Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen?

There is a wide range of sequelae affecting COVID-19 survivors, including impaired physical capacity. These sequelae can affect the quality of life and return to work of the active population. Therefore, one of the pillars of following-up is the evaluation of physical capacity, which can be assessed with field tests (such as the six-minute walk test, the one-minute standing test, the Chester step test, and the shuttle walking test) or laboratory tests (such as the cardiopulmonary exercise test). These tests can be performed in different contexts and have amply demonstrated their usefulness in the assessment of physical capacity both in post-COVID-19 patients and in other chronic respiratory, metabolic, cardiologic, or neurologic diseases. However, when traditional tests cannot be performed, physical function can be a good substitute, especially for assessing the effects of an intervention. For example, the Short Physical Performance Battery assessment and the Timed Up and Go assessment are widely accepted in older adults. Thus, the test should be chosen according to the characteristics of each subject.

Risk Factors for One-Year Mortality in Hospitalized Adults with Severe COVID-19.

As the body's immunity declines with age, elderly-hospitalized patients due to COVID-19 might be at higher mortality risk. Therefore, the aim of this prospective study was to examine the possible risk factors (demographic, social or comorbidities) most associated with mortality one-year after diagnosis of COVID-19. Routine data were collected from a cohort of hospitalized adults with severe COVID-19. The primary endpoint was mortality at one-year after diagnosis of COVID-19. We used a Cox proportional hazard model to estimate the hazard ratios (HRs) for both all-cause and specific cardiorespiratory mortality. A fully adjusted model included sex, socioeconomic status, institutionalization status, disability, smoking habit, and comorbidities as confounders. A total of 368 severe cases hospitalized on average 67.3 ± 15.9 years old were included. Participants aged ≥ 71 years had significantly higher HRs for all-cause mortality (adjusted HRs = 2.86, 95%CI: 2.01-4.07) and cardiorespiratory mortality (adjusted HRs = 2.86, 95%CI: 1.99-4.12). The association between age and mortality after diagnosis of COVID-19 due to both all-causes and cardiorespiratory mortality showed a consistent dose-response fashion. Institutionalization, disability, and socioeconomic status also showed a significant association with mortality. In conclusion, aging itself was the most important risk factor associated with mortality one year after diagnosis of COVID-19. People with disabilities, institutionalized or low socioeconomic status are significantly more likely to die after COVID-19.

The Chester Step Test Is a Reproducible Tool to Assess Exercise Capacity and Exertional Desaturation in Post-COVID-19 Patients.

Many people recovering from an acute episode of coronavirus disease (COVID-19) experience prolonged symptoms. Exercise testing is a feasible and cost-effective option for assessing exercise tolerance, fatigue, and dyspnea related to effort. Being that the Chester step test (CST) is a progressive, submaximal test for predicting aerobic capacity, it could be a good option to explore. This study aimed to determine the reproducibility of CST for assessing exertional desaturation and exercise capacity in patients post-COVID-19 disease. A cross-sectional study was conducted on post-COVID-19 patients. Two attempts of the CST were performed. The intraclass correlation coefficient (ICC) was used to assess agreement between the two tests. Forty-two symptomatic post-COVID-19 patients were included, the mean age was 53.8 ± 10.3 years, and 52% were female. There was no significant difference between both tests (p = 0.896). Twenty-four percent of participants (10 cases) had a clinically significant decrease in SpO2 at the first assessment, compared to 30.1% (13 cases) at the second, with no significant difference. An ICC of 0.993 (95% CI: 0.987 to 0.996) was obtained for the total number of steps in the CST.

Feasibility of the 30 s Sit-to-Stand Test in the Telehealth Setting and Its Relationship to Persistent Symptoms in Non-Hospitalized Patients with Long COVID.

