COVID-19 survivors are physically inactive with high levels of sedentary time, regardless of patient characteristics, disease severity or cardiac dysfunction

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation Background More than 250 million cases of the coronavirus disease-2019 (COVID-19) infection were confirmed across the globe since 2020, leading to a substantial number of COVID-19 related hospital admissions. Many COVID-19 survivors experience long-term health consequences, but data on physical activity patterns and the impact on recovery post-infection are scarce. Purpose This study aimed to objectively assess physical (in)activity patterns among COVID-19 survivors and to explore the association with patient characteristics, disease severity and cardiac dysfunction. We hypothesized that COVID-19 survivors will demonstrate low volumes of physical activity and a high sedentary time, especially those with a more severe disease course (e.g. longer hospital duration;admission to intensive care), cardiac dysfunction, and persistent symptoms at 3-6 months post-discharge. Methods In this cross-sectional cohort study, we objectively assessed physical activity, sedentary behaviour and sleep duration for 24 hrs/day during 8 subsequent days in COVID-19 survivors at 3-6 months post-hospitalisation. Activity patterns were compared across pre-defined subgroups based on patient- and disease characteristics, cardiac biomarker release during hospitalisation, abnormal transthoracic echocardiogram regarding left- and right ventricular function and volumes at 3-6 months of follow-up, and persistence of symptoms post-discharge. Results Physical activity patterns were assessed in 37 patients (60±10 years old;78% male) at 125 [116;132] days after discharge. Patients spent 4.2 [3.2;5.3] hrs/day in light-intensity physical activity and 1.0 [0.8;1.4] hrs/day in moderate-to-vigorous intensity physical activity. Median sleep duration was 8.6 [8.2;9.1] hrs/day. Time spent sitting was 9.8 [8.7;11.2] hrs/day, which was accumulated in 6.0 [4.7;6.9] prolonged sitting bouts (≥30 min) and 41.4 [31.5;48.1] short sitting bouts (<30 min, Central Figure). No differences in activity patterns were found across subgroups, but sleep duration was slightly higher in women versus men (9.2 vs 8.5 hrs/day, p=0.03) and patients with versus without persistent symptoms (9.1 vs 8.3 hrs/day, p=0.02). Conclusions COVID-19 survivors are physically inactive for most of their time at 3-6 months post-hospitalisation. Physical (in)activity patterns are not impacted by patient- nor disease characteristics, underlining the need for a uniform approach for re-activation of COVID-19 survivors. Central Figure. A: objectively measured light-intensity physical activity (LIPA), moderate-to-vigorous intensity physical activity (MVPA), sleep duration and sedentary time in COVID-19 patients at 3-6 months post-hospitalisation (median and interquartile range). B: sitting bout frequency (mean + standard deviation). Central Figure

Comparison between myocardial function assessed by echocardiography during hospitalization for COVID-19 and at 4 months follow-up.

In patients hospitalized for corona virus infectious disease 19 (COVID-19) it is currently unknown whether myocardial function changes after recovery and whether this is related to elevated cardiac biomarkers. In this single center, prospective cohort study we consecutively enrolled hospitalized COVID-19 patients between 1 April and 12 May 2020. All patients underwent transthoracic echocardiography (TTE) evaluation during hospitalization and at a median of 131 days (IQR; 116-136) follow-up. Of the 51 patients included at baseline, 40 (age: 62 years (IQR; 54-68), 78% male) were available for follow-up TTE. At baseline, 68% of the patients had a normal TTE, regarding left ventricular (LV) and right ventricular (RV) volumes and function, compared to 83% at follow-up (p = 0.07). Median LV ejection fraction (60% vs. 58%, p = 0.54) and tricuspid annular plane systolic excursion (23 vs 22 mm, p = 0.18) were comparable between hospitalization and follow-up, but a significantly lower RV diameter (39 vs. 34 mm, p = 0.002) and trend towards better global longitudinal strain (GLS) (- 18.5% vs - 19.1%, p = 0.07) was found at follow-up. Subgroup analysis showed no relation between patients with and without elevated TroponinT and/or NT-proBNP during hospitalization and myocardial function at follow-up. Although there were no significant differences in individual myocardial function parameters at 4 months follow-up compared to hospitalisation for COVID-19, there was an overall trend towards normalization in myocardial function, predominantly due to a higher rate of normal GLS at follow-up.

Cardiac function in relation to myocardial injury in hospitalised patients with COVID-19.

BACKGROUND: Previous studies have reported on myocardial injury in patients with coronavirus infectious disease 19 (COVID-19) defined as elevated cardiac biomarkers. Whether elevated biomarkers truly represent myocardial dysfunction is not known. The aim of this study was to explore the incidence of ventricular dysfunction and assess its relationship with biomarker analyses. METHODS: This cross-sectional study ran from April 1 to May 12, 2020, and consisted of all consecutively admitted patients to the Radboud university medical centre nursing ward for COVID-19. Laboratory assessment included high-sensitivity Troponin T and N­terminal pro-B-type natriuretic peptide (NT-proBNP). Echocardiographic evaluation focused on left and right ventricular systolic function and global longitudinal strain (GLS). RESULTS: In total, 51 patients were included, with a median age of 63 years (range 51-68 years) of whom 80% was male. Troponin T was elevated (>14 ng/l) in 47%, and a clinically relevant Troponin T elevation (10â€¯× URL) was found in three patients (6%). NT-proBNP was elevated (>300 pg/ml) in 24 patients (47%), and in four (8%) the NT-proBNP concentration was >1,000 pg/ml. Left ventricular dysfunction (ejection fraction <52% and/or GLS >-18%) was observed in 27%, while right ventricular dysfunction (TAPSE <17 mm and/or RV S' < 10 cm/s) was seen in 10%. There was no association between elevated Troponin T or NT-proBNP and left or right ventricular dysfunction. Patients with confirmed pulmonary embolism had normal right ventricular function. CONCLUSIONS: In hospitalised patients, it seems that COVID-19 predominantly affects the respiratory system, while cardiac dysfunction occurs less often. Based on a single echocardiographic evaluation, we found no relation between elevated Troponin T or NT-proBNP, and ventricular dysfunction. Echocardiography has limited value in screening for ventricular dysfunction.