Impact of COVID 19 infection on cardiopulmonary functions of a cohort of national level athletes in Sri Lanka

Limited evidence exists regarding adverse effects on cardiovascular and pulmonary function in adults affected by covid 19 infection. We describe the cardiopulmonary functions in a cohort of national level athletes with recent covid infection. 42 healthy athletes were evaluated after at least a 10-day period of quarantine after mild covid infection.44% females [n=19] and 56% males [n=23]. The age range was 15 - 38 years. The commonest persistent symptoms were difficulty in breathing (4.8%), cough (7%) and chest tightness (4.8%). PCFS (post covid functional score) was 0 in 93%. The CXR and 6-minute walk test were normal in all. The spirometry was normal in 83% (n=35). The mean FEV1 were 2.68l and 3.75l;mean FVC were 3.09l and 4.6l in females and males respectively. The mid expiratory flow rate (FEF 25-75) was less than the predicted lower limit of normal in 52.4%(mean=2.8L). Cardiac abnormalities were detected in 7%;moderate interventricular septal dyssynchrony, global hypokinesia with mild LV dysfunction and mild pulmonary hypertension. 13 players with persistent difficulty in breathing and chest tightness who had otherwise normal spirometry and echo were referred for CPET. Only 6 players had CPET due to limited resources: evidence of deconditioning (n=3) and cardiac limitation with poor O2 pulse (n=3). 78% (n=33) had normal cardiopulmonary assessment and were referred for graduated return to practice. Abnormalities were identified in 21% (n=9). Mid expiratory flow was reduced in 53% indicating possible effect on peripheral airways post covid. Evaluation of athletes and guidelines on return to practice after covid infection are an important and timely need.

A pattern of respiratory dysfunction in mild cases of postCOVID-19 athletes: an emerging hypothesis

The purpose of this study was to investigate fitness indicators through cardiac stress test in post-COVID-19 athletes, who were not hospitalized, vs healthy ones. Forty male professional Greek soccer players, were divided into two groups: previously infected with COVID-19 and non-hospitalized (n=20, Age: 25.2+/-4.1 yrs, BSA: 1.9+/-0.2 m2, body fat: 11.8+/-3.4 %) vs. control (n=20, Age: 25.1+/-4.4 yrs, BSA: 2.0+/-0.3 m2, body fat: 10.8+/-4.5 %). Inclusion criteria were: age >=20-to-<=30 yrs, training age >=6 yrs, without recent injury (>12 months) and asymptomatic infected with COVID-19 (<7 days). For each athlete, prior to assessment cardiopulmonary function (CPF) were recorded body composition, spirometry and lactate blood level. Differences between groups were assessed with the independent samples t-test (<0.05). Several differences were detected between the two groups (COVID-19 vs. non-COVID-19 athletes, Table 1) during CPF. Results didn't showed differences between groups in VO2max (55.7+/-4.4 vs. 55.4+/-4.6 ml/min/kg Table 1. Results between groups (*p<0.05, #p<0.001) Post-COVID-19 athletes characterized by increased respiratory work at both rest and maximum effort as well as hyperventilation during exercise, which may explain increased metabolic needs and mechanical stress.

Persistent Symptoms Three Months after Clinical Recovery from COVID-19

Background: There is ample evidence that COVID-19 symptoms may persist after recovery in many cases. This study examined the relationship between symptoms detected 3 months after recovery and those experienced during acute illness, cardiopulmonary function, and self-reported health status Design: Prospective, cohort study of COVID-19 survivors seen 3 months after recovery Methods: Symptoms were assessed using a standard questionnaire and self-reported health status. Patients underwent cardiopulmonary function tests, and chest radiography Results: 166 patients were evaluated between June and November 2020. Acute disease severity was mildmoderate in 53% of patients;and severe-critical in 47%. The number of symptoms had decreased from 2.3 to 1.9 (p<0.001). The prevalence decreased for cough (64 to 24%), shortness of breath (51 to 30.7%), ageusia (21.7 to 6%), anosmia (17.5 to 5.4%), and generalized pain (10.8 to 5. 4%);increased mildly for weakness (47-54.8%) and chest pain (15-17.5%);and increased significantly for exertional dyspnea (3.6-35.5%) and brain fog (3-8.4%). The SF-36 questionnaire was significantly correlated with the number of symptoms at 3 months (highest r=0.43). No variable recorded during acute COVID-19 predicted the number of symptoms or the rates of exertional dyspnea, brain fog, and weakness at 3 months significantly Conclusion(s): 3 months after recovery from COVID-19 infection, 94% of patients had persistent symptoms consistent with post-acute COVID-19 which were associated with a significant decrease in HRQoL. Symptoms persisting after recovery did not correspond systematically to those reported at the onset of the disease, and this should be considered when planning post-infectious care.

