Mortality during the COVID-19 pandemic: findings from the CLINIMEX exercise cohort in the year of 2020

Abstract

Background and Objective: The COVID-19 pandemic has heavily hit Brazil and, in particular, our Clinic's current location in Copacabana, Rio de Janeiro city, where, as of mid-February 2021, resulting in one 1 death per 266 inhabitants. After having recently updated the vital status and mortality data in our exercise population (CLINIMEX cohort), we hypothesized that reviewing their evaluation reports would offer a unique opportunity to unearth some relevant information about the association between selected variables assessed in our comprehensive Exercise Medicine evaluation protocol; in particular, aerobic and musculoskeletal (MUSK) fitness, clinical variables, and death due to COVID-19. Methods: A retrospective study using data from the CLINIMEX cohort that included 6,101 non-athletic men and women aged >30 years who were alive as of March 12th, 2020 and who's vital status was followed up to December 14th, 2020. For data analysis, two approaches were used: 1) comparison of frequency of deaths and relative % of underlying causes of death between the last 18-months pre-pandemic and 9-month pandemic periods; and 2) data from 51 variables from the participant's most recent evaluation, including sex, age and clinical profile plus other variables obtained from physical examination, spirometry, (MUSK) fitness (e.g., sitting-rising test) and maximal cycling leg cardiopulmonary testing (e.g. maximal VO2 and cardiorespiratory optimal point) were selected for comparison between groups of non-COVID-19 and COVID-19 deaths. Results: Age at death varied from 51 to 102 years [mean = 80 years]. Only 4 participants that died, 3 COVID-19 and 1 non-COVID-19, were healthy at the time of their evaluation [p=.52]. COVID-19 was the most frequent (n=35; 36.5%) cause among the 96 deaths during this 9-month period. Comparing pre-pandemic and pandemic periods, there was a 35% increase in deaths and proportionately fewer deaths due to neoplasia and other causes but not from cardiovascular or endocrine diseases. Results of aerobic and MUSK fitness tests indicated that the majority of the study participants were relatively unfit when compared to available age and sex-reference values. Indeed, there were few differences in the 51 selected variables between the two groups, suggesting a somewhat healthier profile among COVID-19 death participants; lower body mass index [p=.04], higher % of predicted forced vital capacity [p=.04], lower number of previous percutaneous coronary interventions [p=.04] and lower resting supine diastolic blood pressure [p=.03], with no differences for aerobic/MUSK fitness variables or past history of exercise/sports [p>.05]. Conclusion: Our data support that COVID-19 was a frequent and premature cause of death in a convenience sample of primarily white, unhealthy, middle-age and elderly individuals and that data from exercise/sport history and physical fitness testing obtained some years earlier were unable to distinguish non-COVID-19 and COVID-19 deaths.

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

“…In our 13 years of clinical experience routinely using the 10-s OLS static balance test in adults with a wide age range and diverse clinical conditions,39 the test has been remarkably safe, well-received by the participants, and importantly, simple to incorporate in our routine practice as it requires less than 1 or 2 min to be applied.…”

High Cardiorespiratory Optimal Point Values Are Related to Cardiovascular Mortality in Men Aged 46 to 70 Years: a Prospective Cohort Study

“…Detailed information about the cohort is available in the supplemental materials of a previously published study. 34 In spite of the fact that most of the participants had a diagnosis of coronary artery disease or risk factors at their baseline evaluation, the annualized death rate was about half of that expected for the general Brazilian population for a similar mean age of 57 years. 35 This may be due to the demographic characteristics of this sample, as well as the possibility that these individuals had adhered to prescribed optimal medical treatment for their clinical conditions, including the chance to participate in a long-term medically-supervised exercise program.…”

“…20,40 This dataset has been carefully cleaned and organized over several years by the principal investigator and close collaborators, making the available information accurate and valid. 34 The quality of censoring was very high, being based on official sources reporting ICD-10 classified death certificates and complemented, when appropriate, by the patient's electronic records and by information obtained from attending physicians, relatives, and close friends. Over the 29-year study period, all CPX were conducted in a single center/exercise lab, using a cycle ramp protocol and metabolic analyzers for expired gases from the same manufacturer.…”