV1, FVC, MVV index, SBP, and DBP were more elevated in males than in females. However, females presented with higher oxygen saturation levels post-COVID-19 compared to males. Using multiple linear regression modeling, sex was not found to be a strong predictor of PFT results. However, individual regression analyses for FEV1, FVC, and MVV index consistently showcased higher values in males. In conclusion, significant PFT differences exist between males and females after recovery from COVID-19 when exposed to stress induction via the 6MWT.
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Affiliation(s)
- Syed S Raza
- Physiology, Khyber Medical College, Peshawar, PAK
| | - Umema Zafar
- Physiology, Khyber Medical College, Peshawar, PAK
| | | | - Hamna Zafar
- Medicine, Khyber Medical College, Peshawar, PAK
| | - Farhan Ullah
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Maha Wazir
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | | | - Hina Wazir
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Hunya Amin
- Physiology, Khyber Medical College, Peshawar, PAK
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26
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D'Isabel S, Berny LM, Frost A, Thongphok C, Jack K, Chaudhry S, Arena R, Smith DL. The effect of mild to moderate COVID-19 infection on the cardiorespiratory fitness of firefighters. Front Public Health 2023; 11:1308605. [PMID: 38106889 PMCID: PMC10724018 DOI: 10.3389/fpubh.2023.1308605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction An adequate level of cardiorespiratory fitness (CRF) is critical for firefighters to perform the strenuous and physiologically demanding work of firefighting safely and effectively. The coronavirus disease 2019 (COVID-19) has been shown to negatively impact CRF in both the acute phase and longer-term following infection. This study aimed to determine changes to the CRF of firefighters pre- to post-mild to moderate COVID-19 infection and to investigate the impact of days past COVID-19 infection on change in CRF. Methods CRF measures from cardiopulmonary exercise testing (CPET) at annual occupational health exams that occurred pre-COVID-19 infection in 2019 were obtained for firefighters from seven Arizona fire departments. Measures were compared to CPET evaluations from annual health exams the following year in a cohort of firefighters who self-reported mild to moderate illness following COVID-19 infection between exams. Results Among a cohort of 103 firefighters, mean age 40 ± 9 years, CRF [as measured by peak oxygen consumption (VO2)] declined by an average of 2.55 ml·kg-1·min-1 or 7.3% (d = -0.38, p < 0.001) following COVID-19 infection (mean time from COVID-19 infection to CPET was 110 ± 78 days). The number of days past COVID-19 infection showed a small, yet significant, relationship to peak VO2 (r = 0.250, p = 0.011). Estimated marginal effects indicated that when biological sex, age, and BMI are controlled for, predicted peak VO2 returned to pre-COVID-19 values ~300 days after COVID-19 infection. Conclusion Peak VO2 (ml·kg-1·min-1) declined 7.3% among firefighters an average of 110 days past reporting mild to moderate COVID-19 infection. This decrease has implications for the operational readiness and safety of firefighters.
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Affiliation(s)
- Susanne D'Isabel
- First Responder Health and Safety Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Lauren M. Berny
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Alex Frost
- Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Chanhtel Thongphok
- Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Kepra Jack
- HeartFit for Duty, Mesa, AZ, United States
| | | | - Ross Arena
- MET-Test, Atlanta, GA, United States
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Denise L. Smith
- First Responder Health and Safety Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
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27
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Fernandes IA, Balavenkataraman A, Bonvie-Hill NE, Patel NM, Taylor BJ, Helgeson SA. Does COVID-19 impair V̇o 2peak in patients with cardiorespiratory disease? Insight from cardiopulmonary responses to maximal exercise pre- and post-illness. J Appl Physiol (1985) 2023; 135:1146-1156. [PMID: 37855032 PMCID: PMC10979800 DOI: 10.1152/japplphysiol.00357.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023] Open
Abstract
Reduced exercise capacity has been suggested as a cardinal sequela of COVID-19. However, only cross-sectional approaches that either do not consider individuals with concomitant cardiorespiratory disease or account for exercise capacity before infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) support this assumption. Is reduced exercise capacity a sequela of SARS-CoV-2 infection in patients with concomitant cardiorespiratory disease? We retrospectively reviewed cardiopulmonary exercise testing (CPET) data collected across three hospitals between October 2018 and March 2022. Forty-two patients who completed a CPET before and after COVID-19 and 25 patients who performed two separate CPETs but did not contract COVID-19 (CTL) were included. Within each patient, the same test protocol was performed at the first and second CPETs. The time between CPETs was similar between the groups (COVID-19 489 ± 534 vs. CTL 534 ± 257 days, P = 0.662). The COVID-19 group performed the CPETs 312 ± 232 days before and 176 ± 110 days after infection. Exercise time, peak heart rate, peak systolic pressure, oxygen uptake (V̇o2) at anaerobic threshold, peak ventilation, and ventilatory efficiency were not different between the CPETs in both groups. Peak V̇o2 was reduced from before to after SARS-CoV-2 infection. However, the change in V̇o2peak from the first to the second CPET was not different between COVID-19 vs. CTL. Accounting for V̇o2peak before COVID-19 and including a group of control patients, we find limited evidence for reduced exercise capacity as a sequela of SARS-CoV-2 infection in patients with concomitant cardiorespiratory disease.NEW & NOTEWORTHY There is accumulating evidence that reduced exercise capacity is, or can be, an outcome following COVID-19. However, evidence to date relies upon cross-sectional approaches that either do not consider patients with concomitant cardiorespiratory disease or account for pre-infection exercise capacity data. Accounting for V̇o2peak before COVID-19 and including a group of control patients, we find limited evidence for reduced exercise capacity as a sequela of SARS-CoV-2 infection in patients with concomitant cardiorespiratory disease.
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Affiliation(s)
- Igor A Fernandes
- Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, United States
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, United States
| | | | | | - Neal M Patel
- Pulmonary & Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Bryan J Taylor
- Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, United States
| | - Scott A Helgeson
- Pulmonary & Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, United States
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28
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Chuatrakoon B, Konghakote S, Sa-nguanmoo P, Nantakool S. Long-term impact of SARS-CoV-2 infection on cardiorespiratory fitness: a meta-analysis. Front Public Health 2023; 11:1215486. [PMID: 37920575 PMCID: PMC10619755 DOI: 10.3389/fpubh.2023.1215486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Background Despite surviving Coronavirus disease 2019 (COVID-19), its long-term impact is of concern. Low cardiorespiratory fitness is a strong predictor of all-cause mortality, and likely affected by multisystem impairments following COVID-19 infection. Accumulating evidence has identified the impact of COVID-19 on cardiorespiratory fitness level. However, the findings have been controversial. Conclusive evidence is still needed. Objectives This review aimed to systematically summarize and synthesize whether the SARS-CoV-2 infection diminishes cardiorespiratory fitness in COVID-19 survivors. Design The study design was a systematic review and meta-analysis. Methods A search was carried out using PubMed, CINAHL, Scopus, Embase and the Cochrane Library, together with reference lists (searching from their inception to January 2023). Observational studies investigating the impact of COVID-19 on outcomes relevant to cardiorespiratory fitness (i.e., peak oxygen uptake) were included. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to identify a pooled effect estimate. Use of a random effects model was considered as the main method. Grading of Recommendation Assessment, Development and Evaluation approach was employed to determine the certainty of evidence. This meta-analysis was registered with PROSPERO (registration number: CRD42023393108). Results Seven eligible studies (4 cross-sectional, 2 cohort, and 1 case-control studies) involving 4,773 participants were included in this meta-analysis. A pooled effect estimates showed that patients in the surviving COVID-19 group had a significant reduction in peak oxygen uptake when compared to their counterparts in the non-COVID-19 group (WMD -6.70, 95%CI -9.34 to -4.06, low certainty). A subgroup analysis by age found that COVID-19 survivors in the young- to middle-aged and middle- to older-aged subgroups had significant reductions in peak oxygen uptake when compared to their counterparts in the non-COVID-19 group (WMD -5.31, 95%CI -7.69 to -2.94, low certainty; WMD -15.63, 95%CI -28.50 to -2.75, very low certainty, respectively). Subgroup analyses by symptom found that patients with moderate to severe symptoms in the surviving COVID-19 group had significantly lower peak oxygen uptake than their counterparts in the non-COVID-19 group (WMD -15.63, 95%CI -28.50 to -2.75, very low certainty). Conclusion The current meta-analysis concluded that patients in the COVID-19 survivors had poorer cardiorespiratory fitness than their counterparts in the non-COVID-19 group, but there is considerable uncertainty of evidence. Poorer cardiorespiratory fitness is likely to be more pronounced in COVID-19 survivors who are getting older and had severe symptoms, but it is uncertain whether such finding has a valuable in clinical context. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, CRD42023393108.
