Mechanisms and Severity of Exercise Intolerance Following COVID-19 and Similar Viral Infections: A Comparative Review

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 VO 2 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.

Hyperaemia during dynamic handgrip exercise is preserved in healthy young subjects after recovery from COVID‐19

“…Exercise intolerance and fatigue seem to be common after recovery from acute COVID-19 infection (Schwendinger et al, 2023;Weldon et al, 2023;Wernhart et al, 2023) and could be attributed to the interaction of several pathophysiological mechanisms in multiple organs and systems (i.e., ventilatory, cardiovascular, musculoskeletal), including vascular control of skeletal muscle blood flow during physical exercise. Therefore, impaired exercise-induced hyperaemia could lead to decreased exercise capacity after COVID-19 infection.…”

Development and Approval of a Multidimensional Model of the Clinical Effectiveness of Treatment Technologies for Patients With a Mild COVID-19 Associated With Comorbidities

“…Коронавірусна інфекція в цілому впливає на різні системи органів, тому викликає значний стрес для організму, а боротьба з вірусом виснажує імунну систему та енергетичні резер-ви організму [42][43][44]. У зв'язку з цим важливим показником стану пацієнта та якості його життя є зникнення такого симптому, як втома.…”