The effect of long-term oxygen therapy on 6-minute walking distance, clinical parameters and hemodynamics in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. A prospective, randomized, controlled trial (SOPHA Study)

Background Current recommendations suggest oxygen (O2) supplementation in patients with pulmonary hypertension (PH). The effect of long-term O2 administration is though merely investigated among these patients. Thus, the aim of this study is to investigate the effect of long term O2 treatment in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) on exercise capacity, clinical parameters and hemodynamics. Methods In this prospective, randomized, controlled trial, 20 patients with PAH or CTEPH under stable PH therapy experiencing O2 desaturations at rest and/or during physical activity will be randomised to receive O2 or standard of care (SoC) for 12 weeks. To patients receiving SoC, O2 therapy will be offered after 12 weeks (cross over design). The primary endpoint is the change of the distance walked in 6 minutes after 12 weeks of treatment. Secondary endpoints include change in clinical parameters and hemodynamics. Results Overall 20 patients (O2 n = 10 vs. SoC n = 10) have already been randomized and 15 have completed the study. Two patients died, one patient due to SARS-CoV2 pneumonia in the oxygen arm and one due to right heart failure in the SoC arm. The O2 therapy is so far well tolerated by all patients. Further results are expected in due course. The study is expected to be completed by the end of December 2022. Conclusion Oxygen therapy is well tolerated. Further results are expected soon. The effect of long-term oxygen supplementation should be furtherly investigated in larger controlled-trials.

Impact of COVID-19 Infection on Cardiorespiratory Fitness, Sleep, and Psychology of Endurance Athletes-CAESAR Study.

COVID-19 has a deteriorating impact on health which is especially important for endurance athletes (EAs) who need to maintain continuity of training. The illness affects sleep and psychology, which influence sport performance. The aims of this study were: (1) to assess the consequences of mild COVID-19 on sleep and psychology and (2) to assess the consequences of mild COVID-19 on cardiopulmonary exercise test (CPET) results. A total of 49 EAs (males = 43, 87.76%; females = 6, 12.24%; age = 39.9 ± 7.8 years; height = 178.4 ± 6.8 cm; weight = 76.3 ± 10.4 kg; BMI = 24.0 ± 2.6 kg·m-2) underwent a maximal cycling or running CPET pre- and post-COVID-19 and completed an original survey. Exercise performance deteriorated after COVID-19 (maximal oxygen uptake, VO2max = 47.81 ± 7.81 vs. 44.97 ± 7.00 mL·kg·min-1 pre- and post-infection, respectively; p < 0.001). Waking up at night affected the heart rate (HR) at the respiratory compensation point (RCP) (p = 0.028). Sleep time influenced pulmonary ventilation (p = 0.013), breathing frequency (p = 0.010), and blood lactate concentration (Lac) (p = 0.013) at the RCP. The maximal power/speed (p = 0.046) and HR (p = 0.070) were linked to the quality of sleep. Stress management and relaxation techniques were linked with VO2max (p = 0.046), maximal power/speed (p = 0.033), and maximal Lac (p = 0.045). Cardiorespiratory fitness deteriorated after mild COVID-19 and was correlated with sleep and psychological indices. Medical professionals should encourage EAs to maintain proper mental health and sleep after COVID-19 infection to facilitate recovery.

Impaired Neuromuscular Efficiency and Symptom-Limited Aerobic Exercise Capacity 4 Weeks After Recovery From COVID-19 Appear to Be Associated With Disease Severity at Onset.

OBJECTIVE: The objectives of this study were to evaluate neuromuscular recruitment and efficiency in participants who recovered from COVID-19 and assess the association between neuromuscular efficiency and symptom-limited aerobic exercise capacity. METHODS: Participants who recovered from mild (n = 31) and severe (n = 17) COVID-19 were evaluated and compared with a reference group (n = 15). Participants underwent symptom-limited ergometer exercise testing with simultaneous electromyography evaluation after a 4-week recovery period. Activation of muscle fiber types IIa and IIb and neuromuscular efficiency (watts/percentage of root-mean-square obtained at the maximum effort) were determined from electromyography of the right vastus lateralis. RESULTS: Participants who had recovered from severe COVID-19 had lower power output and higher neuromuscular activity than the reference group and those who had recovered from mild COVID-19. Type IIa and IIb fibers were activated at a lower power output in participants who had recovered from severe COVID-19 than in the reference group and those who had recovered from mild COVID-19, with large effect sizes (0.40 for type IIa and 0.48 for type IIb). Neuromuscular efficiency was lower in participants who had recovered from severe COVID-19 than in the reference group and those who had recovered from mild COVID-19, with a large effect size (0.45). Neuromuscular efficiency showed a correlation with symptom-limited aerobic exercise capacity (r = 0.83). No differences were observed between participants who had recovered from mild COVID-19 and the reference group for any variables. CONCLUSION: This physiological observational study supports the notion that more severe COVID-19 symptoms at disease onset appear to correspondingly impair neuromuscular efficiency in survivors over a short time frame of 4 weeks after recovery, potentially contributing to reduced cardiorespiratory capacity. Further studies are needed to replicate and extend these findings with respect to their clinical implications for assessment/evaluation and interventions. IMPACT: After 4 weeks of recovery, neuromuscular impairment is particularly evident in severe cases; this problem may contribute to reduced cardiopulmonary exercise capacity.

