Exercise Intolerance in Post-Acute Sequelae of COVID-19 and the Value of Cardiopulmonary Exercise Testing- a Mini-Review

Alonso, Álvaro; Ladrón, Raquel; Ybarra-Falcón, Cristina; Tobar, Javier; Román, José Alberto San

doi:10.3389/fmed.2022.924819

Cited by 20 publications

(21 citation statements)

References 56 publications

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“…Patients with PCC participated less in moderate to vigorous physical activity and showed lower aerobic capacity, as previously shown even in nonhospitalized patients . The maximum heart rate was consistent across groups, and all individuals in the cohort met the peak V̇O 2 criteria (ie, reached >85% of their predicted maximum heart rate, respiratory exchange ratio >1.10, RPE >18, and lactate accumulation >8 mmol) .…”

Section: Discussionsupporting

confidence: 60%

Functional Limitations and Exercise Intolerance in Patients With Post-COVID Condition

Tryfonos,

Pourhamidi,

Jörnåker

et al. 2024

JAMA Netw Open

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ImportanceMany patients with post-COVID condition (PCC) experience persistent fatigue, muscle pain, and cognitive problems that worsen after exertion (referred to as postexertional malaise). Recommendations currently advise against exercise in this population to prevent symptom worsening; however, prolonged inactivity is associated with risk of long-term health deterioration.ObjectiveTo assess postexertional symptoms in patients with PCC after exercise compared with control participants and to comprehensively investigate the physiologic mechanisms underlying PCC.Design, Setting, and ParticipantsIn this randomized crossover clinical trial, nonhospitalized patients without concomitant diseases and with persistent (≥3 months) symptoms, including postexertional malaise, after SARS-CoV-2 infection were recruited in Sweden from September 2022 to July 2023. Age- and sex-matched control participants were also recruited.InterventionsAfter comprehensive physiologic characterization, participants completed 3 exercise trials (high-intensity interval training [HIIT], moderate-intensity continuous training [MICT], and strength training [ST]) in a randomized order. Symptoms were reported at baseline, immediately after exercise, and 48 hours after exercise.Main Outcomes and MeasuresThe primary outcome was between-group differences in changes in fatigue symptoms from baseline to 48 hours after exercise, assessed via the visual analog scale (VAS). Questionnaires, cardiopulmonary exercise testing, inflammatory markers, and physiologic characterization provided information on the physiologic function of patients with PCC.ResultsThirty-one patients with PCC (mean [SD] age, 46.6 [10.0] years; 24 [77%] women) and 31 healthy control participants (mean [SD] age, 47.3 [8.9] years; 23 [74%] women) were included. Patients with PCC reported more symptoms than controls at all time points. However, there was no difference between the groups in the worsening of fatigue in response to the different exercises (mean [SD] VAS ranks for HIIT: PCC, 29.3 [19.5]; controls, 28.7 [11.4]; P = .08; MICT: PCC, 31.2 [17.0]; controls, 24.6 [11.7]; P = .09; ST: PCC, 31.0 [19.7]; controls, 28.1 [12.2]; P = .49). Patients with PCC had greater exacerbation of muscle pain after HIIT (mean [SD] VAS ranks, 33.4 [17.7] vs 25.0 [11.3]; P = .04) and reported more concentration difficulties after MICT (mean [SD] VAS ranks, 33.0 [17.1] vs 23.3 [10.6]; P = .03) compared with controls. At baseline, patients with PCC showed preserved lung and heart function but had a 21% lower peak volume of oxygen consumption (mean difference: −6.8 mL/kg/min; 95% CI, −10.7 to −2.9 mL/kg/min; P &lt; .001) and less isometric knee extension muscle strength (mean difference: −37 Nm; 95% CI, −67 to −7 Nm; P = .02) compared with controls. Patients with PCC spent 43% less time on moderate to vigorous physical activity (mean difference, −26.5 minutes/d; 95% CI, −42.0 to −11.1 minutes/d; P = .001). Of note, 4 patients with PCC (13%) had postural orthostatic tachycardia, and 18 of 29 (62%) showed signs of myopathy as determined by neurophysiologic testing.Conclusions and RelevanceIn this study, nonhospitalized patients with PCC generally tolerated exercise with preserved cardiovascular function but showed lower aerobic capacity and less muscle strength than the control group. They also showed signs of postural orthostatic tachycardia and myopathy. The findings suggest cautious exercise adoption could be recommended to prevent further skeletal muscle deconditioning and health impairment in patients with PCC.Trial RegistrationClinicalTrials.gov Identifier: NCT05445830