Fatigue, dyspnea and pain are the main limitations of patients with long COVID. The aim of this study was to determine the feasibility of the 30 s sit-to-stand (30s-STS) test in the telehealth setting and its relationship to persistent symptoms in a sample of non-hospitalized patients with long COVID. A cross-sectional study was conducted in community patients with long COVID. Data collection and assessments were performed by videoconference and consisted of the fatigue assessment scale (FAS), London activity of daily living scale (LCADL), post-COVID-19 functional status (PCFS) and European quality of life questionnaire (EQ-5D-5L), including the pain/discomfort dimension. The 30s-STS test was performed using a standardized protocol adapted for remote use, and the modified Borg scale (0−10) was used to assess dyspnea and lower limb fatigue immediately after the test. The feasibility of the 30s-STS test was assessed by the proportion of eligible participants who were able to complete the test. Safety was assessed by the number of adverse events that occurred during the test. Seventy-nine participants were included (median age: 44 years, 86.1% women). Performance in the 30s-STS test was 11.5 ± 3.2 repetitions with 60.8% of the sample below reference values. All eligible participants were able to complete the test. No adverse events were reported during the evaluation. Participants with lower 30s-STS performance had more fatigue and dyspnea, worse quality of life, more severe pain/discomfort, and worse functional status (p < 0.05). A significant correlation was obtained between LCADL and dyspnea, reported on the Borg scale (0−10) post 30s-STS (r = 0.71; p < 0.001). In conclusion, the 30s-STS test proved to be a feasible test to implement in the telehealth setting and is related to fatigue, dyspnea, quality of life and pain in non-hospitalized patients with long COVID. Clinicians may use this test when assessment of the physical sequelae of COVID-19 in the face-to-face setting is not possible.

Lifestyles during the First Wave of COVID-19: A Cross-Sectional Study of 16,811 Adults from Spanish-Speaking Countries in South America.

The aim of this research was to analyze the lifestyles of adults from Spanish-speaking countries in South America during the COVID-19 pandemic using a cross-sectional, analytical, and multicenter study. The target population was composed of people aged 18 and older who resided in South America during the pandemic; the final sample comprised 16,811 participants who were predominantly female, with ages ranging from 18 to 79 years. The results showed that approximately six out of ten respondents did not engage in any physical activity; only one in four respondents indicated that their diet was sufficient and balanced; and most washed their hands frequently and showered every day. Regarding the type of isolation, half reported that it was voluntary and the rest mandatory or restricted. Regarding mobility, six out of ten surveyed leave their residence on a weekly basis. Regarding the use of personal protective equipment, the majority used masks and a smaller proportion used gloves. In conclusion, the majority of respondents did not perform any physical activity; moreover, one in four reported having a sufficient balanced diet. We therefore recommend an improvement of public policies to promote better lifestyles in South America, in particular the reorientation of the health system to prevent similar situations.

Resiliencia en las personas mayores durante la primera ola pandémica de la COVID-19 en Chile: una perspectiva desde los determinantes sociales de la salud Resilience in older people during the first wave of the COVID-19 pandemic in Chile: perspective from the social determinants of health

Objetivo: Evaluar la asociación entre los determinantes sociales de la salud (DSS) y la resiliencia en las personas mayores durante el primer periodo de confinamiento en la pandemia COVID-19 en Chile. Métodos: Se realizó un estudio observacional con diseño transversal utilizando los datos de una encuesta representativa a nivel nacional. En dicha encuesta, mediante un proceso de aleatorización sistemática, una submuestra de personas con edad ≥ 60 años de la comunidad fueron entrevistadas telefónicamente durante la primera ola pandémica de la COVID-19 en Chile. La resiliencia se evaluó utilizando la Brief Resilient Coping Scale (BRCS) y los síntomas depresivos con el Patient Health Questionnaire (PHQ-9). Los DSS considerados fueron: edad, género, nivel educacional, condición laboral, aislamiento social, soledad, insatisfacción de necesidades de vivienda y de atención en salud. Resultados: Se obtuvo una muestra total de 582 personas. La edad promedio fue de 71 años (DT=7.64;69% mujeres). Se obtuvo una asociación significativa entre una baja resiliencia y las siguientes condiciones: alta soledad (​​OR: 1.776 [IC 95%: 1.146-2.751], alto riesgo de aislamiento social (OR: 1.667 [IC 95% 1.149-2.419]) y síntomas depresivos (OR: 2.602 [IC 95% 1.795-3.774]). El género femenino fue un factor protector (OR: 0.589 [IC 95%: 0.406-0.855]). Conclusión: Los DSS como la alta soledad y el aislamiento social son factores que se asocian con una baja resiliencia de las personas mayores durante la pandemia de la COVID-19, por lo que se deben tener en cuenta al momento de planificar estrategias de intervención en la salud pública.