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.

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.

Sympathetic Neural Overdrive, Aortic Stiffening, Endothelial Dysfunction, and Impaired Exercise Capacity in Severe COVID-19 Survivors: A Mid-Term Study of Cardiovascular Sequelae.

BACKGROUND: COVID-19 has become a dramatic health problem during this century. In addition to high mortality rate, COVID-19 survivors are at increased risk for cardiovascular diseases 1-year after infection. Explanations for these manifestations are still unclear but can involve a constellation of biological alterations. We hypothesized that COVID-19 survivors compared with controls exhibit sympathetic overdrive, vascular dysfunction, cardiac morpho-functional changes, impaired exercise capacity, and increased oxidative stress. METHODS: Nineteen severe COVID-19 survivors and 19 well-matched controls completed the study. Muscle sympathetic nerve activity (microneurography), brachial artery flow-mediated dilation and blood flow (Doppler-Ultrasound), carotid-femoral pulse wave velocity (Complior), cardiac morpho-functional parameters (echocardiography), peak oxygen uptake (cardiopulmonary exercise testing), and oxidative stress were measured ~3 months after hospital discharge. Complementary experiments were conducted on human umbilical vein endothelial cells cultured with plasma samples from subjects. RESULTS: Muscle sympathetic nerve activity and carotid-femoral pulse wave velocity were greater and brachial artery flow-mediated dilation, brachial artery blood flow, E/e' ratio, and peak oxygen uptake were lower in COVID-19 survivors than in controls. COVID-19 survivors had lower circulating antioxidant markers compared with controls, but there were no differences in plasma-treated human umbilical vein endothelial cells nitric oxide production and reactive oxygen species bioactivity. Diminished peak oxygen uptake was associated with sympathetic overdrive, vascular dysfunction, and reduced diastolic function in COVID-19 survivors. CONCLUSIONS: Our study revealed that COVID-19 survivors have sympathetic overactivation, vascular dysfunction, cardiac morpho-functional changes, and reduced exercise capacity. These findings indicate the need for further investigation to determine whether these manifestations are persistent longer-term and their impact on the cardiovascular health of COVID-19 survivors.

Effect of Pulmonary Rehabilitation for Patients With Post-COVID-19: A Systematic Review and Meta-Analysis.

Background: Evidence increasingly suggested that impaired respiratory function remained in about 40% of patients with coronavirus disease 2019 (COVID-19) after discharge, jeopardizing their activities of daily living and quality of life (QoL) in a long term. Pulmonary rehabilitation (PR) can improve exercise capacity and QoL in individuals with chronic lung disease; however, evidence on the effect of PR for patients with post-COIVD-19 was scarce. This study aimed to conduct a systematic review and meta-analysis to evaluate the effect of PR on lung impairment for patients with post-COVID-19. Methods: Five databases were searched for all the published trials of PR for patients with post-COVID-19 from 2019 to October 2021. Data were extracted using a standardized form. The risks of bias of included studies were assessed using the Cochrane risk of the bias assessment tool. Data were synthesized where possible; otherwise, qualitative analysis was done. Results: Among 6,000 retrieved studies, 3 studies with 233 patients after COVID-19 were included. The pooled estimate of PR effect on 6-min walk test (6-MWT) (50.41, 95% CI 34.34 to 66.48; p < 0.0001) was in favor of the experiment group with clinical importance. It is found that PR could improve the symptom of dyspnea and QoL; however, its effect on pulmonary function test was inconsistent across studies. The risk of bias of included studies varied, with major concerns on the risk of blinding of participants and interventions performers. Conclusion: The review showed that PR could improve exercise capacity measured by 6-MWT among patients with mild-to-moderate lung impairment after COVID-19. The interpretation of effects on lung function, dyspnea, and QoL should be cautious due to inadequate and conflicting data reported across studies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289562, identifier: CRD42021289562.