Therapeutic Effects of Metaverse Rehabilitation for Cerebral Palsy: A Randomized Controlled Trial.

Metaverse physical therapy (MPT), an adjuvant technology for the rehabilitation of children with cerebral palsy (CP), has gained notoriety in the clinical field owing to its accessibility and because it provides motivation for rehabilitation. The aim is to compare the gross motor function and cardiopulmonary function, the activities of daily living, quality of life (QOL), and the perceived risk of coronavirus disease (COVID)-19 transmission between MPT and conventional physical therapy (CPT). A convenience sample of 26 children with CP (mean age, 11.23 ± 3.24 years, 14 females) were randomized into either the MPT or CPT group and received therapy three days/week for four weeks. Clinical outcomes included gross-motor-function measure 66 (GMFM-66), heart rate (HR), Borg-rating perceived exertion (BRPE), functional independence measure (FIM), pediatric QOL, and the risk of COVID-19 transmission. An analysis of variance showed that compared with CPT, MPT exerted positive effects on GMFM, HR, and BRPE. An independent t-test showed that compared with CPT, MPT exerted positive effects on the perceived transmission risk of COVID-19 but not on FIM and QOL. Our results provide promising therapeutic evidence that MPT improves gross motor function, cardiopulmonary function, and the risk of COVID-19 in children with CP.

The Greifswald Post COVID Rehabilitation Study and Research (PoCoRe)-Study Design, Characteristics and Evaluation Tools.

(1) Background: COVID-19 is often associated with significant long-term symptoms and disability, i.e., the long/post-COVID syndrome (PCS). Even after presumably mild COVID-19 infections, an increasing number of patients seek medical help for these long-term sequelae, which can affect various organ systems. The pathogenesis of PCS is not yet understood. Therapy has so far been limited to symptomatic treatment. The Greifswald Post COVID Rehabilitation Study (PoCoRe) aims to follow and deeply phenotype outpatients with PCS in the long term, taking a holistic and comprehensive approach to the analysis of their symptoms, signs and biomarkers. (2) Methods: Post-COVID outpatients are screened for symptoms in different organ systems with a standardized medical history, clinical examination, various questionnaires as well as physical and cardiopulmonary function tests. In addition, biomaterials are collected for the analysis of immunomodulators, cytokines, chemokines, proteome patterns as well as specific (auto)antibodies. Patients are treated according to their individual needs, adhering to the current standard of care. PoCoRe's overall aim is to optimize diagnostics and therapy in PCS patients.

Short-Term Associations between Size-Fractioned Particles and Cardiopulmonary Function in COPD Patients: A Panel Study in Shanghai, China, during 2014-2021.

It remains unknown which size fractions dominate the adverse cardiopulmonary effects of particulate matter (PM). Therefore, this study aimed to explore the differential associations between size-fractioned particle number concentrations (PNCs) and cardiopulmonary function measures, including the forced expiratory volume in one second (FEV1), the forced vital capacity (FVC), and the left ventricular ejection fraction (LVEF). We conducted a panel study among 211 patients with chronic obstructive pulmonary disease (COPD) in Shanghai, China, between January 2014 and December 2021. We applied linear mixed-effect models to determine the associations between cardiopulmonary function measures and PNCs ranging from 0.01 to 10 µm in diameter. Generally, only particles <1 µm showed significant associations, i.e., ultrafine particles (UFPs, <0.1 µm) for FVC and particles ranging from 0.1 to 1 µm for FEV1 and LVEF. An interquartile range (IQR) increment in UFP was associated with decreases of 78.4 mL in FVC. PNC0.1-0.3 and PNC0.3-1 corresponded to the strongest effects on FEV1 (119.5 mL) and LVEF (1.5%) per IQR increment. Particles <1 µm might dominate the cardiopulmonary toxicity of PM, but UFPs might not always have the strongest effect. Tailored regulations towards particles <1 µm should be intensified to reduce PM pollution and protect vulnerable populations.