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Affiliation(s)
- Busaba Chuatrakoon
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Supatcha Konghakote
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Piangkwan Sa-nguanmoo
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sothida Nantakool
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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29
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Caravita S, Baratto C, Filippo A, Soranna D, Dewachter C, Zambon A, Perego GB, Muraru D, Senni M, Badano LP, Parati G, Vachiéry JL, Fudim M. Shedding Light on Latent Pulmonary Vascular Disease in Heart Failure With Preserved Ejection Fraction. JACC. HEART FAILURE 2023; 11:1427-1438. [PMID: 37115127 DOI: 10.1016/j.jchf.2023.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Among patients with heart failure with preserved ejection fraction (HFpEF), a distinct hemodynamic phenotype has been recently described, ie, latent pulmonary vascular disease (HFpEF-latentPVD), defined by exercise pulmonary vascular resistance (PVR) >1.74 WU. OBJECTIVES This study aims to explore the pathophysiological significance of HFpEF-latentPVD. METHODS The authors analyzed a cohort of patients who had undergone supine exercise right heart catheterization with cardiac output (CO) measured by direct Fick method, between 2016 and 2021. HFpEF-latentPVD patients were compared with HFpEF control patients. RESULTS Out of 86 HFpEF patients, 21% qualified as having HFpEF-latentPVD, 78% of whom had PVR >2 WU at rest. Patients with HFpEF-latentPVD were older, with a higher pretest probability of HFpEF, and more frequently experienced atrial fibrillation and at least moderate tricuspid regurgitation (P < 0.05). PVR trajectories differed between HFpEF-latentPVD patients and HFpEF control patients (Pinteraction = 0.008), slightly increasing in the former and reducing in the latter. HFpEF-latentPVD patients displayed more frequent hemodynamically significant tricuspid regurgitation during exercise (P = 0.002) and had more impaired CO and stroke volume reserve (P < 0.05). Exercise PVR was correlated with mixed venous O2 tension (R2 = 0.33) and stroke volume (R2 = 0.31) in HFpEF-latentPVD patients. The HFpEF-latentPVD patients had had higher dead space ventilation during exercise and higher PaCO2 (P < 0.05), which correlated with resting PVR (R2 = 0.21). Event-free survival was reduced in HFpEF-latentPVD patients (P < 0.05). CONCLUSIONS The results suggest that when CO is measured by direct Fick, few HFpEF patients have isolated latent PVD (ie, normal PVR at rest, becoming abnormal during exercise). HFpEF-latentPVD patients present with CO limitation to exercise, associated with dynamic tricuspid regurgitation, altered ventilatory control, and pulmonary vascular hyperreactivity, portending a poor prognosis.
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Affiliation(s)
- Sergio Caravita
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy; Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, Italy
| | - Claudia Baratto
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, Italy.
| | - Aurora Filippo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Davide Soranna
- Biostatistic Unit, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Céline Dewachter
- Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Bruxelles, Belgium
| | - Antonella Zambon
- Biostatistic Unit, IRCCS Istituto Auxologico Italiano, Milano, Italy; Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milano, Italy
| | | | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Michele Senni
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy; Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luigi P Badano
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Jean-Luc Vachiéry
- Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Bruxelles, Belgium
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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30
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Noureddine S, Roux-Claudé P, Eberst G, Westeel V, Barnig C, Claudé F. [The role of the cardiopulmonary exercise test and pulmonary rehabilitation in long COVID-19]. Rev Mal Respir 2023; 40:604-622. [PMID: 37357041 PMCID: PMC10289121 DOI: 10.1016/j.rmr.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/12/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Long COVID refers to persistent symptoms, lasting more than 4 weeks after acute SARS-CoV-2 infection, even though the infection itself has been successfully controlled and remedied. Patient complaints are diverse, and the underlying physiopathological mechanisms are not well understood. Dyspnea and muscle fatigue are among the most commonly reported symptoms. STATE OF THE ART Cardiopulmonary exercise test (CPET) has been recognized as a useful tool in investigation of unexplained dyspnea. In patients with chronic lung disease, pulmonary rehabilitation is a program designed to counteract dyspnea, to increase exercise capacity and to improve quality of life. PERSPECTIVES Publications on CPET and pulmonary rehabilitation are needed in order to deepen comprehension and enhance management of long-COVID-19. CONCLUSIONS CPET reports have shown that symptoms persisting in the aftermath of acute SARS-CoV-2 infection may be related to deconditioning, a common occurrence after ICU stay, to cardiac dysautonomia subsequent to critical infections and, finally, to dysfunctional breathing subsequent to mild infections. These findings justify pulmonary rehabilitation, which has proven to be effective regardless of the severity of the initial infection, not only immediately after hospital discharge, but also at later points in time.
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Affiliation(s)
- S Noureddine
- Service de pneumologie, d'oncologie thoracique et d'allergologie respiratoire, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
| | - P Roux-Claudé
- Service de pneumologie, d'oncologie thoracique et d'allergologie respiratoire, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - G Eberst
- Service de pneumologie, d'oncologie thoracique et d'allergologie respiratoire, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - V Westeel
- Service de pneumologie, d'oncologie thoracique et d'allergologie respiratoire, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - C Barnig
- Service de pneumologie, d'oncologie thoracique et d'allergologie respiratoire, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; UMR1098 Inserm, établissement français du sang de Bourgogne-Franche-Comté, 8, rue du Docteur-Jean-François-Xavier-Girod, 25000 Besançon, France
| | - F Claudé
- Service de pneumologie, d'oncologie thoracique et d'allergologie respiratoire, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
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Komici K, Bencivenga L, Rengo G, Bianco A, Guerra G. Ventilatory efficiency in post-COVID-19 athletes. Physiol Rep 2023; 11:e15795. [PMID: 37734918 PMCID: PMC10513909 DOI: 10.14814/phy2.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/11/2023] [Accepted: 08/07/2023] [Indexed: 09/23/2023] Open
Abstract
Limitation in exercise capacity has not been described in athletes affected by SARS-CoV-2 infection. However, patients who have recovered from COVID-19 without cardiopulmonary impairment show exaggerated ventilatory response during exercise. Therefore, we aimed to evaluate the ventilatory efficiency (VEf) in competitive athletes recovered from COVID-19 and to characterize the ventilation versus carbon dioxide relationship (VE/VCO2 ) slope in this population. Thirty-seven competitive athletes with COVID-19 were recruited for this study. All participants underwent spirometry, echocardiography, and cardiopulmonary exercise testing (CPET). z-FVC values and end-title pressure of CO2 (PET CO2 ) were lower in the third tertile compared with the first tertile: -0.753 ± 0.473 vs. 0.037 ± 0.911, p = 0.05; 42.2 ± 2.7 vs. 37.1 ± 2.5 mmHg, p < 0.01. VE/VCO2 slope was significantly correlated to maximal VCO2 /VE and maximal VO2 /VE: coefficient = -0.5 R2 = 0.58, p < 0.0001 and coefficient = -0.3 R2 = 0.16, p = 0.008. Competitive athletes affected by SARS-CoV-2 infection, without cardio-respiratory disease sequel, may present ventilatory inefficiency (ViE), without exercise capacity limitation. FVC is higher in athletes with better ventilatory performance during exercise, and increased VE/VCO2 slope is inversely correlated to max VCO2 /VE and max VO2 /VE.