30 s sit-to-stand power is positively associated with chest muscle thickness in COVID-19 survivors.

INTRODUCTION: After hospitalization, early detection of musculoskeletal sequelae might help healthcare professionals to improve and individualize treatment, accelerating recovery after COVID-19. The objective was to determine the association between the 30s sit-to-stand muscle power (30s-STS) and cross-sectional area of the chest muscles (pectoralis) in COVID-19 survivors. METHOD: This cross-sectional study collected routine data from COVID-19 survivors one month after hospitalization: 1) a chest computed tomography (CT) scan and 2) a functional capacity test (30s-STS). The pectoralis muscle area (PMA) was measured from axial CT images. For each gender, patients were categorized into tertiles based on PMA. The 30s-STS was performed to determine the leg extension power. The allometric and relative STS power were calculated as absolute 30s-STS power normalized to height squared and body mass. The two-way ANOVA was used to compare the gender-stratified tertiles of 30s-STS power variants. RESULTS: Fifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years, 30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant differences between the PMA tertiles in absolute STS power (p = .002) and allometric STS power (p = .001). There were no significant gender x PMA tertile interactions (all variables p > .05). The high tertile of PMA showed a higher allometric STS power compared to the low and middle tertile, p = .002 and p = .004, respectively. Absolute STS power and allometric STS power had a moderate correlation with the PMA, r = 0.519 (p < .001) and r = 0.458 (p < .001) respectively. CONCLUSION: The 30s-STS power is associated with pectoralis muscle thickness in both male and female COVID-19 survivors. Thus, this test may indicate global muscle-wasting and may be used as a screening tool for lower extremity functional capacity in the early stages of rehabilitation planning in COVID-19 survivors.

The Impact of Charlson Comorbidity Index on the Functional Capacity of COVID-19 Survivors: A Prospective Cohort Study with One-Year Follow-Up.

OBJECTIVE: To determine the association between the Charlson comorbidity index (CCI) score after discharge with 6-min walk test (6MWT) 1 year after discharge in a cohort of COVID-19 survivors. METHODS: In this prospective study, data were collected from a consecutive sample of patients hospitalized for COVID-19. The CCI score was calculated from the comorbidity data. The main outcome was the distance walked in the 6MWT at 1 year after discharge. Associations between CCI and meters covered in the 6MWT were assessed through crude and adjusted linear regressions. The model was adjusted for possible confounding factors (sex, days of hospitalization, and basal physical capacity through sit-to-stand test one month after discharge). RESULTS: A total of 41 patients were included (mean age 58.8 ± 12.7 years, 20/21 men/women). A significant association was observed between CCI and 6MWT (meters): (i) crude model: ß = -18.7, 95% CI = -34.7 to -2.6, p < 0.05; (ii) model adjusted for propensity score including sex, days of hospitalization, and sit-to-stand: ß = -23.0, 95% CI = -39.1 to -6.8, p < 0.05. CONCLUSIONS: A higher CCI score after discharge indicates worse performance on the 6MWT at 1-year follow-up in COVID-19 survivors. The CCI score could also be used as a screening tool to make important clinical decisions.

The Impact of Charlson Comorbidity Index on the Functional Capacity of COVID-19 Survivors: A Prospective Cohort Study with One-Year Follow-Up

Objective: To determine the association between the Charlson comorbidity index (CCI) score after discharge with 6-min walk test (6MWT) 1 year after discharge in a cohort of COVID-19 survivors. Methods: In this prospective study, data were collected from a consecutive sample of patients hospitalized for COVID-19. The CCI score was calculated from the comorbidity data. The main outcome was the distance walked in the 6MWT at 1 year after discharge. Associations between CCI and meters covered in the 6MWT were assessed through crude and adjusted linear regressions. The model was adjusted for possible confounding factors (sex, days of hospitalization, and basal physical capacity through sit-to-stand test one month after discharge). Results: A total of 41 patients were included (mean age 58.8 ±12.7 years, 20/21 men/women). A significant association was observed between CCI and 6MWT (meters): (i) crude model: β= −18.7, 95% CI = −34.7 to −2.6, p < 0.05;(ii) model adjusted for propensity score including sex, days of hospitalization, and sit-to-stand: β= −23.0, 95% CI = −39.1 to −6.8, p < 0.05. Conclusions: A higher CCI score after discharge indicates worse performance on the 6MWT at 1-year follow-up in COVID-19 survivors. The CCI score could also be used as a screening tool to make important clinical decisions.