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Section: Discussionsupporting

confidence: 60%

Functional Limitations and Exercise Intolerance in Patients With Post-COVID Condition

Tryfonos,

Pourhamidi,

Jörnåker

et al. 2024

JAMA Netw Open

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“…Genetic disorders such as the Noonan and Costello syndrome shows some heart, skin, and hair manifestations [36], also reported as post-COVID sequelae [37]. Also, catecholaminergic polymorphic ventricular tachycardia causes arrhythmias as well as exercise intolerance [38], the latter have also been reported as post-COVID sequelae [39].…”

Section: Discussionmentioning

confidence: 99%

SARS-Cov2 seasonality and adaptation are driven by solar activity.

Gonzalez-Lugo¹

2023

Preprint

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Since its isolation in Wuhan SARS-Cov2 showed a high mutation rate hindering the ability to properly characterize. Also as a consequence of its size, traditional sequence analysis methods were computationally constrained. However, applying variational autoencoders (VAEs) to a custom sequence representation results in a series of clusters sorted by the sunshine duration (SD) rate of change (SDRC). The transition between clusters is characterized by changes in viral genome size, apparent deletions can be found throughout the SARS-Cov2 genome. This series of deletions might behave as an internal clock inside the genome. Using SD-derived features as a time scale results in synchronizing COVID-19 cases into a single period. Both SD-derived features and solar features correlate with COVID-19 cases, except for wavelengths at the SWIR band, pointing towards a solar-dependent seasonality. Further development of analysis techniques will help us to better understand the seasonality and adaptation of pathogenic organisms.

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“…In this sense, a small decreased DL'co at rest could indicate that the lung is less able to transfer gas efficiently during exercise. In fact, a common finding from the cardiopulmonary exercise test in post-COVID subjects is a ventilatory inefficiency suggesting an abnormal response to carbon dioxide production [40].…”

Section: Discussionmentioning

confidence: 99%

Effects of SARS-CoV-2 on Pulmonary Function and Muscle Strength Testing in Military Subjects According to the Period of Infection: Cross-Sectional Study

Ora

Rogliani

Ferrón³

et al. 2023

Diagnostics

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Background: Pulmonary function can be impaired as a long-term consequence of SARS-CoV-2 infection. The aim of this study was to evaluate the effect of SARS-CoV-2 infection on pulmonary function, exercise tolerance, and muscle strength in healthy middle-aged military outpatients according during the period of infection. Methods: A cross-sectional study was carried out from March 2020 to November 2022 at the Military Hospital “Celio” (Rome, Italy). If someone had a diagnosis of SARS-CoV-2 infection certified by molecular nasal swab and if they performed pulmonary function tests, diffusion of carbon monoxide (DL’co), a six Minute Walk Test (6MWT), a Handgrip (HG) Test, and a One Minute Sit to Stand Test (1′STST). The included subjects were divided into two groups, A and B, according to the period of infection: A) from March 2020 to August 2021 and B) from September 2021 to October 2022. Results: One hundred fifty-three subjects were included in the study: 79 in Group A and 74 in Group B. Although the values were within the normal range, Group A had smaller FVC, FEV1, and DL’co compared to Group B. Group A also walked a shorter distance at the 6MWT and performed fewer repetitions in the 1′STS test compared to Group B. In both groups, the DL’co (%predicted) correlated with the 6MWT distance (R2 = 0.107, p < 0.001), the number of repetitions of the 1′STST (R2 = 0.086, p = 0.001), and the strength at the HG test (R2 = 0.08, p < 0.001). Conclusions: This study shows that the SARS-CoV-2 infection in healthy middle-aged military outpatients was more severe in the first waves than in the later ones and that, in healthy and physically fit individuals, even a marginal reduction in resting respiratory test values can have a major impact on exercise tolerance and muscles strength. Moreover, it shows that those infected more recently had symptoms related to the upper respiratory tract infection compared to those of the first waves.

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Exercise Intolerance in Post-Acute Sequelae of COVID-19 and the Value of Cardiopulmonary Exercise Testing- a Mini-Review

Cited by 20 publications

References 56 publications

Functional Limitations and Exercise Intolerance in Patients With Post-COVID Condition

Functional Limitations and Exercise Intolerance in Patients With Post-COVID Condition

SARS-Cov2 seasonality and adaptation are driven by solar activity.

Effects of SARS-CoV-2 on Pulmonary Function and Muscle Strength Testing in Military Subjects According to the Period of Infection: Cross-Sectional Study

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