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Affiliation(s)
- Klara Komici
- Department of Medicine and Health SciencesUniversity of MoliseCampobassoItaly
- Exercise and Sports Medicine UnitAntonio Cardarelli HospitalCampobassoItaly
| | - Leonardo Bencivenga
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Giuseppe Rengo
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
- Istituti Clinici Scientifici Maugeri IRCCS‐Scientific Institute of Telese TermeTelese TermeItaly
| | - Andrea Bianco
- Department of Translational Medical SciencesUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Germano Guerra
- Department of Medicine and Health SciencesUniversity of MoliseCampobassoItaly
- Exercise and Sports Medicine UnitAntonio Cardarelli HospitalCampobassoItaly
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32
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Faria D, Moll-Bernardes R, Testa L, Moniz CMV, Rodrigues EC, Mota JM, Souza FR, Alves MJNN, Ono BE, Izaias JE, Sales AO, Rodrigues TS, Salemi VMC, Jordão CP, De Angelis K, Craighead DH, Rossman MJ, Bortolotto LA, Consolim-Colombo FM, Irigoyen MCC, Seals DR, Negrão CE, Sales ARK. Neurovascular and hemodynamic responses to mental stress and exercise in severe COVID-19 survivors. Am J Physiol Regul Integr Comp Physiol 2023; 325:R269-R279. [PMID: 37449870 PMCID: PMC10625836 DOI: 10.1152/ajpregu.00111.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Previous studies show that COVID-19 survivors have elevated muscle sympathetic nerve activity (MSNA), endothelial dysfunction, and aortic stiffening. However, the neurovascular responses to mental stress and exercise are still unexplored. We hypothesized that COVID-19 survivors, compared with age- and body mass index (BMI)-matched control subjects, exhibit abnormal neurovascular responses to mental stress and physical exercise. Fifteen severe COVID-19 survivors (aged: 49 ± 2 yr, BMI: 30 ± 1 kg/m2) and 15 well-matched control subjects (aged: 46 ± 3 yr, BMI: 29 ± 1 kg/m2) were studied. MSNA (microneurography), forearm blood flow (FBF), and forearm vascular conductance (FVC, venous occlusion plethysmography), mean arterial pressure (MAP, Finometer), and heart rate (HR, ECG) were measured during a 3-min mental stress (Stroop Color-Word Test) and during a 3-min isometric handgrip exercise (30% of maximal voluntary contraction). During mental stress, MSNA (frequency and incidence) responses were higher in COVID-19 survivors than in controls (P < 0.001), and FBF and FVC responses were attenuated (P < 0.05). MAP was similar between the groups (P > 0.05). In contrast, the MSNA (frequency and incidence) and FBF and FVC responses to handgrip exercise were similar between the groups (P > 0.05). MAP was lower in COVID-19 survivors (P < 0.05). COVID-19 survivors exhibit an exaggerated MSNA and blunted vasodilatory response to mental challenge compared with healthy adults. However, the neurovascular response to handgrip exercise is preserved in COVID-19 survivors. Overall, the abnormal neurovascular control in response to mental stress suggests that COVID-19 survivors may have an increased risk to cardiovascular events during mental challenge.
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Affiliation(s)
- Diego Faria
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | | | - Laura Testa
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - Camila M V Moniz
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - Erika C Rodrigues
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Jose M Mota
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - Francis R Souza
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Janieire N N Alves
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruna E Ono
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - João E Izaias
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - Artur O Sales
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - Thais S Rodrigues
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera M C Salemi
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Camila P Jordão
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Katia De Angelis
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Luiz A Bortolotto
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda M Consolim-Colombo
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria C C Irigoyen
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Carlos E Negrão
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Escola de Educação Física e Esporte, Universidade de São Paulo, São Paulo, Brazil
| | - Allan R K Sales
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Monteiro IP, Appelt PA, Sisconetto AT, Minaré Baldo Sucupira KS, Bazan R, Luvizutto GJ, Pascucci Sande de Souza LA. Post-coronavirus disease 2019 functional impairments, limitations, and restrictions: A prospective cohort study based on the international classification of functioning, disability, and health. J Cent Nerv Syst Dis 2023; 15:11795735231195759. [PMID: 38025402 PMCID: PMC10655659 DOI: 10.1177/11795735231195759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background Current knowledge regarding coronavirus disease 2019 (COVID-19) is constantly evolving, and the long-term functional impairments, limitations, and restrictions have not yet been well established. Objective to evaluate the impact of post-COVID condition on the human functioning through the International Classification of Functioning, Disability and Health (ICF) classification. Methods This is a prospective cohort study with 53 individuals with post-COVID condition at 3 time points: 0 to 3 (baseline), 3 to 6, and 6-12 months (follow-up). Outcomes were organized in dichotomous variable: No impairment (0); presence of impairment (≥1) in body function, structure, activities, and participation domains according to the ICF checklist. Chi-square test was used to determine the differences of 3 time points, and association with persistent symptoms. Results A statistically significant difference was observed between the periods, with greater disabilities at 6-12 than at 0-3 months in mental, sensory, pain, and movement-related functions; cardiovascular, immunological, and respiratory systems. In terms of activity and participation, a greater limitation at 6-12 months was observed than at 0-3 months in learning and applying knowledge, general tasks, and mobility. In the domain of interpersonal interactions and relationships, there was a statistically significant difference between the 6-12 and 3-6 months groups. Associations between COVID-19 symptoms and ICF components at the first follow-up were: anosmia and dysgeusia with weight maintenance, fatigue and irritability with pain, brain fog with watching and listening, walking difficulty with pain, and headache with pain, watching, and listening. At the second follow-up were: anosmia and dysgeusia with energy and drive functions, attention, memory, and emotional functions; dizziness with watching and listening; fatigue with emotional function, pain, undertaking multiple tasks, lifting and carrying objects, and driving; irritability with energy and drive, emotional function, undertaking multiple tasks, lifting and carrying objects, and walking; walking difficulty with energy and driving, emotional function, respiration, muscle power, cardiovascular system, undertaking multiple tasks, lifting and carrying objects, and walking; and headache with emotional function, watching, and listening. Conclusions Individuals with COVID-19 persistent symptoms showed impairments in structure and function, activity limitations, and participation restrictions during the 1-year follow-up period.
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Affiliation(s)
- Isabella Polo Monteiro
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brasil
| | - Pablo Andrei Appelt
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brasil
| | | | | | - Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Universidade Estadual Paulista (UNESP), Botucatu, Brasil
| | - Gustavo José Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brasil
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Sen S, Khosla S, Awan O, Cohen S, Gollie JM. Endothelial dysfunction in autoimmune, pulmonary, and kidney systems, and exercise tolerance following SARS-CoV-2 infection. Front Med (Lausanne) 2023; 10:1197061. [PMID: 37575987 PMCID: PMC10413142 DOI: 10.3389/fmed.2023.1197061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Long COVID is characterized by persistent symptoms beyond 3-months of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection that last for at least 2 months and cannot be explained by an alternative diagnosis. Autonomic, immunologic, endothelial, and hypercoagulation are implicated as possible mechanisms of long COVID symptoms. Despite recognition of the public health challenges posed by long COVID, the current understanding of the pathophysiological underpinnings is still evolving. In this narrative review, we explore the long-term effects of SARS-CoV-2 infection on T cell activation such as autoimmune disorders and endothelial cell dysfunction involving vascular impairments within pulmonary and renal architecture. We have described how endothelial dysfunction and vascular abnormalities may underscore findings of exercise intolerance by way of impaired peripheral oxygen extraction in individuals with long COVID.