Impact of lockdown on cardiopulmonary function in children with heart disease

Background and Aim: The COVID-19 lockdown in Germany has led to the closure of sports facilities and to the closure of schools with their curricular physical activities (PA). However, physical activity is essential for improving or at least maintaining cardiopulmonary function assessed by VO2peak. VO2peak represents the best pre-dictor for mortality and morbidity in patients with congenital heart disease (CHD). It is therefore essential to evaluate the effect of lock-downs on this important parameter in children with heart disease. Method(s): We evaluated data from cardiopulmonary exercise data from before lockdown with twin-paired data from during lockdown. The statistically approved twin-pairing was achieved by matching patients with similar heart disease, age, sex, and test method. The subjects con-sisted of a variety of patients who had received cardiopulmonary exer-cise testing in our department in the past 3 years. Result(s): We were able to twin-pair 52 tests leading to 27 twins. A mean RER of more than 1.1 was achieved in both groups with comparable exercise times. There was a significant decrease of cardiopulmonary function (VO2peak: 35.7 +/- 9.8 vs.30.4 +/- 10.6) in our patient cohort along with a significant decrease in peak O2pulse (13.3 +/- 4.1 vs. 11.4 +/- 4.5), a surrogate parameter for stroke volume and most pronounced in peak minute ventilation (VE: 83.05 +/- 29.08 vs.71,49 +/- 24.96). Conclusion(s): We observed a significant decline of V O-2peak during lockdown. This involved a loss of cardiac function assessed by O2pulse as well as a loss of pulmonary function assessed by V E. We believe that the decline of these important predictive param-eters could be explained by the limited access to sports facilities as well as the restriction of regular daily movement as a consequence of closing schools and thus curricular PA. Measures need to be established to ensure access to physical activity for children suffer-ing from heart disease during lockdowns.

Impact of coronavirus disease 2019 on functional capacity in paediatric congenital heart disease assessed by cardiopulmonary exercise test

Background and Aim: Since December 2019 the novel coronavirus disease 2019 (COVID-19) has been burdening all health systems worldwide. However, cardiopulmonary repercussions in paediat-ric patients with congenital heart disease (CHD) are unknown. The aim of this study is to compare changes in cardiopulmonary exercise test (CPET) in this patients before and after COVID-19. Method(s): Prospective observational study was lead comparing CPET results after COVID-19 in paediatric patients with stable CHD who had a previous routine CPET. All underwent for stand-ardised CPET, using Godfrey ramp protocol as recommended by the European Society of Cardiology (ESC). Measured variables, expressed by predicted values, were: forced vital capacity (FVC), forced expiratory volume (FEV1), ratio of minute venti-lation to carbon dioxide production (VE/VO2 slope), peak oxy-gen consumption (peak VO2), oxygen uptake efficiency slope (OUES), oxygen pulse (O2 pulse) and peak heart rate (pHR). Wilcoxon test was used to compare continuous variables for related samples. Result(s): Ten patients (6 boys, 60%;mean age 11,4 +/- 2,4 years) with hemodynamically stable CHD (3 Tetralogy of Fallot, 30%;2 trans-position of the great arteries, 20%;2 dilated cardiomyopathy, 20%;2 Kawasaki disease, 20%;1 cardiac tumor, 10%) were selected to repeat a post-COVID CPET. All of them had mild COVID and could follow ambulatory treatment. Comparing before/post COVID tests, there were no significantly changes in predicted res-piratory parameters: FVC (90,6 +/- 7,4 vs 98,1 +/- 23,9%;p = 0,799), FEV1 (89,5 +/- 13,8 vs 94,5 +/- 8,8%;p = 0,475), VE/CO2 slope (31,6 +/- 3,7 vs 30,6 +/- 3,9degree, p = 0,203). In the same way, no significantly changes were seen in cardiovascular predicted parameters: oxygen pulse (97,3 +/- 19,2 vs 98,5 +/- 17,4%, p = 0,798), peak VO2 (82,4 +/- 19,4 vs 76,8 +/- 13,7;p = 0,123) and OUES (1,79 +/- 0,4 vs 2,01 +/- 0,6;p = 0,066). Respect peak VO2, there was a non-significant slightly decrease in post-COVID test (82,4 +/- 19,4 vs 76,8 +/- 13,7;p = 0,123). Conclusion(s): In our series, post-COVID CPET results showed that paediatric patients with hemodynamically stable CHD had no impairment in their functional capacity in relation to Sars-CoV-2 disease. Contrary to adults with previous cardiovascular disease, children should have mild infections without sequelae in cardio-pulmonary function.

