Submaximal and maximal exercise tests in the follow up of severe Covid-19

Background: One-minute sit and stand test (1STST) is a very feasible test of functional capacity. The maximal cardiopulmonary exercise test (CPET) is more complex and comprehensive to evaluate exercise capacity. These tests might have different responses in the late recovery of patients with Covid-19. Aim(s): Identify the persistence of capacity limitation through 1STST and CPET at 30 and 90 days after the onset of symptoms in patients who had a severe and critical illness from Covid-19. Our hypothesis is that 1STST is a submaximal test limited by time and may not detect exercise capacity limitation in some patients. Method(s): Prospective study involving 17 patients with severe Covid-19. The time of the first 5 repetitions and the number of repetitions in 60 seconds in 1STST were used to identify lower performance. Maximal CPET on the cycle was performed and peak VO <= 83% pred was used to confirm lower performance. Result(s): The 1STST was considered submaximal and identified 52% of the patients with greater time than expected to perform 5 repetitions in 30 days, and only 11.8% in 90 days. The number of repetitions in 60 sec was reduced by 58.8% at 30 days and persists this reduction by 11.8% at 90 days (table). CPET identified a much lower performance of 58.8% mainly after 90 days. Conclusion(s): Both tests had different responses in the magnitude of recovery from 30 to 90 days after severe Covid-19. There is a substantial proportion of patients who are potentially impaired and improved in 1STST but not in CPET.

Exercise capacity in one minute sit to stand test and cardiopulmonary exercise test after 90 days of severe Covid 19

Exercise capacity is impaired after severe Covid 19. Exercise tests have different characteristics and are necessary to better understanding the recovery phase. Aim(s): To evaluate the physiological variables in 1 Minute Sit to Stand (1STST) and Cardiopulmonary Exercise Test (CPET) in severe Covid 19 recovery at 90 days after the onset of symptoms. Method(s): We assessed 25 post-severe Covid 19 individuals after 90 days the onset of symptoms. We performed bioelectrial impedance to verify skeletal muscle mass (SMM), hand grip (HG) to determine muscle strength, 1STST and CPET to verify exercise capacity. Result(s): In 1STST, 28% of the sample presented performance below the reference for Brazilian population (Furlanetto, K. et al. Arch Phys Med Rehabil 2022;103(1): 20-28). The impairment was found in 5 first repetitions, as in the number of repetitions performed in 1 minute. The physiological responses of the 1STST proved to be a submaximal test (RER = 0.97). In CPET, we found a maximum effort (RER = 1.22) and peripheral muscle limitation. Performance was reduced in 68% of the individuals. In both tests, good and significant correlations were observed with SMM and HG. Conclusion(s): After 90 days of Covid-19, we still found significant correlations of peripheral muscle disfunction and exercise performance in both tests. Interventions focusing on peripheral muscle rehabilitation might be highly relevant in critical Covid-19.