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Affiliation(s)
- Sabyasachi Sen
- Division of Endocrinology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC, United States
- Division of Endocrinology, Department of Medicine, George Washington University, Washington, DC, United States
| | - Shikha Khosla
- Division of Endocrinology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC, United States
- Division of Endocrinology, Department of Medicine, George Washington University, Washington, DC, United States
| | - Omar Awan
- Division of Pulmonary Medicine, Department of Medicine, Veterans Affairs Medical Center, Washington, DC, United States
- Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, The George Washington University, Washington, DC, United States
| | - Scott Cohen
- Division of Nephrology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC, United States
| | - Jared M. Gollie
- Research and Development Service, Veterans Affairs Medical Center, Washington, DC, United States
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, DC, United States
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Wedig IJ, Durocher JJ, McDaniel J, Elmer SJ. Blood flow restriction as a potential therapy to restore physical function following COVID-19 infection. Front Physiol 2023; 14:1235172. [PMID: 37546539 PMCID: PMC10400776 DOI: 10.3389/fphys.2023.1235172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Accumulating evidence indicates that some COVID-19 survivors display reduced muscle mass, muscle strength, and aerobic capacity, which contribute to impairments in physical function that can persist for months after the acute phase of illness. Accordingly, strategies to restore muscle mass, muscle strength, and aerobic capacity following infection are critical to mitigate the long-term consequences of COVID-19. Blood flow restriction (BFR), which involves the application of mechanical compression to the limbs, presents a promising therapy that could be utilized throughout different phases of COVID-19 illness. Specifically, we hypothesize that: 1) use of passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to high-intensity exercise without BFR for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. The various applications of BFR may also serve as a targeted therapy to address the underlying pathophysiology of COVID-19 and provide benefits to the musculoskeletal system as well as other organ systems affected by the disease. Consequently, we present a theoretical framework with which BFR could be implemented throughout the progression from acute illness to outpatient rehabilitation with the goal of improving short- and long-term outcomes in COVID-19 survivors. We envision that this paper will encourage discussion and consideration among researchers and clinicians of the potential therapeutic benefits of BFR to treat not only COVID-19 but similar pathologies and cases of acute critical illness.
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Affiliation(s)
- Isaac J. Wedig
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI, United States
- Health Research Institute, Michigan Technological University, Houghton, MI, United States
| | - John J. Durocher
- Department of Biological Sciences and Integrative Physiology and Health Sciences Center, Purdue University Northwest, Hammond, IN, United States
| | - John McDaniel
- Department of Exercise Physiology, Kent State University, Kent, OH, United States
| | - Steven J. Elmer
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI, United States
- Health Research Institute, Michigan Technological University, Houghton, MI, United States
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Wernhart S, Weihe E, Totzeck M, Balcer B, Rassaf T, Luedike P. Cardiopulmonary Profiling of Athletes with Post-Exertional Malaise after COVID-19 Infection-A Single-Center Experience. J Clin Med 2023; 12:4348. [PMID: 37445382 DOI: 10.3390/jcm12134348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Cardiopulmonary exercise testing (CPET) has been suggested by the European Society of Cardiology (ESC) for assessing the exercise limitations of apparently healthy individuals, but data on elite athletes regarding this test are scarce. (2) Methods: We analyzed CPET in elite (n = 43, 21.9 ± 3.7 years) and recreational (n = 40, 34.7 ± 13.0 years) athletes with persistent subjective exercise intolerance and post-exertional malaise (PEM) after COVID-19 infection. The primary outcome was the point prevalence of the adequate cardiopulmonary response (ACPR), defined by the presence of all of the following ESC criteria for apparently healthy individuals: (1) >100% of predicted peak oxygen consumption (predVO2peak), (2) VE/VCO2 < 30, (3) no exercise oscillatory ventilation (EOV), and (4) heart rate recovery of ≥12 beats/minute 1 min after exercise termination (HRR1). Results: ACPR occurred more frequently in elite athletes than in recreational athletes (70.0% vs. 39.5%; p = 0.005), mainly driven by the lower VE/VCO2 (<30: 97.7% vs. 65%, p < 0.001). Elite (11.6%) and recreational athletes (22.5%) showing a plateau of O2 pulse did not display ACPR. Conclusions: ACPR was not observed in all recreational and elite athletes with PEM. In particular, perturbed VE/VCO2 and the plateauing of O2 pulse are suitable for quantifying exercise limitations and may identify a high-risk population with long-COVID-19 syndrome who require their training intensities to be adapted.
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Affiliation(s)
- Simon Wernhart
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Eberhard Weihe
- Institute for Anatomy and Cell Biology, University Marburg, Robert-Kochstrasse 8, 35037 Marburg, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Bastian Balcer
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Weldon EJ, Hong B, Hayashi J, Goo C, Carrazana E, Viereck J, Liow K. Mechanisms and Severity of Exercise Intolerance Following COVID-19 and Similar Viral Infections: A Comparative Review. Cureus 2023; 15:e39722. [PMID: 37398713 PMCID: PMC10310058 DOI: 10.7759/cureus.39722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Approximately 19% of the population is suffering from "Long COVID", also known as post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC), which often results in exercise intolerance. As COVID infections continue to be common, studying the long-term consequences of coronavirus disease (COVID) on physical function has become increasingly important. This narrative review will aim to summarize the current literature surrounding exercise intolerance following COVID infection in terms of mechanism, current management approaches, and comparison with similar conditions and will aim to define limitations in the current literature. Multiple organ systems have been implicated in the onset of long-lasting exercise intolerance post-COVID, including cardiac impairment, endothelial dysfunction, decreased VO2 max and oxygen extraction, deconditioning due to bed rest, and fatigue. Treatment modalities for severe COVID have also been shown to cause myopathy and/or worsen deconditioning. Besides COVID-specific pathophysiology, general febrile illness as commonly experienced during infection will cause hypermetabolic muscle catabolism, impaired cooling, and dehydration, which acutely cause exercise intolerance. The mechanisms of exercise intolerance seen with PASC also appear similar to post-infectious fatigue syndrome and infectious mononucleosis. However, the severity and duration of the exercise intolerance seen with PASC is greater than that of any of the isolated mechanisms described above and thus is likely a combination of the proposed mechanisms. Physicians should consider post-infectious fatigue syndrome (PIFS), especially if fatigue persists after six months following COVID recovery. It is important for physicians, patients, and social systems to anticipate exercise intolerance lasting for weeks to months in patients with long COVID. These findings underscore the importance of long-term management of patients with COVID and the need for ongoing research to identify effective treatments for exercise intolerance in this population. By recognizing and addressing exercise intolerance in patients with long COVID, clinicians can provide proper supportive interventions, such as exercise programs, physical therapy, and mental health counseling, to improve patient outcomes.