Social determinants of health associated with severity and mortality in patients with COVID-19.

INTRODUCTION: Historically, pandemics have resulted in higher mortality rates in the most vulnerable populations. Social determinants of health (SDH) have been associated with people morbidity and mortality at different levels. OBJECTIVE: To determine the relationship between SDH and COVID-19 severity and mortality. METHODS: Retrospective study, where data from patients with COVID-19 were collected at a public hospital in Chile. Sociodemographic variables related to structural SDH were classified according to the following categories: gender, age (< 65 years, ≥ 65 years), secondary education (completed or not), work status (active, inactive) and income (< USD 320, ≥ USD 320). RESULTS: A total of 1,012 laboratory-confirmed COVID-19 cases were included. Average age was 64.2 ± 17.5 years. Mortality of the entire sample was 14.5 %. Age, level of education, unemployment and income had a strong association with mortality (p < 0.001). CONCLUSIONS: The findings reinforce the idea that SDH should be considered a public health priority, which is why political efforts should focus on reducing health inequalities for future generations.

INTRODUCCIÓN: Históricamente, las pandemias han tenido como resultado tasas de mortalidad más altas en las poblaciones más vulnerables. Los determinantes sociales de la salud (DSS) se han asociado a la morbimortalidad de las personas en diferentes niveles. OBJETIVO: Determinar la relación entre los DSS, la severidad de COVID-19 y la mortalidad por esta enfermedad. MÉTODOS: Estudio retrospectivo en el que se recolectaron datos de pacientes con COVID-19 en un hospital público de Chile. Las variables sociodemográficas relacionadas con los DSS estructurales se clasificaron según las siguientes categorías: sexo, edad (< 65 años, ≥ 65 años), educación secundaria (completada o no), condición de trabajo (activo, inactivo) e ingreso económico (< USD 320, ≥ USD 320). RESULTADOS: Fueron incluidos 1012 casos con COVID-19 confirmados por laboratorio. La edad promedio fue de 64.2 ± 17.5 años. La mortalidad de la muestra total fue de 14.5 %. La edad, nivel educativo, desempleo e ingresos tuvieron fuerte asociación con la mortalidad (p < 0.001). CONCLUSIONES: Los hallazgos refuerzan la idea de que los DSS deben considerarse una prioridad de salud pública, por lo que los esfuerzos políticos deben centrarse en reducir las desigualdades en salud para las generaciones futuras.

Use of sit-to-stand test to assess the physical capacity and exertional desaturation in patients post COVID-19.

We propose the use of the 1-minute sit-to-stand test (1STST) to evaluate the physical capacity and exertional desaturation one month after discharge in a sample of patients who survived COVID-19 pneumonia. This was a cross-sectional study that collected routine data from consecutive patients admitted to the outpatient program in a public hospital in Chile. Patients were asked to complete a 1STST. Data were analyzed according to those with and without a prolonged hospital stay of >10 days. Eighty-three percent of the patients were able to complete the test (N = 50). The median age was 62.7 ± 12.5 years. The average number of repetitions in the 1STST was 20.9 ± 4.8. Thirty-two percent of patients had a decrease in pulse oxygen saturation (SpO2) ≥ 4 points. The prolonged hospital stay subgroup had a significant increase in exertional desaturation (mean difference = 2.6; 95% CI = 1.2 to 3.9; p = 0.001) and dyspnea (mean difference = 1.1; 95% CI = 0.4 to 2.1; p = 0.042) compared to the group of length of stay ≤10 days. In-hospital survivors of COVID-19, the 1STST showed a decrease in physical capacity at one month in those 90% who were able to complete it. The 1STST was able to discriminate between those with and without a prolonged hospital stay and was able to detect exertional desaturation in some patients.