The effect of medium-term recovery status after COVID-19 illness on cardiopulmonary exercise capacity in a physically active adult population

Abstract

Background: A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high functioning populations ranging from front-line emergency services to professional or amateur/recreational athletes. Aim: To describe the medium-term cardiopulmonary exercise profiles of individuals with 'persistent symptoms' and individuals who feel 'recovered' after hospitalization or mild-moderate community infection following COVID-19 to an age, sex and job-role matched control group. Methods: 113 participants underwent cardiopulmonary functional tests at a mean 159±7 days (~5 months) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered), and 26 controls. Results: Hospitalized groups had the least favorable body composition (body mass, body mass index and waist circumference) compared to controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇O2) at peak exercise (hospitalized-symptomatic, 29.9±5.0ml/kg/min; community-symptomatic, 34.4±7.2ml/kg/min; vs. control 43.9±3.1ml/kg/min, both p<0.001). Hospitalized-symptomatic individuals had a steeper V̇E/V̇CO2 slope (lower ventilatory efficiency) (30.5±5.3 vs. 25.5±2.6, p=0.003) vs. controls. Hospitalized-recovered had a significantly lower oxygen uptake at peak (32.6±6.6ml/kg/min vs. 43.9 ±13.1ml/kg/min, p=0.015) compared to controls. No significant differences were reported between community-recovered individuals and controls in any cardiopulmonary parameter. Conclusion: Medium term findings suggest community-recovered individuals did not differ in cardiopulmonary fitness from physically active healthy controls. This suggests their readiness to return to higher levels of physical activity. However, the hospitalized-recovered group and both groups with persistent symptoms had enduring functional limitations, warranting further monitoring, rehabilitation and recovery.

Post-Acute COVID-19 Sequelae in a Working Population at One Year Follow-Up: A Wide Range of Impacts from an Italian Sample

“…The individual and societal impact of this condition has not been fully understood yet. Various studies have shown how this syndrome leads to significant limitations in functional abilities and to a general reduction in quality of life; this is the case, especially, though not exclusively, in patients who have experienced a severe disease or have undergone a hospital stay [ 10 , 11 , 12 , 13 , 14 , 15 ]. A longitudinal cohort study recently performed in China showed that the population surviving COVID-19 after a hospital stay, even after two years from the acute illness, had more lasting symptoms and more residual pain or discomfort, as well as anxiety or depression, compared to controls [ 16 ].…”

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

“…37 Although some studies suggest that acute severity may not impact exercise capacity, 38,39 most studies suggest higher acuity is associated with worse exercise capacity. 31,36,40-42 One study reported worse peak VO 2 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.…”

“…Included studies oversample hospitalized individuals with greater acute severity, more comorbidities, and lower baseline fitness. Hospitalization or need for intensive care is associated with greater reductions in peak VO2 31,36,[40][41][42] and with LC, but most with LC were not hospitalized. 68 Differential selection bias may occur among those hospitalized, referred for clinical CPETs, or who attend CPET after joining a cohort.…”

“…Most included participants were hospitalized for severe acute infection and most remained symptomatic, so these studies largely estimate exercise capacity among those with posthospitalization LC. Exceptions include Ladlow and Mouslon who recruited active military personnel 31 and athletes, 32 respectively. Three studies (Brown, Ladlow, Cassar) included frequency-matched contemporary controls.…”

“…Three studies (Brown, Ladlow, Cassar) included frequency-matched contemporary controls. 31,[33][34][35] Five studies included age-and sex-matched historical controls with unexplained dyspnea and normal exercise capacity 27,30 or irrespective of exercise capacity. 26,32,36 Alba and Singh's discrepant results may be explained by using control groups with reduced (Alba) versus known normal exercise capacity (Singh).…”