EFFECTS OF THE COVID-19 PANDEMIC ON CARDIOPULMONARY FUNCTION IN CHILDREN WITH CEREBRAL PALSY: A PRELIMINARY STUDY

The purpose of this study was to examine what effects the coronavirus disease 2019 (COVID-19) pandemic has on the cardiopulmonary endurance, heart rate and oxygen saturation in children with cerebral palsy (CP) during a 6-min walk test (6MWT). This study had a laboratory design and tested a single group pre- and post-COVID-19. A convenience sample of 8 participants with CP (three females;mean age±SD=13±6.4 years) that was recruited from a community-based rehabilitation center was enrolled in the current study. Due to COVID-19, no rehabilitation was provided by a physical therapist for two months as the participants stayed at home. The descriptive statistics and paired t-test were derived by examining the participants’ cardiopulmonary function via the Borg scale, 6MWT, heart rate and oxygen saturation, while they underwent rehabilitation versus the two months without rehabilitation due to COVID-19. The participants’ walking distances, oxygen saturation and heart rates were measured, and the Borg scale was used to assess the participants’ perceptions of their fatigue, breathlessness, and effort and exertion during the 6MWT. The descriptive statistical analysis demonstrated the following effects when comparing the post-COVID-19 results to those before the pandemic: greater distance on the 6 MWT test (0.69%), minimal changes in oxygen saturation (−0.3%) and increased heart rate (8.4%) and Borg scale values (19.4%). Paired t-test suggested that a significant difference was shown on the Borg scale (P=0.04) and heart rate (P=0.01). The results of this study provide clinical, evidence-based insights into the impact of the COVID-19 pandemic on cardiopulmonary function in children with CP. The clinical case series study demonstrated that after the COVID-19 pandemic, the participants with CP experienced increased heart rates and decreased minimal oxygen saturation, cardiopulmonary endurance. Recent advances in communication and information technology allow physical therapists to train and refine individually through remote rehabilitation. Exercise and combining VR remote education can be a way to maintain cardiopulmonary functions that have fallen due to the pandemic. [ FROM AUTHOR] Copyright of Journal of Mechanics in Medicine & Biology is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Corona-consequences: The impact of lockdown on cardiopulmonary function of children with congenital heart disease

Background: As a consequence of the COVID-19 lockdown physical activity (PA) was difficult to access. PA is essential for improving and maintaining cardiopulmonary function, assessed by cardiopulmonary exercise testing (CPET) as VO2 peak. VO2 peak is the best predictor for mortality and morbidity in patients with congenital heart disease (CHD). The question arises whether the COVID-19-lockdown led to a loss of cardiopulmonary function in typical cardiopediatric patients. Method: We conducted a retrospective study in which CPETs from before lockdown were compared with twin-paired tests during lockdown. The matching of the twins consisted of similar heart disease, comparable age, sex, and test method. The patients consisted of typical patients from our hospital. All tests were performed on either a treadmill or a bicycle. Results: We were able to twin-pair 90 tests leading to 45 twins. Overall, there were 38 healthy and 52 patients with CHD. A mean RER of more than 1.1 was achieved in both groups with comparable exercise times. There was a significant decrease of cardiopulmonary function in patients with CHD along with peak O2pulse and peak VEs ([Table]). Healthy children showed a nonsignificant increase of cardiopulmonary function. Conclusion: During lockdown cardiopulmonary function declined in our patients with CHD. Causes for this decline could be the lack of availability of sports facilities, restriction of regular daily movement, and the closing of schools and curricular PA. Interestingly, healthy children did not show this loss of cardiopulmonary function. Maybe this could point to more movement-oriented school concepts in the future.

A multi-disciplinary rehabilitation approach for people surviving severe COVID-19-a case series and literature review.

BACKGROUND/PURPOSE: COronaVIrus Disease 2019 (COVID-19) has caused tremendous casualties and morbidities worldwide. Multisystem manifestations, including muscle weakness, dyspnea, cognitive decline, dysphagia, and dysarthria are frequently reported among critically ill patients. The resultant activity limitations and participation restrictions call for an organized and multidisciplinary approach to rehabilitation. Taiwan had a rapid surge in community infection cases from May to July 2021, and our team established a team-based approach in response to the rehabilitation needs for the in-patients, especially the critically-ill group. METHODS: We built a core treatment team and established a referral pathway for critically ill patients with COVID-19 based on a multidisciplinary approach. The care process and outcomes of a case series of patients who received in-patient rehabilitation after medical stabilization were presented. RESULTS: Our clinical care module was established according to interim World Health Organization guidance and current research and demonstrated a high degree of feasibility. Five patients with multiple impairments received in-patient rehabilitation and experienced significant functional improvement. We documented improvements in motor function, swallowing function, and activities of daily living after the rehabilitation. CONCLUSION: Our clinical experience suggests considerable benefits can be obtained from a well-organized and multidisciplinary rehabilitation approach for severe COVID-19 patients.

