NO RELATIONSHIP BETWEEN PULMONARY FUNCTION AND EXERCISE CAPACITY IN PEOPLE WITH POSTACUTE SEQUELAE OF SARS-COV-2 INFECTION

SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Breathlessness, fatigue, and exertional intolerance can persist for several months in up to 50% people after recovery from SARS-CoV-2 infection. The physiological underpinning(s) of the reduced exercise capacity associated with post-acute sequelae of SARS-CoV-2 infection (PASC) requires further investigation. We characterized pulmonary function relative to normative values and determined the relationship between measures of pulmonary function and peak pulmonary O2 uptake (V̇O2peak) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO), and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed in ten adults (five females;age 41 ± 11 y;BMI 21 ± 5 kg/m2) with PASC. Time from initial SARS-CoV-2 infection to study enrollment was 6 ± 4 months. At the time of study, participants (n) reported persistent fatigue (9), breathlessness (9), headache (6), chest tightness (4), cough (2), muscle pain (4), palpitations (4), dizziness (5), and nausea (1). RESULTS: There was inter-individual heterogeneity in total lung capacity (TLC;range 68 to 117% predicted), forced vital capacity (FVC;range 73 to 123% predicted), forced expiratory volume in 1 s (FEV1;92 to 109% predicted), and maximal voluntary ventilation (MVV;range 75 to 122% predicted);however, no group mean measure of spirometric function or lung volume was different relative to normative values. Conversely, group mean DLCO (21 ± 9 vs. 27 ± 5 ml/min/mmHg, P = 0.017) and MIP (75 ± 43 vs. 102 ± 18 cmH2O, P = 0.049) were reduced relative to normative values. During the CPET, peak RER and heart rate were 1.16 ± 0.12 and 174 ± 16 beats/min (97 ± 8% predicted), respectively. V̇O2peak was 27.3 ± 6.8 ml/kg/min (90 ± 20% predicted, range 49-122% predicted, V̇O2peak <85% predicted in 4 of 10 participants), and there was no clear evidence of ventilatory or gas exchange impairment to exercise (breathing reserve 49 ± 31 L;minimum SpO2 96 ± 2%;V̇E/V̇CO2 nadir 27 ± 2;∆PETCO2 7.4 ± 2.8 mmHg). There was no relationship between percent predicted V̇O2peak and percent predicted TLC (r2 = 0.061, P = 0.492), FVC (r2 = 0.196, P = 0.200), FEV1 (r2 = 0.173, P = 0.232), MVV (r2 = 0.037, P = 0.595), DLCO (r2 = 0.007, P = 0.836), and MIP (r2 = 0.007, P = 0.820). CONCLUSIONS: Impaired pulmonary function and decreased exercise capacity are present in some but not all people with PASC who report persistent fatigue and breathlessness. Presently, we find no relationship between pulmonary function and V̇O2peak in people with PASC. CLINICAL IMPLICATIONS: Some but not all people with PASC have normal exercise capacity within ~2-12 months after recovery from SARS-CoV-2 infection. CPET may be considered when evaluating the presence and mechanistic underpinning(s) of impaired exercise capacity in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support

EXERCISE THERAPY TO COMBAT THE POSTACUTE SEQUELAE OF COVID-19: A CASE SERIES

SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Short- and long-term postacute sequelae of SARS-CoV-2 infection (PASC) includes a constellation of clinical symptoms that persist following recovery from COVID-19. The precise pathophysiology of PASC is unknown but likely multifactorial, and intervention strategies to combat PASC are lacking. Our aim was to investigate whether homebased exercise training (HBExT) enhances recovery of and/or improves exercise capacity, pulmonary function, symptoms, and overall health-related quality of life (HRQoL) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO) and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed before and after 8-weeks of HBExT in three adults (2 males, 48 and 40 years old;1 female, 37 years old) with PASC. Symptoms (via standard questionnaire) and HRQoL (via EQ-5D-3L questionnaire) were also assessed before and after HBExT. HBExT consisted of 3-to-4 aerobic (duration 25-40 min, intensity 60-80% heart rate reserve) and 2-to-3 resistance (7 exercises, 8-12 repetitions, 2-3 sets) sessions per week, and was prescribed and tracked in each participant using a mobile application (Connected mHealth) integrated with a heart rate monitor (Polar H7). RESULTS: Time from initial SARS-CoV-2 infection to enrollment in the study (in months) and adherence rate to HBExT was 8 and 66%, 4 and 71%, and 3 and 100% for the three participants. Before to after HBExT, there was a 13 ± 7% increase in exercise time (12.6 ± 2.0 vs. 14.1 ± 1.3 min) and a 14 ± 9% increase in peak O2 uptake (V̇O2peak;27.6 ± 2.8 vs. 31.5 ± 2.5 ml/kg/min) during the CPET. Neither the heart rate nor the pulmonary gas exchange (V̇E/V̇CO2, PETCO2, SpO2) response to CPET was different before vs. after HBExT. Conversely, peak-exercise breathing reserve was lower (13 ± 16 vs. 30 ± 11 L/min) and O2pulse was greater (16.3 ± 1.2 vs. 13.8 ± 0.2 ml/beat) following HBExT. No remarkable changes in pulmonary function or DLCO were noted after HBExT;however, there was a 16 ± 12% increase in MIP from before to after HBExT (74 ± 21 vs. 85 ± 18 cmH2O). After HBExT, a fraction of the participants reported resolution of persistent fatigue (n = 1), breathlessness (n = 2), chest tightness (n = 1), palpitations (n = 1), and dizziness (n = 2), and overall health score (via EQ-5D-3L) was increased (42 ± 34 vs. 81 ± 6;100 = ‘best health imaginable’). CONCLUSIONS: Prescribed exercise training may increase exercise capacity and inspiratory muscle strength, alleviate persistent symptoms of fatigue and breathlessness, and improve overall HRQoL in people with PASC. CLINICAL IMPLICATIONS: Exercise-based therapy may improve functional capacity and partially alleviate persistent symptoms in people with PASC, strengthening calls for cardiopulmonary rehabilitation as a potential therapeutic intervention in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Isabel Cortopassi No relevant relationships by Igor Fernandes No relevant relationships by Scott Helgeson No relevant relationships by Elizabeth Johnson No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Patricia Mergo No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support