Repeated cardiopulmonary performance measurements in young competitive handball players with and without SARS-CoV-2 infection.

BACKGROUND: The SARS-CoV-2 virus and its long-term consequences in adolescents have a global impact on upcoming medical issues. The aim of this study was to investigate the effects of a SARS-CoV-2 infection on cardiorespiratory parameters in young athletes. METHODS: In a cohort study involving repeated measurements during a six-month period, cardiorespiratory parameters were assessed in infected (SCoV) and non-infected (noSCoV) athletes. We evaluated handball players (17.2 ± 1.0 years) via performance diagnostics and a specific examination after a SARS-CoV-2 infection or without. RESULTS: We observed no significant differences between the two groups at the first visit. But between the first and second visit, the SCoV group's maximum power output was significantly lower than the noSCoV group's (- 48.3 ± 12.5; p ≤ 0.01 vs. - 15.0 ± 26.0 W; p = 0.09). At the second visit, lung diffusion capacity (DLCO/VA, %predicted) did not differ between groups (111.6 ± 11.5 vs. 116.1 ± 11.8%; p = 0.45). HR during comparative stress showed no group differences. The SCoV group's mean oxygen uptake during incremental exercise was lower (Two-way-ANOVA: 1912 vs. 2106 ml; p ≤ 0.01; mean difference: - 194 ml; 95% CI - 317 to - 71); we also noted a significantly lower stroke volume course during exercise (Two-way-ANAOVA: 147.5 vs. 169.5 ml; mean difference: - 22 ml; p ≤ 0.01; 95% CI - 34.2 to - 9.9). The probability of premature ventricular complexes after a SARS-CoV-2 infection yielded an odds ratio of 1.6 (95% CI 0.24-10.81). CONCLUSIONS: The physical performance of young athletes infected with SARS-CoV-2 was impaired. This decreased performance is probably due to cardiac and/or peripheral deconditioning. Studies with larger cohorts are needed to make more profound conclusions.

Pulmonary Rehabilitation in Patients with COVID-19-A Protocol for Systematic Review and Meta-Analysis.

INTRODUCTION: Pulmonary rehabilitation (PR) is a well-established treatment for patients with chronic lung disease; however, its role in patients with COVID-19 has not been systematically studied. We provide a protocol outlining the methods and analyses that will be used in the systematic review. METHODS: The methodology of this systematic review protocol has been filed in PROSPERO under the registration number CRD42022301418. Five electronic databases (PubMed, Web of Science, Cochrane Library, EBSCO, and CNKI databases) will be searched from 2019 to 28 July 2022, using pre-determined search terms. Eligibility criteria will be defined using a PICOS framework. Pulmonary function, exercise capacity, and health-related quality of life will be the primary outcomes. Quantitative findings will be narratively synthesized, whilst argument synthesis combined with refutational analysis will be employed to synthesize qualitative data. RESULTS: The results will be presented by both meta-analysis and qualitative analysis. CONCLUSION: This protocol describes what will be the first systematic review to conduct a worldwide assessment of the effect of PR in patients with COVID-19. Because this is a systematic review and meta-analysis, no ethical approval is needed. The systematic review and meta-analysis will be published in a peer-reviewed journal and disseminated both electronically and in print.

Effect of Pulmonary Rehabilitation Approaches on Dyspnea, Exercise Capacity, Fatigue, Lung Functions, and Quality of Life in Patients With COVID-19: A Systematic Review and Meta-analysis.

