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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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Pszczołowska M, Walczak K, Misków W, Antosz K, Batko J, Karska J, Leszek J. Molecular cross-talk between long COVID-19 and Alzheimer's disease. GeroScience 2024; 46:2885-2899. [PMID: 38393535 PMCID: PMC11009207 DOI: 10.1007/s11357-024-01096-1] [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: 11/22/2023] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The long COVID (coronavirus disease), a multisystemic condition following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, is one of the widespread problems. Some of its symptoms affect the nervous system and resemble symptoms of Alzheimer's disease (AD)-a neurodegenerative condition caused by the accumulation of amyloid beta and hyperphosphorylation of tau proteins. Multiple studies have found dependence between these two conditions. Patients with Alzheimer's disease have a greater risk of SARS-CoV-2 infection due to increased levels of angiotensin-converting enzyme 2 (ACE2), and the infection itself promotes amyloid beta generation which enhances the risk of AD. Also, the molecular pathways are alike-misregulations in folate-mediated one-carbon metabolism, a deficit of Cq10, and disease-associated microglia. Medical imaging in both of these diseases shows a decrease in the volume of gray matter, global brain size reduction, and hypometabolism in the parahippocampal gyrus, thalamus, and cingulate cortex. In some studies, a similar approach to applied medication can be seen, including the use of amino adamantanes and phenolic compounds of rosemary. The significance of these connections and their possible application in medical practice still needs further study but there is a possibility that they will help to better understand long COVID.
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Affiliation(s)
| | - Kamil Walczak
- Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
| | - Weronika Misków
- Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
| | - Katarzyna Antosz
- Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
| | - Joanna Batko
- Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
| | - Julia Karska
- Clinic of Psychiatry, Department of Psychiatry, Medical Department, Wrocław Medical University, Wrocław, Poland
| | - Jerzy Leszek
- Clinic of Psychiatry, Department of Psychiatry, Medical Department, Wrocław Medical University, Wrocław, Poland
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Carey C, Khatoon M, Seriki D, Agwunobi A. Acute mesenteric haematoma and hematoperitoneum following a coughing episode induced by COVID-19. J Surg Case Rep 2023; 2023:rjad450. [PMID: 37560603 PMCID: PMC10409590 DOI: 10.1093/jscr/rjad450] [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: 06/11/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023] Open
Abstract
Acute mesenteric haematoma (AMH) is a rare condition and established causes include blunt trauma, aneurysmal rupture, acute pancreatitis and anticoagulant use. A male patient in his 50s presented with abdominal pain and loss of consciousness that was immediately preceded by a prolonged coughing episode. A computed tomography (CT) abdomen-pelvis revealed two acute mesenteric haematomas and haematoperitoneum and admission swabs diagnosed coronavirus disease 2019 (COVID-19). The patient had no other acute clinical issues and was not taking anticoagulants. The haematomas were managed conservatively and a follow up computed tomography (CT) 4 weeks post-discharge revealed significant improvement. No clear vessel was identified as the source of the bleed in any of the investigations. This case represents a rare instance of AMH and haematoperitoneum with no established cause. We theorize that the combination of the patient's systemic response to COVID-19 and raised intra-abdominal pressure caused by coughing contributed to the bleeding.
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Affiliation(s)
- Charles Carey
- The General Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust Cobbett House Manchester Royal Infirmary, Manchester M13 9PL, UK
| | - Maryam Khatoon
- The General Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust Cobbett House Manchester Royal Infirmary, Manchester M13 9PL, UK
| | - Dare Seriki
- The General Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust Cobbett House Manchester Royal Infirmary, Manchester M13 9PL, UK
| | - Anselm Agwunobi
- The General Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust Cobbett House Manchester Royal Infirmary, Manchester M13 9PL, UK
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Thirupathi A, Yong W, Oflaz O, Agascioglu E, Gu Y. Exercise and COVID-19: exercise intensity reassures immunological benefits of post-COVID-19 condition. Front Physiol 2023; 14:1036925. [PMID: 37275224 PMCID: PMC10233405 DOI: 10.3389/fphys.2023.1036925] [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: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 06/07/2023] Open
Abstract
Any form of physical activity, including exercise, has various benefits at the physiological (improving cardiac and respiratory functions, increasing skeletal muscle mass, and maintaining homeostasis) and psychological levels (improving cognitive function, reducing anxiety and depression) which help to combat any type of infection. In contrast, the infectivity ratio could reduce the physical activity of an individual, such as performing a habitual exercise. Adaptation to different exercise strategies including intensity and duration may better increase physical performance and improve the symptoms. For example, low to moderate intensity perhaps fails to induce this adaptive process, while high-intensity of exercise compromises immune health. This can aggravate the infection rate (Open window theory). However, high intensity with a shorter time produces various morphological alterations in the primary organs including the lungs and heart, which facilitate life support in COVID-19 patients. However, less information about exercise protocols failed to assure the benefits of exercise to COVID-19 patients, particularly post-COVID-19 conditions. Therefore, this review will answer how exercise intensity is crucial to reassure the exercise benefits for promoting safe participation before infection and post-COVID-19 conditions.
