Protective effect of BNT162b2 vaccination on aerobic capacity following mild to moderate SARS-CoV-2 infection: a cross sectional study, Israel, March-December 2021

Blumberg, Yair; Edelstein, Michael; Jabal, Kamal Abu; Golan, Ron; Perets, Yuval; Saad, Musa; Levinas, Tatyana; Saleem, Dabbah; Israeli, Zeev; Yacoubi, Salah; Raya, Alaa Abu; Amital, Anat; Halabi, Majdi

doi:10.1101/2021.12.30.21268538

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…Clinical variability may result from the spectrum of LC severity and symptoms . Most studies recruited before widespread vaccination, but 1 study reported lower peak V̇ o 2 among unvaccinated compared with vaccinated individuals. In addition, methodologic variability in the definition of LC and CPET exercise modality (treadmill, upright cycle ergometer, or supine cycle ergometer) may also contribute.…”

Section: Resultsmentioning

confidence: 99%

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Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults

et al. 2022

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ImportanceReduced exercise capacity is commonly reported among individuals with COVID-19 symptoms more than 3 months after SARS-CoV-2 infection (long COVID-19 [LC]). Cardiopulmonary exercise testing (CPET) is the criterion standard to measure exercise capacity and identify patterns of exertional intolerance.ObjectivesTo estimate the difference in exercise capacity among individuals with and without LC symptoms and characterize physiological patterns of limitations to elucidate possible mechanisms of LC.Data SourcesA search of PubMed, EMBASE, Web of Science, preprint servers, conference abstracts, and cited references was performed on December 20, 2021, and again on May 24, 2022. A preprint search of medrxiv.org, biorxiv.org, and researchsquare.com was performed on June 9, 2022.Study SelectionStudies of adults with SARS-CoV-2 infection more than 3 months earlier that included CPET-measured peak oxygen consumption (V̇o2) were screened independently by 2 blinded reviewers; 72 (2%) were selected for full-text review, and 35 (1%) met the inclusion criteria. An additional 3 studies were identified from preprint servers.Data Extraction and SynthesisData extraction was performed by 2 independent reviewers according to the PRISMA reporting guideline. Data were pooled using random-effects models.Main Outcomes and MeasuresDifference in peak V̇o2 (in mL/kg/min) among individuals with and without persistent COVID-19 symptoms more than 3 months after SARS-CoV-2 infection.ResultsA total of 38 studies were identified that performed CPET on 2160 individuals 3 to 18 months after SARS-CoV-2 infection, including 1228 with symptoms consistent with LC. Most studies were case series of individuals with LC or cross-sectional assessments within posthospitalization cohorts. Based on a meta-analysis of 9 studies including 464 individuals with LC symptoms and 359 without symptoms, the mean peak V̇o2 was −4.9 (95% CI, −6.4 to −3.4) mL/kg/min among those with symptoms with a low degree of certainty. Deconditioning and peripheral limitations (abnormal oxygen extraction) were common, but dysfunctional breathing and chronotropic incompetence were also described. The existing literature was limited by small sample sizes, selection bias, confounding, and varying symptom definitions and CPET interpretations, resulting in high risk of bias and heterogeneity.Conclusions and RelevanceThe findings of this systematic review and meta-analysis study suggest that exercise capacity was reduced more than 3 months after SARS-CoV-2 infection among individuals with symptoms consistent with LC compared with individuals without LC symptoms, with low confidence. Potential mechanisms for exertional intolerance other than deconditioning include altered autonomic function (eg, chronotropic incompetence, dysfunctional breathing), endothelial dysfunction, and muscular or mitochondrial pathology.

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Section: Resultsmentioning

confidence: 99%

“…We identified 41 reports of 38 observational studies in which CPET was performed among 2160 individuals 3 to 18 months after SARS-CoV-2 infection, including 1228 individuals with symptoms consistent with LC. The studies included 33 published reports, 2 conference abstracts, and 3 preprints (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults

et al. 2022

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“…In this prospective cross-sectional study by Blumberg et al [ 21 ], 28 unvaccinated and 15 vaccinated participants were recruited. All the individuals underwent a symptom limited cardio-pulmonary exercise test (CPET) after acute COVID-19 infection to compare aerobic capacity and exercise performance.…”