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Affiliation(s)
- Edward J Weldon
- Department of Neurology, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
- Brain Research, Innovation, & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Bradon Hong
- Department of Neurology, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
- Brain Research, Innovation, & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Jeffrey Hayashi
- Department of Neurology, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
- Brain Research, Innovation, & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Connor Goo
- Department of Neurology, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
- Brain Research, Innovation, & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Enrique Carrazana
- Brain Research, Innovation, & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Department of Neurology, Hawaii Neuro COVID Clinic, Honolulu, USA
| | - Jason Viereck
- Brain Research, Innovation, & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Department of Neurology, Hawaii Neuro COVID Clinic, Honolulu, USA
| | - Kore Liow
- Brain Research, Innovation, & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Department of Neurology, Hawaii Neuro COVID Clinic, Honolulu, USA
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Milne KM, Cowan J, Schaeffer MR, Voduc N, Corrales-Medina V, Lavoie KL, Chirinos JA, Puyat JH, Abdallah SJ, Guenette JA. Exercise responses and mental health symptoms in COVID-19 survivors with dyspnoea. ERJ Open Res 2023; 9:00606-2022. [PMID: 37337509 PMCID: PMC10258874 DOI: 10.1183/23120541.00606-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/25/2023] [Indexed: 06/21/2023] Open
Abstract
Objectives Dyspnoea is a common persistent symptom post-coronavirus disease 2019 (COVID-19) illness. However, the mechanisms underlying dyspnoea in the post-COVID-19 syndrome remain unclear. The aim of our study was to examine dyspnoea quality and intensity, burden of mental health symptoms, and differences in exercise responses in people with and without persistent dyspnoea following COVID-19. Methods 49 participants with mild-to-critical COVID-19 were included in this cross-sectional study 4 months after acute illness. Between-group comparisons were made in those with and without persistent dyspnoea (defined as modified Medical Research Council dyspnoea score ≥1). Participants completed standardised dyspnoea and mental health symptom questionnaires, pulmonary function tests, and incremental cardiopulmonary exercise testing. Results Exertional dyspnoea intensity and unpleasantness were increased in the dyspnoea group. The dyspnoea group described dyspnoea qualities of suffocating and tightness at peak exercise (p<0.05). Ventilatory equivalent for carbon dioxide (V'E/V'CO2) nadir was higher (32±5 versus 28±3, p<0.001) and anaerobic threshold was lower (41±12 versus 49±11% predicted maximum oxygen uptake, p=0.04) in the dyspnoea group, indicating ventilatory inefficiency and deconditioning in this group. The dyspnoea group experienced greater symptoms of anxiety, depression and post-traumatic stress (all p<0.05). A subset of participants demonstrated gas-exchange and breathing pattern abnormalities suggestive of dysfunctional breathing. Conclusions People with persistent dyspnoea following COVID-19 experience a specific dyspnoea quality phenotype. Dyspnoea post-COVID-19 is related to abnormal pulmonary gas exchange and deconditioning and is linked to increased symptoms of anxiety, depression and post-traumatic stress.
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Affiliation(s)
- Kathryn M. Milne
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St Paul's Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Juthaporn Cowan
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Michele R. Schaeffer
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St Paul's Hospital, Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Nha Voduc
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Kim L. Lavoie
- Montréal Behavioural Medicine Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, University of Québec at Montréal, Montréal, QC, Canada
| | - Julio A. Chirinos
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph H. Puyat
- Centre for Health Evaluation and Outcome Sciences, Providence Research, St Paul's Hospital, Vancouver, BC, Canada
| | - Sara J. Abdallah
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jordan A. Guenette
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St Paul's Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
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Schwendinger F, Knaier R, Radtke T, Schmidt-Trucksäss A. Response to Comment on: “Low Cardiorespiratory Fitness Post‐COVID‐19: A Narrative Review”. Sports Med 2023; 53:1473-1477. [PMCID: PMC10123462 DOI: 10.1007/s40279-023-01848-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Fabian Schwendinger
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Raphael Knaier
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
- Division of Sleep Medicine, Harvard Medical School, Boston, MA USA
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA USA
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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Singh I, Leitner BP, Wang Y, Zhang H, Joseph P, Lutchmansingh DD, Gulati M, Possick JD, Damsky W, Hwa J, Heerdt PM, Chun HJ. Proteomic profiling demonstrates inflammatory and endotheliopathy signatures associated with impaired cardiopulmonary exercise hemodynamic profile in Post Acute Sequelae of SARS-CoV-2 infection (PASC) syndrome. Pulm Circ 2023; 13:e12220. [PMID: 37091121 PMCID: PMC10113513 DOI: 10.1002/pul2.12220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
Approximately 50% of patients who recover from the acute SARS-CoV-2 experience Post Acute Sequelae of SARS-CoV-2 infection (PASC) syndrome. The pathophysiological hallmark of PASC is characterized by impaired system oxygen extraction (EO2) on invasive cardiopulmonary exercise test (iCPET). However, the mechanistic insights into impaired EO2 remain unclear. We studied 21 consecutive iCPET in PASC patients with unexplained exertional intolerance. PASC patients were dichotomized into mildly reduced (EO2peak-mild) and severely reduced (EO2peak-severe) EO2 groups according to the median peak EO2 value. Proteomic profiling was performed on mixed venous blood plasma obtained at peak exercise during iCPET. PASC patients as a group exhibited depressed peak exercise aerobic capacity (peak VO2; 85 ± 18 vs. 131 ± 45% predicted; p = 0.0002) with normal systemic oxygen delivery, DO2 (37 ± 9 vs. 42 ± 15 mL/kg/min; p = 0.43) and reduced EO2 (0.4 ± 0.1 vs. 0.8 ± 0.1; p < 0.0001). PASC patients with EO2peak-mild exhibited greater DO2 compared to those with EO2peak-severe [42.9 (34.2-41.2) vs. 32.1 (26.8-38.0) mL/kg/min; p = 0.01]. The proteins with increased expression in the EO2peak-severe group were involved in inflammatory and fibrotic processes. In the EO2peak-mild group, proteins associated with oxidative phosphorylation and glycogen metabolism were elevated. In PASC patients with impaired EO2, there exist a spectrum of PASC phenotype related to differential aberrant protein expression and cardio-pulmonary physiologic response. PASC patients with EO2peak-severe exhibit a maladaptive physiologic and proteomic signature consistent with persistent inflammatory state and endothelial dysfunction, while in the EO2peak-mild group, there is enhanced expression of proteins involved in oxidative phosphorylation-mediated ATP synthesis along with an enhanced cardiopulmonary physiological response.
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Affiliation(s)
| | | | - Yiwei Wang
- Department of DermatologyYale School of MedicineNew HavenConnecticutUSA
| | - Hanming Zhang
- Department of Comparative MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Phillip Joseph
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Denyse D. Lutchmansingh
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Mridu Gulati
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Jennifer D. Possick
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep MedicineYale School of MedicineNew HavenConnecticutUSA
| | - William Damsky
- Department of DermatologyYale School of MedicineNew HavenConnecticutUSA
| | - John Hwa
- Department of Medicine, Yale Cardiovascular Research Center, Section of Cardiovascular MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Paul M. Heerdt
- Department of Anesthesiology, Division of Applied HemodynamicsYale School of MedicineNew HavenConnecticutUSA
| | - Hyung J. Chun
- Department of Medicine, Yale Cardiovascular Research Center, Section of Cardiovascular MedicineYale School of MedicineNew HavenConnecticutUSA
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Sova M, Sovova E, Ozana J, Moravcova K, Sovova M, Jelinek L, Mizera J, Genzor S. Post-COVID Syndrome and Cardiorespiratory Fitness—26-Month Experience of Single Center. Life (Basel) 2023; 13:life13030684. [PMID: 36983838 PMCID: PMC10056713 DOI: 10.3390/life13030684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction: Persistent post-COVID syndrome, also referred to as long COVID, is a pathologic entity that involves persistent physical, medical, and cognitive sequelae following COVID-19. Decreased fitness has repeatedly been reported in numerous studies dealing with post-COVID syndrome, however, it is still not fully clear which groups of patients may be more susceptible for persisting symptoms. Aim: The aim of our study was to evaluate the number of post-COVID patients with cardiac symptoms, where these patients were evaluated by CPET and the results compared with a control group of patients. Methods: Follow-up of patients in post-COVID outpatient clinic from 1 March 2020 to 31 May 2022. Inclusion criteria were positive PCR test for SARS-CoV-2 and age 18–100. The initial examination was performed 4–12 weeks after the disease onset. All patients with possible cardiac symptoms had completed cardiopulmonary exercise testing. The control group was randomly selected from a database of clients in 2019, with the preventive reason for evaluation. Results: From 1 March 2020 to 31 May 2022, 2732 patients (45.7% males) were evaluated with a mean age of 54.6 ± 14.7. CPET was indicated only in 97 patients (3.5%). Seventy-four patients (26 male) achieved the exercise maximum and a comparison were made with a control group (same age (p = 0.801), BMI (p = 0.721), and sex ratio). No significant dependence between the parameter VO2 max mL/kg/min and post-COVID disability was demonstrated (p = 0.412). Spearman’s correlation analysis did not show a significant relationship between the parameter VO2 max mL/kg/min and the severity of COVID-19 (p = 0.285). Conclusions: Cardiac symptoms occurred in only a small percentage of patients in our study. There is a need for further studies that would objectively evaluate the effect of COVID-19 disease on the patient’s health.