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Affiliation(s)
- Anand Thirupathi
- Research Academy of Medicine Combining Sports, Ningbo No 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Wang Yong
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Ofcan Oflaz
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Eda Agascioglu
- Department of Medical Biology, Faculty of Medicine, Lokman Hekim University, Ankara, Türkiye
| | - Yaodong Gu
- Research Academy of Medicine Combining Sports, Ningbo No 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Leng A, Shah M, Ahmad SA, Premraj L, Wildi K, Li Bassi G, Pardo CA, Choi A, Cho SM. Pathogenesis Underlying Neurological Manifestations of Long COVID Syndrome and Potential Therapeutics. Cells 2023; 12:816. [PMID: 36899952 PMCID: PMC10001044 DOI: 10.3390/cells12050816] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The development of long-term symptoms of coronavirus disease 2019 (COVID-19) more than four weeks after primary infection, termed "long COVID" or post-acute sequela of COVID-19 (PASC), can implicate persistent neurological complications in up to one third of patients and present as fatigue, "brain fog", headaches, cognitive impairment, dysautonomia, neuropsychiatric symptoms, anosmia, hypogeusia, and peripheral neuropathy. Pathogenic mechanisms of these symptoms of long COVID remain largely unclear; however, several hypotheses implicate both nervous system and systemic pathogenic mechanisms such as SARS-CoV2 viral persistence and neuroinvasion, abnormal immunological response, autoimmunity, coagulopathies, and endotheliopathy. Outside of the CNS, SARS-CoV-2 can invade the support and stem cells of the olfactory epithelium leading to persistent alterations to olfactory function. SARS-CoV-2 infection may induce abnormalities in innate and adaptive immunity including monocyte expansion, T-cell exhaustion, and prolonged cytokine release, which may cause neuroinflammatory responses and microglia activation, white matter abnormalities, and microvascular changes. Additionally, microvascular clot formation can occlude capillaries and endotheliopathy, due to SARS-CoV-2 protease activity and complement activation, can contribute to hypoxic neuronal injury and blood-brain barrier dysfunction, respectively. Current therapeutics target pathological mechanisms by employing antivirals, decreasing inflammation, and promoting olfactory epithelium regeneration. Thus, from laboratory evidence and clinical trials in the literature, we sought to synthesize the pathophysiological pathways underlying neurological symptoms of long COVID and potential therapeutics.
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Affiliation(s)
- Albert Leng
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Manuj Shah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Syed Ameen Ahmad
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Lavienraj Premraj
- Department of Neurology, Griffith University School of Medicine, Gold Coast, Brisbane, QLD 4215, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Intensive Care Unit, St Andrew’s War Memorial Hospital and the Wesley Hospital, Uniting Care Hospitals, Brisbane, QLD 4000, Australia
- Wesley Medical Research, Auchenflower, QLD 4066, Australia
| | - Carlos A. Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Alex Choi
- Division of Neurosciences Critical Care, Department of Neurosurgery, UT Houston, Houston, TX 77030, USA
| | - Sung-Min Cho
- Divisions of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Network autonomic analysis of post-acute sequelae of COVID-19 and postural tachycardia syndrome. Neurol Sci 2022; 43:6627-6638. [PMID: 36169757 PMCID: PMC9517969 DOI: 10.1007/s10072-022-06423-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022]
Abstract
Background The autonomic nervous system (ANS) is a complex network where sympathetic and parasympathetic domains interact inside and outside of the network. Correlation-based network analysis (NA) is a novel approach enabling the quantification of these interactions. The aim of this study is to assess the applicability of NA to assess relationships between autonomic, sensory, respiratory, cerebrovascular, and inflammatory markers on post-acute sequela of COVID-19 (PASC) and postural tachycardia syndrome (POTS). Methods In this retrospective study, datasets from PASC (n = 15), POTS (n = 15), and matched controls (n = 11) were analyzed. Networks were constructed from surveys (autonomic and sensory), autonomic tests (deep breathing, Valsalva maneuver, tilt, and sudomotor test) results using heart rate, blood pressure, cerebral blood flow velocity (CBFv), capnography, skin biopsies for assessment of small fiber neuropathy (SFN), and various inflammatory markers. Networks were characterized by clusters and centrality metrics. Results Standard analysis showed widespread abnormalities including reduced orthostatic CBFv in 100%/88% (PASC/POTS), SFN 77%/88%, mild-to-moderate dysautonomia 100%/100%, hypocapnia 87%/100%, and elevated inflammatory markers. NA showed different signatures for both disorders with centrality metrics of vascular and inflammatory variables playing prominent roles in differentiating PASC from POTS. Conclusions NA is suitable for a relationship analysis between autonomic and nonautonomic components. Our preliminary analyses indicate that NA can expand the value of autonomic testing and provide new insight into the functioning of the ANS and related systems in complex disease processes such as PASC and POTS. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06423-y.