Section: Resultsmentioning

confidence: 99%

COVID-19 Vaccine and Long COVID: A Scoping Review

Mumtaz¹,

Sheikh

Khan³

et al. 2022

Life

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As the COVID-19 pandemic progresses, changing definitions and therapeutics regarding the post-acute sequela of COVID-19, particularly long COVID, have become a subject of great interest and study. The study aims to describe the pathophysiology and discuss different therapeutic agents currently available for long COVID. Another objective is to assess comparative efficacy between different types of vaccines on symptoms of long COVID. A preliminary search was conducted using Ovid Medline, Embase, medRxiv, and NIH COVID-19 portfolios. A total of 16 studies were included in our review. Despite some of the data showing variable results, most of the vaccinated patients reported improvement in long COVID symptoms with no significant difference between various types of vaccines. Further trials are needed to better identify the comparative efficacy of vaccines for long COVID and ascertain other therapeutic modalities.

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“…31,36,[40][41][42] One study reported worse peak VO2 among unvaccinated compared to vaccinated individuals. 43 Patients experience the total effect of SARS-CoV-2, but estimating the direct effect independent of hospitalization may be more helpful to understand pathophysiology. In addition, variability in definition of LC, time since infection, and enrollment criteria also resulted in heterogeneity, but lack of specificity in definition should bias results toward the null.…”

Section: Exercise Capacity In Lc Compared To Recovered Individualsmentioning

confidence: 99%

Cardiopulmonary exercise testing to evaluate post-acute sequelae of COVID-19 (“Long COVID”): a systematic review and meta-analysis

Durstenfeld

Sun

Tahir

et al. 2022

Preprint

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Importance: Reduced exercise capacity is commonly reported among individuals with Long COVID (LC). Cardiopulmonary exercise testing (CPET) is the gold-standard to measure exercise capacity to identify causes of exertional intolerance. Objectives: To estimate the effect of SARS-CoV-2 infection on exercise capacity including those with and without LC symptoms and to characterize physiologic patterns of limitations to elucidate possible mechanisms of LC. Data Sources: We searched PubMed, EMBASE, and Web of Science, preprint severs, conference abstracts, and cited references in December 2021 and again in May 2022. Study Selection: We included studies of adults with SARS-CoV-2 infection at least three months prior that included CPET measured peak VO2. 3,523 studies were screened independently by two blinded reviewers; 72 (2.2%) were selected for full-text review and 36 (1.2%) met the inclusion criteria; we identified 3 additional studies from preprint servers. Data Extraction and Synthesis: Data extraction was done by two independent reviewers according to PRISMA guidelines. Data were pooled with random-effects models. Main Outcomes and Measures: A priori primary outcomes were differences in peak VO2 (in ml/kg/min) among those with and without SARS-CoV-2 infection and LC. Results: We identified 39 studies that performed CPET on 2,209 individuals 3-18 months after SARS-CoV-2 infection, including 944 individuals with LC symptoms and 246 SARS-CoV-2 uninfected controls. Most were case-series of individuals with LC or post-hospitalization cohorts. By meta-analysis of 9 studies including 404 infected individuals, peak VO2 was 7.4 ml/kg/min (95%CI 3.7 to 11.0) lower among infected versus uninfected individuals. A high degree of heterogeneity was attributable to patient and control selection, and these studies mostly included previously hospitalized, persistently symptomatic individuals. Based on meta-analysis of 9 studies with 464 individuals with LC, peak VO2 was 4.9 ml/kg/min (95%CI 3.4 to 6.4) lower compared to those without symptoms. Deconditioning was common, but dysfunctional breathing, chronotropic incompetence, and abnormal oxygen extraction were also described. Conclusions and Relevance: These studies suggest that exercise capacity is reduced after SARS-CoV-2 infection especially among those hospitalized for acute COVID-19 and individuals with LC. Mechanisms for exertional intolerance besides deconditioning may be multifactorial or related to underlying autonomic dysfunction.

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Protective effect of BNT162b2 vaccination on aerobic capacity following mild to moderate SARS-CoV-2 infection: a cross sectional study, Israel, March-December 2021

Cited by 3 publications

References 9 publications

Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults

Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults

COVID-19 Vaccine and Long COVID: A Scoping Review

Cardiopulmonary exercise testing to evaluate post-acute sequelae of COVID-19 (“Long COVID”): a systematic review and meta-analysis

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