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Affiliation(s)
- Milan Sova
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Brno, Masaryk University Brno, 601 77 Brno, Czech Republic
| | - Eliska Sovova
- Department of Sport Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Jaromir Ozana
- Department of Sport Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Katarina Moravcova
- Department of Sport Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Marketa Sovova
- Department of Sport Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Libor Jelinek
- Department of Sport Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Jan Mizera
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
- Center for Digital Health, University Hospital Olomouc, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
- Correspondence:
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Zulbaran‐Rojas A, Lee M, Bara RO, Flores‐Camargo A, Spitz G, Finco MG, Bagheri AB, Modi D, Shaib F, Najafi B. Electrical stimulation to regain lower extremity muscle perfusion and endurance in patients with post-acute sequelae of SARS CoV-2: A randomized controlled trial. Physiol Rep 2023; 11:e15636. [PMID: 36905161 PMCID: PMC10006649 DOI: 10.14814/phy2.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
Muscle deconditioning and impaired vascular function in the lower extremities (LE) are among the long-term symptoms experienced by COVID-19 patients with a history of severe illness. These symptoms are part of the post-acute sequelae of Sars-CoV-2 (PASC) and currently lack evidence-based treatment. To investigate the efficacy of lower extremity electrical stimulation (E-Stim) in addressing PASC-related muscle deconditioning, we conducted a double-blinded randomized controlled trial. Eighteen (n = 18) patients with LE muscle deconditioning were randomly assigned to either the intervention (IG) or the control (CG) group, resulting in 36 LE being assessed. Both groups received daily 1 h E-Stim on both gastrocnemius muscles for 4 weeks, with the device functional in the IG and nonfunctional in the CG. Changes in plantar oxyhemoglobin (OxyHb) and gastrocnemius muscle endurance (GNMe) in response to 4 weeks of daily 1 h E-Stim were assessed. At each study visit, outcomes were measured at onset (t0 ), 60 min (t60 ), and 10 min after E-Stim therapy (t70 ) by recording ΔOxyHb with near-infrared spectroscopy. ΔGNMe was measured with surface electromyography at two time intervals: 0-5 min (Intv1 ) and: 55-60 min (Intv2 ). Baseline OxyHb decreased in both groups at t60 (IG: p = 0.046; CG: p = 0.026) and t70 (IG = p = 0.021; CG: p = 0.060) from t0 . At 4 weeks, the IG's OxyHb increased from t60 to t70 (p < 0.001), while the CG's decreased (p = 0.003). The IG had higher ΔOxyHb values than the CG at t70 (p = 0.004). Baseline GNMe did not increase in either group from Intv1 to Intv2 . At 4 weeks, the IG's GNMe increased (p = 0.031), whereas the CG did not change. There was a significant association between ΔOxyHb and ΔGNMe (r = 0.628, p = 0.003) at 4 weeks in the IG. In conclusion, E-Stim can improve muscle perfusion and muscle endurance in individuals with PASC experiencing LE muscle deconditioning.
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Affiliation(s)
- Alejandro Zulbaran‐Rojas
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Myeounggon Lee
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Rasha O. Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Areli Flores‐Camargo
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Gil Spitz
- Baylor St Luke's Medical Center, Exercise PhysiologyLiver Transplant ProgramHoustonTexasUSA
| | - M. G. Finco
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amir Behzad Bagheri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Dipaben Modi
- Department of Pulmonary Critical CareBaylor College of MedicineHoustonTexasUSA
| | - Fidaa Shaib
- Department of Pulmonary Critical CareBaylor College of MedicineHoustonTexasUSA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
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Baratto C, Caravita S, Corbetta G, Soranna D, Zambon A, Dewachter C, Gavazzoni M, Heilbron F, Tomaselli M, Radu N, Perelli FP, Perego GB, Vachiéry JL, Parati G, Badano LP, Muraru D. Impact of severe secondary tricuspid regurgitation on rest and exercise hemodynamics of patients with heart failure and a preserved left ventricular ejection fraction. Front Cardiovasc Med 2023; 10:1061118. [PMID: 36937944 PMCID: PMC10014840 DOI: 10.3389/fcvm.2023.1061118] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background Both secondary tricuspid regurgitation (STR) and heart failure with preserved ejection fraction (HFpEF) are relevant public health problems in the elderly population, presenting with potential overlaps and sharing similar risk factors. However, the impact of severe STR on hemodynamics and cardiorespiratory adaptation to exercise in HFpEF remains to be clarified. Aim To explore the impact of STR on exercise hemodynamics and cardiorespiratory adaptation in HFpEF. Methods We analyzed invasive hemodynamics and gas-exchange data obtained at rest and during exercise from HFpEF patients with severe STR (HFpEF-STR), compared with 1:1 age-, sex-, and body mass index (BMI)- matched HFpEF patients with mild or no STR (HFpEF-controls). Results Twelve HFpEF with atrial-STR (mean age 72 years, 92% females, BMI 28 Kg/m2) and 12 HFpEF-controls patients were analyzed. HFpEF-STR had higher (p < 0.01) right atrial pressure than HFpEF-controls both at rest (10 ± 1 vs. 5 ± 1 mmHg) and during exercise (23 ± 2 vs. 14 ± 2 mmHg). Despite higher pulmonary artery wedge pressure (PAWP) at rest in HFpEF-STR than in HFpEF-controls (17 ± 2 vs. 11 ± 2, p = 0.04), PAWP at peak exercise was no more different (28 ± 2 vs. 29 ± 2). Left ventricular transmural pressure and cardiac output (CO) increased less in HFpEF-STR than in HFpEF-controls (interaction p-value < 0.05). This latter was due to lower stroke volume (SV) values both at rest (48 ± 9 vs. 77 ± 9 mL, p < 0.05) and at peak exercise (54 ± 10 vs. 93 ± 10 mL, p < 0.05). Despite these differences, the two groups of patients laid on the same oxygen consumption isophlets because of the increased peripheral oxygen extraction in HFpEF-STR (p < 0.01). We found an inverse relationship between pulmonary vascular resistance and SV, both at rest and at peak exercise (R 2 = 0.12 and 0.19, respectively). Conclusions Severe STR complicating HFpEF impairs SV and CO reserve, leading to pulmonary vascular de-recruitment and relative left heart underfilling, undermining the typical HFpEF pathophysiology.
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Affiliation(s)
- Claudia Baratto
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Sergio Caravita
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Giorgia Corbetta
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Davide Soranna
- Biostatistic Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonella Zambon
- Biostatistic Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milan, Italy
| | - Céline Dewachter
- Department of Cardiology, Hôpital Académique Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Mara Gavazzoni
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Michele Tomaselli
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Noela Radu
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Francesco Paolo Perelli
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Jean-Luc Vachiéry
- Department of Cardiology, Hôpital Académique Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Gianfranco Parati
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luigi P. Badano
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Denisa Muraru
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Barker-Davies RM, Ladlow P, Chamley R, Nicol E, Holdsworth DA. Reduced athletic performance post-COVID-19 is associated with reduced anaerobic threshold. BMJ Case Rep 2023; 16:16/2/e250191. [PMID: 36805865 PMCID: PMC9943905 DOI: 10.1136/bcr-2022-250191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Detailed characterisation of cardiopulmonary limitations in patients post-COVID-19 is currently limited, particularly in elite athletes. A male elite distance runner in his late 30s experienced chest pain following confirmed COVID-19. He underwent cardiopulmonary exercise testing (CPET) at 5 months postacute illness. Subjective exercise tolerance was reduced compared with normal, he described inability to 'kick' (rapidly accelerate). His CPET was compared with an identical protocol 15 months prior to COVID-19. While supranormal maximal oxygen uptake was maintained (155% of peak predicted V̇O2) anaerobic threshold (AT), a better predictor of endurance performance, reduced from 84% to 71% predicted peak V̇O2 maximum. Likewise, fat oxidation at AT reduced by 21%, from 0.35 to 0.28 g/min. Focusing exclusively on V̇O2 maximum risks missing an impairment of oxidative metabolism. Reduced AT suggests a peripheral disorder of aerobic metabolism. This finding may result from virally mediated mitochondrial dysfunction beyond normal 'deconditioning', associated with impaired fat oxidation.