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Slavkova N, Nedevska M. Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment. Radiol Case Rep 2022; 17:3228-3232. [PMID: 35801131 PMCID: PMC9250319 DOI: 10.1016/j.radcr.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 12/04/2022] Open
Abstract
The course of the new SARS-CoV-2 (COVID-19) is unpredictable and is still being investigated. Although the majority of complications are expected to affect the respiratory system, there have been reports in literature concerning the adverse effects of the infection on bone and joint tissue. Several complications have been observed in the maxillofacial area in people who suffered from the infection, including osteonecrosis and osteomyelitis of the jaw. These complications have been subject to various hypotheses. They may result either from the disease pathogenetic mechanism or from a response to the therapeutic modalities used to treat the underlying disease, and overuse of particular medications – glucocorticoids, antirheumatics, interleukin-6 inhibitors, and antibiotics. This article presents a case of osteonecrosis of the maxilla after severe COVID-19 infection.
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Foged F, Rasmussen IE, Bjørn Budde J, Rasmussen RS, Rasmussen V, Lyngbæk M, Jønck S, Krogh-Madsen R, Lindegaard B, Ried-Larsen M, Berg RMG, Christensen RH. Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: a randomised cross-over trial. BMJ Open Sport Exerc Med 2021; 7:e001156. [PMID: 34493958 PMCID: PMC8413475 DOI: 10.1136/bmjsem-2021-001156] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Many patients with COVID-19 suffer from persistent symptoms, many of which may potentially be reversed by high-intensity interval training (HIIT). Yet, the safety and tolerability of HIIT after COVID-19 is controversial. This study aimed to investigate the fidelity, tolerability and safety of three different HIIT protocols in individuals that had recently been hospitalised due to COVID-19. METHODS The study was a randomised cross-over trial. We compared three supervised HIIT protocols (4×4, 6×1, 10-20-30) in 10 individuals recently discharged after hospitalisation for severe COVID-19. Each HIIT protocol had a duration of 38 min and was performed with a 1-week washout between them. Outcomes included adverse events, exercise training intensity and tolerability assessed by the Likert scale (1-10). RESULTS All 10 participants aged 61 (mean, SD 8) years (5 males) completed all three HIIT protocols with no adverse events. High intensities were achieved in all three protocols, although they differed in terms of time spent with a heart rate ≥85% of maximum (mean (SD); 4×4: 13.7 (6.4) min; 10-20-30: 12.1 (3.8) min; 6×1: 6.1 (5.6) min; p=0.03). The three protocols were all well tolerated with similar Likert scale scores (mean (SD); 4×4: 8 (2), 10-20-30: 8 (2), 6×1: 9 (2), p=0.72). CONCLUSION Our findings indicate that recently hospitalised individuals for severe COVID-19 may safely tolerate acute bouts of supervised HIIT as per protocol. This warrants future studies testing the potential of regular HIIT as a rehabilitation strategy in this context.
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Affiliation(s)
- Frederik Foged
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | | | - Josephine Bjørn Budde
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Villads Rasmussen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Mark Lyngbæk
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Simon Jønck
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Pulmonary Medicine and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ronan Martin Griffin Berg
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine & PET, 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, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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