OBJECTIVE: To qualitatively synthesize and quantitatively evaluate the effect of pulmonary rehabilitation (PR) on dyspnea, lung functions, fatigue, exercise capacity, and quality of life (QoL) in patients with COVID-19. DATA SOURCES: PubMed, Web of Science, and Cochrane databases were searched from January 2020 to April 2022. DATA SELECTION: Randomized controlled trials (RCTs) assessing the effect of PR on dyspnea, lung functions, fatigue, exercise capacity, and QoL in patients with COVID-19. DATA EXTRACTION: The mean difference (MD) and a 95% CI were estimated for all the outcome measures using random effect models. The following data were extracted by 2 independent reviewers: (1) first author; (2) publication year; (3) nationality; (4) number of patients included (5) comorbidities; (6) ventilatory support; (7) length of inpatient stay; (8) type of PR; (9) outcome measures; and (10) main findings. The risk of bias was evaluated using the cochrane risk of bias tool. DATA SYNTHESIS: A total of 8 RCTs involving 449 participants were included in the review. PR was found to be significantly effective in improving dyspnea (5 studies, SMD -2.11 [95% CI, -2.96 to -1.27; P<.001]) and exercise capacity (MD 65.85 m [95% CI, 42.86 to 88.83; P<.001]) in patients with both acute and chronic COVID-19 with mild to severe symptoms, whereas fatigue (MD -2.42 [95% CI, -2.72 to -2.11, P<.05]) and lung functions (MD 0.26 L [95% CI, 0.04 to 0.48, P<.05]) were significantly improved in acute COVID-19 patients with mild symptoms. The effect of PR on QoL was inconsistent across studies. PR was found to be safe and feasible for patients with COVID-19. CONCLUSION: Evidence from studies indicates that PR program is superior to no intervention in improving dyspnea, exercise capacity, lung functions, and fatigue in patients with COVID-19. PR appears to be safe and beneficial for both acute and chronic COVID-19 patients.

Predictors of Prolonged Cardiopulmonary Exercise Impairment After COVID-19 Infection: A Prospective Observational Study.

Objectives: Coronavirus disease 2019 (COVID-19) is a global pandemic affecting individuals to varying degrees. There is emerging evidence that even patients with mild symptoms will suffer from prolonged physical impairment. Methods: In this prospective observational study, lung function, and cardiopulmonary exercise testing have been performed in 100 patients for 3-6 months after COVID-19 diagnosis (post-CoVG). Depending on the severity of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, patients were divided into asymptomatic, or mild to moderate (mild post-CoVG), and severe post-CoVG [hospitalization with or without intensive care unit/non-invasive ventilation (ICU/NIV)]. Results have been compared with age, sex, and body mass index (BMI) matched control group (CG, N = 50). Results: Both lung function (resting) and exercise capacity (peak workload, Wpeak and peak oxygen uptake, VO2 peak - % predicted) were considerably affected in patients with severe post-CoV (81.7 ± 27.6 and 86.1 ± 20.6%), compared to the mild post-CoVG (104.8 ± 24.0%, p = 0.001 and 100.4 ± 24.8; p = 0.003). In addition, also the submaximal exercise performance was significantly reduced in the severe post-CoVG (predicted VT1/VO2 peak; p = 0.013 and VT2/VO2 peak; p = 0.001). Multiple linear regression analyses revealed that 74 % (adjusted R 2) of the variance in relative VO2 peak of patients who had CoV could be explained by the following variables: lower age, male sex, lower BMI, higher DLCO, higher predicted heart rate (HR) peak, lower breathing reserve (BR), and lower SaO2 peak, which were related to higher relative VO2 peak values. Higher NT-proBNP and lower creatinine kinase (CK) values were seen in severe cases compared to patients who experienced mild CoV. Discussion: Maximal and submaximal exercise performance in patients recovering from severe COVID-19 remain negatively affected for 3-6 months after COVID-19 diagnosis. The presented findings reveal that impaired pulmonary, cardiac, and skeletal muscle function contributed to the limitation of VO2 peak in those patients, which may have important implications on rehabilitation programs.

The 6-Minute Walk Test: Indications and Guidelines for Use in Outpatient Practices.

The 6-Minute Walk Test (6MWT) is a standardized tool used to measure lung impairment. It is used in outpatient primary and pulmonary practices to objectively assess functional exercise capacity and hypoxemia in patients with chronic lung disease. Screening for functional decrease in exercise tolerance and hypoxemia aids in initiating and maintaining the use of oxygen supplementation to improve functional improvement in chronic lung patients. It has new applications for recovering COVID-19 pneumonia patients to assess for clinical compromise. Discussion includes elements and guideline recommendations for 6MWT, indications for use, appropriate patient populations appropriate, safety, coding, and current reimbursement insurance guidelines.