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Affiliation(s)
| | - Peter Ladlow
- Academic Department of Military Rehabilitation, Loughborough, UK
| | | | - Edward Nicol
- Department of Cardiology, Royal Brompton Hospital, London, UK
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45
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Singh I, Joseph P. Short- and long-term noninvasive cardiopulmonary exercise assessment in previously hospitalised COVID-19 patients. Eur Respir J 2023; 61:13993003.01739-2022. [PMID: 36137592 PMCID: PMC9515479 DOI: 10.1183/13993003.01739-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has had a staggering impact on the global healthcare system [1]. It was estimated that by November 2021, over 3 billion individuals or 44% of the world's population had been infected with SARS-CoV-2 at least once [2]. In previously hospitalised COVID-19 patients, noninvasive cardiopulmonary exercise testing demonstrated interval improvement in peak exercise aerobic capacity between 3 and 12 months following hospitalisationhttps://bit.ly/3BVWwrK
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Affiliation(s)
- Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Phillip Joseph
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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46
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Milani M, Milani JGPO, Cipriano GFB, Cahalin LP, Stein R, Cipriano G. Cardiopulmonary Exercise Testing in Post-COVID-19 Patients: Where Does Exercise Intolerance Come From? Arq Bras Cardiol 2023; 120:e20220150. [PMID: 36888777 DOI: 10.36660/abc.20220150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/26/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Post-COVID-19 exercise intolerance is poorly understood. Cardiopulmonary exercise testing (CPET) can identify the underlying exercise limitations. OBJECTIVES To evaluate the source and magnitude of exercise intolerance in post-COVID-19 subjects. METHODS Cohort study assessing subjects with different COVID-19 illness severities and a control group selected by propensity score matching. In a selected sample with CPET prior to viral infection, before and after comparisons were performed. Level of significance was 5% in the entire analysis. RESULTS One hundred forty-four subjects with COVID-19 were assessed (median age: 43.0 years, 57% male), with different illness severities (60% mild, 21% moderate, 19% severe). CPET was performed 11.5 (7.0, 21.2) weeks after disease onset, with exercise limitations being attributed to the peripheral muscle (92%), and the pulmonary (6%), and cardiovascular (2%) systems. Lower median percent-predicted peak oxygen uptake was observed in the severe subgroup (72.2%) as compared to the controls (91.6%). Oxygen uptake differed among illness severities and controls at peak and ventilatory thresholds. Conversely, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse were similar. Subgroup analysis of 42 subjects with prior CPET revealed significant reduction in only peak treadmill speed in the mild subgroup and in oxygen uptake at peak and ventilatory thresholds in the moderate/severe subgroup. By contrast, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse did not change significantly. CONCLUSIONS Peripheral muscle fatigue was the most common exercise limitation etiology in post-COVID-19 patients regardless of the illness severity. Data suggest that treatment should emphasize comprehensive rehabilitation programs, including aerobic and muscle strengthening components.
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Affiliation(s)
- Mauricio Milani
- Fitcordis Medicina do Exercício , Brasília , DF - Brasil.,Universidade de Brasília - Programa de Pós-Graduação em Ciências e Tecnologias da Saúde , Brasília , DF - Brasil
| | - Juliana Goulart Prata Oliveira Milani
- Fitcordis Medicina do Exercício , Brasília , DF - Brasil.,Universidade de Brasília - Programa de Pós-Graduação em Ciências e Tecnologias da Saúde , Brasília , DF - Brasil
| | - Graziella França Bernardelli Cipriano
- Universidade de Brasília - Programa de Pós-Graduação em Ciências e Tecnologias da Saúde , Brasília , DF - Brasil.,Universidade de Brasília - Programa de Ciências da Reabilitação , Brasília , DF - Brasil
| | - Lawrence Patrick Cahalin
- Department of Physical Therapy , University of Miami , Miller School of Medicine , Florida - EUA
| | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares , Porto Alegre , RS - Brasil
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Noureddine S, Roux-Claudé P, Laurent L, Ritter O, Dolla P, Karaer S, Claudé F, Eberst G, Westeel V, Barnig C. Evaluation of long-term sequelae by cardiopulmonary exercise testing 12 months after hospitalization for severe COVID-19. BMC Pulm Med 2023; 23:13. [PMID: 36635717 PMCID: PMC9834678 DOI: 10.1186/s12890-023-02313-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae. METHODS In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed. RESULTS Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O2 uptake (V'O2) considered within normal limits (median peak predicted O2 uptake (V'O2) of 98% [87.2-106.3]). Length of ICU stay remained an independent predictor of V'O2. More than half of the patients with a normal peak predicted V'O2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21-0.32] at anaerobic threshold (AT) and 0.29 [0.25-0.34] at peak) and a widened median peak alveolar-arterial gradient for O2 (35.2 mmHg [31.2-44.8]. Peak PetCO2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (DLCO) (r2 = - 0.15; p = 0.01). CONCLUSIONS Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V'O2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea. TRIAL REGISTRATION NCT04519320 (19/08/2020).
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Affiliation(s)
- Sofia Noureddine
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France
| | - Pauline Roux-Claudé
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France
| | - Lucie Laurent
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France
| | - Ophélie Ritter
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France
| | - Pauline Dolla
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France
| | - Sinan Karaer
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France
| | - Frédéric Claudé
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France
| | - Guillaume Eberst
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France ,grid.7459.f0000 0001 2188 3779Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France and UMR 1098, University of Franche-Comté, Besançon, France
| | - Virginie Westeel
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France ,grid.7459.f0000 0001 2188 3779Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France and UMR 1098, University of Franche-Comté, Besançon, France
| | - Cindy Barnig
- grid.411158.80000 0004 0638 9213Department of Chest Disease, University Hospital Besançon, 25000 Besançon, France ,grid.7459.f0000 0001 2188 3779UMR1098, University of Franche-Comté, INSERM, EFS BFC, F-25000 Besançon, France
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Schwendinger F, Knaier R, Radtke T, Schmidt-Trucksäss A. Low Cardiorespiratory Fitness Post-COVID-19: A Narrative Review. Sports Med 2023; 53:51-74. [PMID: 36115933 PMCID: PMC9483283 DOI: 10.1007/s40279-022-01751-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
Patients recovering from COVID-19 often report symptoms of exhaustion, fatigue and dyspnoea and present with exercise intolerance persisting for months post-infection. Numerous studies investigated these sequelae and their possible underlying mechanisms using cardiopulmonary exercise testing. We aimed to provide an in-depth discussion as well as an overview of the contribution of selected organ systems to exercise intolerance based on the Wasserman gears. The gears represent the pulmonary system, cardiovascular system, and periphery/musculature and mitochondria. Thirty-two studies that examined adult patients post-COVID-19 via cardiopulmonary exercise testing were included. In 22 of 26 studies reporting cardiorespiratory fitness (herein defined as peak oxygen uptake-VO2peak), VO2peak was < 90% of predicted value in patients. VO2peak was notably below normal even in the long-term. Given the available evidence, the contribution of respiratory function to low VO2peak seems to be only minor except for lung diffusion capacity. The prevalence of low lung diffusion capacity was high in the included studies. The cardiovascular system might contribute to low VO2peak via subnormal cardiac output due to chronotropic incompetence and reduced stroke volume, especially in the first months post-infection. Chronotropic incompetence was similarly present in the moderate- and long-term follow-up. However, contrary findings exist. Peripheral factors such as muscle mass, strength and perfusion, mitochondrial function, or arteriovenous oxygen difference may also contribute to low VO2peak. More data are required, however. The findings of this review do not support deconditioning as the primary mechanism of low VO2peak post-COVID-19. Post-COVID-19 sequelae are multifaceted and require individual diagnosis and treatment.