Physiological Effects of Surgical and N95 Masks During Exercise in the COVID-19 era.

BACKGROUND: During the COVID-19 pandemic, studies of the physiological effects of masking during exercise have been rare. METHODS: Twelve healthcare workers performed a cardiopulmonary exercise test while wearing a surgical mask, an N95 mask, or no mask. Variables were collected at rest, warm-up, anaerobic threshold, and maximal exercise. RESULTS: From rest to maximal exercise, both the surgical and N95 masks decreased inspiratory flow, minute ventilation, and prolonged inspiratory time compared to the no mask condition. Oxygen uptake (VO2) and oxygen pulse (VO2/HR) decreased at rest, warm-up, and maximal exercise in both the surgical and N95 mask conditions (vs. no mask). At the anaerobic threshold, the surgical mask also led to a reduction of oxygen uptake and oxygen pulse compared to no mask. The maximal oxygen uptake (VO2% predicted) also decreased in both the surgical and N95 mask conditions. In addition, the severity of dyspnea increased, and exercise time decreased for both surgical and N95 masks. Compared to no mask, wearing an N95 mask led to lower breathing frequency and lower ventilation efficacy (assessed by VE/VCO2 and VE/VO2) from rest to maximal exercise (all p < 0.05 for trend). Wearing an N95 also led to retention of carbon dioxide (p < 0.05 for trend). CONCLUSIONS: Wearing a surgical mask leads to a somewhat negative impact on cardiopulmonary function, and this effect is more serious with an N95 mask. Attention should be paid to exercise while wearing surgical or N95 masks.

Long-term cardiopulmonary effects after Covid-19 infection

Introduction: The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic of 2020 has an influence on people's lives worldwide, impacting global health and putting pressure on health care systems. Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and long-term impairment after Covid-19 infection. Methods: This study was a prospective, multicenter registry study. Patients with verified COVID-19 infection, who were treated at our dedicated COVID hospital (Klinik Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During each study visit the following tests and investigations were performed: detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), pulmonary computed tomography (CT) scan, lung function test, spiroergometry and six-minute walk test (6MWT), and a comprehensive list of laboratory parameters including cardiac bio markers such as brain natriuretic peptide (NTpro BNP) and troponin T. Results: In this interim analysis of an ongoing trial, the first 65 patients are presented. Baseline values are shown in table 1: 34 (59%) were male and the median age was 48.5 years (36.4-59.3). 86% of all patients included so far had an only mild to moderate course of disease and 14% of them had a severe course and were admitted to our intensive care unit. At the time of the study visit, the majority of patients still complained about symptoms: 40% presented with fatigue and weakness, 36% with exertional dyspnea, 21% with vertigo, 17% had an impaired taste or smell. Only 28% were completely asymptomatic (figure 1). From a cardiac perspective, the only abnormal findings noted in echocardiography studies were reduced left ventricular global longitudinal strain. Cardiac MRI revealed pericardial effusion in 19%, however, these were only minimal (≤9mm) and not visible in echocardiography. Furthermore, cardiac MRI showed positive late gadolinium enhancement in 11%. Pulmonary function tests were abnormal in 16%. Pulmonary CT scans showed post infectious residues like bilateral ground glass opacities and fibrosis in 45%. Exercise capacity as measured by the 6-minute walk test with BORG Dyspnea Score and by spiroergometry was reduced in almost 40% of our study participants. Conclusions: This interim analysis showed that most previously hospitalized patients still suffer from chronic fatigue, exertional dyspnea and impaired cardiopulmonary function after Covid-19 infection. Furthermore, even though cardiac and pulmonary imaging revealed numerous pathologic findings, and exercise capacity was reduced, no correlations could be found with persisting symptoms.

Short-term outpatient follow-up of COVID-19 patients: A multidisciplinary approach.

BACKGROUND: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients.In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped. METHODS: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status. FINDINGS: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients. INTERPRETATION: Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role.