Effect of COVID-19 Infection on the Functional Exercise Capacity and Echocardiographic Findings of Healthcare Workers

Objective: COVID-19 disease has affected all segments of society, especially healthcare workers. We aimed to evaluate the exercise capacity and cardiac functions of healthcare workers who had COVID-19 infection. Methods: Forty healthcare workers with COVID-19 infection (21 females, 19 males), who have completed their treatment, were assessed on the 30th day of recovery. Twenty healthy volunteers were matched as a control group. Exercise capacity was measured using the sixminute walk test (6MWT). The results of 6MWT were given as an absolute value in meters. Cardiac functions were evaluated by echocardiography. Results: Walking distances were similar in both healthcare workers with COVID-19 and healthy controls. 0´ pulse and 6´ pulse were significantly high in healthcare workers, whereas 0´ SpO2 was low in 6MWT. The thorax CT findings showed a positive correlation with the total number of symptoms and clinical severity. Ejection fraction (EF) showed a negative correlation with 6´ pulse, and the right atrial area revealed a negative correlation with 6´ SO2. The mean distance in 6MWT performed by inpatients and outpatients was 546.9±36.8 m vs 511.8±54.0 m, respectively. The walking distance and EF of outpatients were lower than inpatients. Enoxaparin treatment was independently associated with walking distance and EF. Conclusion: COVID-19 infection and hospitalization status affect cardiac functions and physical functional capacity. In our study, we showed that prophylactic enoxaparin use was the strongest independent factor affecting EF and walking distance in healthcare workers with mild to moderate COVID-19 infection. We think that it is important to follow up with healthcare professionals in terms of possible impairments in cardiac function and exercise capacity after COVID-19 infection. (English) [ FROM AUTHOR] Amaç: COVID-19 enfeksiyonu, başta sağlık çalışanları olmak üzere toplumun tüm kesimlerini etkilemiştir. COVID-19 enfeksiyonu olan sağlık çalışanlarının egzersiz kapasitesini ve kalp fonksiyonlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: COVID-19 enfeksiyonlu (21 kadın, 19 erkek) tedavilerini tamamlayan 40 sağlık çalışanı, iyileşmelerinin otuzuncu gününde değerlendirildi. Yirmi sağlıklı gönüllü kontrol grubu olarak eşleştirildi. Egzersiz kapasitesi altı dakika yürüme testi (6DYT) ile ölçüldü. 6DYT sonuçları metre cinsinden mutlak değer olarak verildi. Kalp fonksiyonları ekokardiyografi ile değerlendirildi. Bulgular: COVID-19 enfeksiyonu geçirmiş sağlık çalışanları ve sağlıklı kontrollerde yürüme mesafesi benzerdi. Sağlık çalışanlarında 0' nabız ve 6' nabız anlamlı olarak yüksek, 6DYT'de 0' SpO2 düşüktü. Toraks BT bulguları, toplam semptom sayısı ve klinik şiddet ile pozitif korelasyon gösterdi. Ejeksiyon fraksiyonu (EF) 6' nabız ile negatif korelasyon ve RA alanı 6' SO2 ile negatif korelasyon bulundu. Yatan hastalar ve ayaktan hastalar tarafından yapılan 6DYT'de ortalama mesafe sırasıyla 546.9±36.8m ve 511.8±54.0m idi. Ayaktan hastaların yürüme mesafesi ve EF'si yatan hastalara göre daha düşüktü. Enoksaparin tedavisi bağımsız olarak yürüme mesafesi ve EF ile ilişkiliydi. Sonuç: COVID-19 enfeksiyonu ve hastanede yatış durumu, kardiyak fonksiyonları ve fiziksel fonksiyonel kapasiteyi etkilemektedir. Çalışmamızda, hafif ve orta dereceli COVID-19 enfeksiyonu geçirmiş sağlık çalışanlarında, EF ve yürüme mesafesini etkileyen en güçlü bağımsız faktörün profilaktik enoksaparin kullanımı olduğunu gösterdik. Sağlık çalışanlarının COVID-19 enfeksiyonu sonrası kardiyak fonksiyon ve egzersiz kapasitesinde olası sorunlar açısından takibinin önemli olduğu düşünmekteyiz. (Turkish) [ FROM AUTHOR] Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing 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.)

Intrinsic Exercise Capacity Affects Glycine and Angiotensin-Converting Enzyme 2 (ACE2) Levels in Sedentary and Exercise Trained Rats.