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Affiliation(s)
- Fabian Schwendinger
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Raphael Knaier
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland.
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Astin R, Banerjee A, Baker MR, Dani M, Ford E, Hull JH, Lim PB, McNarry M, Morten K, O'Sullivan O, Pretorius E, Raman B, Soteropoulos DS, Taquet M, Hall CN. Long COVID: mechanisms, risk factors and recovery. Exp Physiol 2023; 108:12-27. [PMID: 36412084 PMCID: PMC10103775 DOI: 10.1113/ep090802] [Citation(s) in RCA: 83] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
NEW FINDINGS What is the topic of this review? The emerging condition of long COVID, its epidemiology, pathophysiological impacts on patients of different backgrounds, physiological mechanisms emerging as explanations of the condition, and treatment strategies being trialled. The review leads from a Physiological Society online conference on this topic. What advances does it highlight? Progress in understanding the pathophysiology and cellular mechanisms underlying Long COVID and potential therapeutic and management strategies. ABSTRACT Long COVID, the prolonged illness and fatigue suffered by a small proportion of those infected with SARS-CoV-2, is placing an increasing burden on individuals and society. A Physiological Society virtual meeting in February 2022 brought clinicians and researchers together to discuss the current understanding of long COVID mechanisms, risk factors and recovery. This review highlights the themes arising from that meeting. It considers the nature of long COVID, exploring its links with other post-viral illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome, and highlights how long COVID research can help us better support those suffering from all post-viral syndromes. Long COVID research started particularly swiftly in populations routinely monitoring their physical performance - namely the military and elite athletes. The review highlights how the high degree of diagnosis, intervention and monitoring of success in these active populations can suggest management strategies for the wider population. We then consider how a key component of performance monitoring in active populations, cardiopulmonary exercise training, has revealed long COVID-related changes in physiology - including alterations in peripheral muscle function, ventilatory inefficiency and autonomic dysfunction. The nature and impact of dysautonomia are further discussed in relation to postural orthostatic tachycardia syndrome, fatigue and treatment strategies that aim to combat sympathetic overactivation by stimulating the vagus nerve. We then interrogate the mechanisms that underlie long COVID symptoms, with a focus on impaired oxygen delivery due to micro-clotting and disruption of cellular energy metabolism, before considering treatment strategies that indirectly or directly tackle these mechanisms. These include remote inspiratory muscle training and integrated care pathways that combine rehabilitation and drug interventions with research into long COVID healthcare access across different populations. Overall, this review showcases how physiological research reveals the changes that occur in long COVID and how different therapeutic strategies are being developed and tested to combat this condition.
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Affiliation(s)
- Rónan Astin
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
- Centre for Human Health and PerformanceInstitute for Sport Exercise and HealthUniversity College LondonLondonUK
| | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
- Department of CardiologyBarts Health NHS TrustLondonUK
| | - Mark R. Baker
- Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Melanie Dani
- Imperial Syncope UnitImperial College Healthcare NHS TrustLondonUK
| | | | - James H. Hull
- Institute of SportExercise and Health (ISEH)Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Royal Brompton HospitalLondonUK
| | - Phang Boon Lim
- Imperial Syncope UnitImperial College Healthcare NHS TrustLondonUK
| | - Melitta McNarry
- Applied Sports, Technology, Exercise and Medicine Research CentreSwansea UniversitySwanseaUK
| | - Karl Morten
- Applied Sports, Technology, Exercise and Medicine Research CentreSwansea UniversitySwanseaUK
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | - Oliver O'Sullivan
- Academic Department of Military RehabilitationDefence Medical Rehabilitation Centre Stanford HallLoughboroughUK
- School of MedicineUniversity of NottinghamNottinghamUK
| | - Etheresia Pretorius
- Department of Physiological SciencesFaculty of ScienceStellenbosch UniversityStellenboschSouth Africa
- Department of Biochemistry and Systems BiologyInstitute of SystemsMolecular and Integrative BiologyFaculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Betty Raman
- Radcliffe Department of MedicineDivision of Cardiovascular MedicineUniversity of OxfordOxfordUK
- Radcliffe Department of MedicineDivision of Cardiovascular MedicineOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | - Maxime Taquet
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Catherine N. Hall
- School of Psychology and Sussex NeuroscienceUniversity of SussexFalmerUK
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Jimeno-Almazán A, Buendía-Romero Á, Martínez-Cava A, Franco-López F, Sánchez-Alcaraz BJ, Courel-Ibáñez J, Pallarés JG. Effects of a concurrent training, respiratory muscle exercise, and self-management recommendations on recovery from post-COVID-19 conditions: the RECOVE trial. J Appl Physiol (1985) 2023; 134:95-104. [PMID: 36476156 PMCID: PMC9829459 DOI: 10.1152/japplphysiol.00489.2022] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to determine the effectiveness of physical exercise, respiratory muscle training, and the self-management World Health Organization (WHO) recommendations leaflet on the recovery of physical fitness, quality of life, and symptom status in people with post-COVID-19 conditions. Eighty nonhospitalized adults with a post-COVID-19 condition were randomly assigned to one of four 8-wk parallel intervention groups: 1) multicomponent exercise program based on concurrent training (CT, number of subjects (n) = 20; 3 resistance and endurance supervised sessions per week at low-moderate intensity); 2) inspiratory muscle training (RM, n = 17; 2 standardized daily sessions); 3) a combination of both of the above (CTRM, n = 23); and 4) control group (CON, n = 20; following the WHO guidelines for post-COVID-19-related illness rehabilitation). No significant differences between groups were detected at baseline. Although no significant differences between interventions were detected in the V̇o2max, significant individual improvements were identified in the CT (7.5%; effect size, ES = 0.28) and CTRM (7.8%; ES = 0.36) groups. Lower body muscle strength significantly improved in the CT and CTRM (14.5%-32.6%; ES = 0.27-1.13) groups compared with RM and CON (-0.3% to 11.3%; ES = 0.10-0.19). The CT and CTRM groups improved significantly for dyspnea and fatigue, as did the health status. In addition, significant differences between interventions were described in fatigue and depression scales favoring CT and CTRM interventions. An individualized and supervised concurrent training with or without inspiratory muscle training was safe and more effective than self-care recommendations and inspiratory muscle training alone, to regain cardiovascular and muscular fitness, improve symptom severity, and health status in outpatients with post-COVID-19 conditions.NEW & NOTEWORTHY Eight weeks of concurrent training, with or without inspiratory muscle exercise, was better than WHO "Support for Rehabilitation: Self-Management after COVID-19-Related Illness" recommendations or inspiratory muscle training alone to improve cardiopulmonary fitness, strength, and symptom severity, in a safe and effective manner. The RECOVE trial proved the benefits and utility of a supervised exercise program in people with post-COVID-19 conditions after mild COVID-19 in an ambulatory setting.
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Affiliation(s)
- Amaya Jimeno-Almazán
- 1Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain,2General Subdirectorate for Healthcare Quality, Safety and Evaluation, Murcia Health Service, Murcia, Spain
| | - Ángel Buendía-Romero
- 1Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Alejandro Martínez-Cava
- 1Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Francisco Franco-López
- 1Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | | | - Javier Courel-Ibáñez
- 3Department of Physical Education and Sports, Faculty of Education and Sport Sciences, University of Granada, Melilla, Spain
| | - Jesús G. Pallarés
- 1Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain
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