Angiotensin-converting enzyme 2 (ACE2) has been identified as the cellular entry receptor for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). High ACE2 tissue expression and low glycine levels were suggested to increase susceptibility for SARS-CoV-2 infection and increasing circulating ACE2 has been proposed as one possible strategy to combat COVID-19. In humans, aerobic physical exercise induces an increase in plasma ACE2 in some individuals. However, it is not clear whether glycine and ACE2 levels depend on intrinsic exercise capacity or on exercise training. We used rats selectively bred for high intrinsic exercise capacity (HCR) or low exercise capacity (LCR) and tested the influence of this genetic predetermination and/or aerobic exercise on metabolites, ACE2 tissue expression and circulating ACE 2. ACE2 expression was measured in different tissues in the sedentary animals and again after 4 weeks of high-intensity aerobic exercise in both LCRs and HCRs. Sedentary HCRs exhibited significantly higher circulating ACE2 concentrations compared to LCRs, but a lower expression of ACE2 in all investigated tissues except for adipose tissue. Body weight was negatively correlated with serum ACE2 and positively correlated with ACE2 expression in the heart. Aerobic exercise caused a significant decrease in ACE2 expression in the lung, heart, muscle, and kidney both in LCRs and HCRs. Our results suggest that ACE2 expression, circulating ACE2 and glycine serum concentration are related to aerobic intrinsic exercise capacity and can be influenced with exercise. These results may support the hypothesis that physically fit individuals have a lower susceptibility for COVID-19 infection.

Lung function and exercise capacity 6 months after hospital discharge for critical COVID-19.

BACKGROUND: The significant morbidity caused by COVID-19 necessitates further understanding of long-term recovery. Our aim was to evaluate long-term lung function, exercise capacity, and radiological findings in patients after critical COVID-19. METHODS: Patients who received treatment in ICU for COVID-19 between March 2020 and January 2021 underwent pulmonary function tests, a 6MWD and CXR 6 months after hospital discharge. RESULTS: A restrictive ventilatory defect was found in 35% (23/65) and an impaired diffusing capacity in 52% (32/62) at 6 months. The 6-minute walk distance was reduced in 33% (18/55), and 7% (4/55) of the patients had reduced exercise capacity. Chest X-ray was abnormal in 78% (52/67) at 6 months after hospital discharge. CONCLUSION: A significant number of patients had persisting lung function impairment and radiological abnormalities at 6 months after critical COVID-19. Reduced exercise capacity was rare.

The effect of medium-term recovery status after COVID-19 illness on cardiopulmonary exercise capacity in a physically active adult population.

A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high-functioning populations ranging from frontline emergency services to professional or amateur/recreational athletes. The aim of the study is to describe the medium-term cardiopulmonary exercise profiles of individuals with "persistent symptoms" and individuals who feel "recovered" after hospitalization or mild-moderate community infection following COVID-19 to an age, sex, and job-role matched control group. A total of 113 participants underwent cardiopulmonary functional tests at a mean of 159 ± 7 days (∼5 mo) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered); and 26 controls. Hospitalized groups had the least favorable body composition (body mass, body mass index, and waist circumference) compared with controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇o2) at peak exercise (hospitalized-symptomatic, 29.9 ± 5.0 mL/kg/min; community-symptomatic, 34.4 ± 7.2 mL/kg/min; vs. control 43.9 ± 3.1 mL/kg/min, both P < 0.001). Hospitalized-symptomatic individuals had a steeper V̇e/V̇co2 slope (lower ventilatory efficiency) (30.5 ± 5.3 vs. 25.5 ± 2.6, P = 0.003) versus. controls. Hospitalized-recovered had a significantly lower oxygen uptake at peak (32.6 ± 6.6 mL/kg/min vs. 43.9 ± 13.1 mL/kg/min, P = 0.015) compared with controls. No significant differences were reported between community-recovered individuals and controls in any cardiopulmonary parameter. In conclusion, medium-term findings suggest that community-recovered individuals did not differ in cardiopulmonary fitness from physically active healthy controls. This suggests their readiness to return to higher levels of physical activity. However, the hospitalized-recovered group and both groups with persistent symptoms had enduring functional limitations, warranting further monitoring, rehabilitation, and recovery.NEW & NOTEWORTHY At 5 mo postinfection, community-treated individuals who feel recovered have comparable cardiopulmonary exercise profiles to the physically trained and active controls, suggesting a readiness to return to higher intensity/volumes of exercise. However, both symptomatic groups and the hospital-recovered group have persistent functional limitations when compared with active controls, supporting the requirement for ongoing monitoring, rehabilitation, and recovery.

Effects of surgical facemasks on perceived exertion during submaximal exercise test in healthy children.

Only a few data associated to wearability of facemask during exercise are available in children. The aim of the study was to evaluate the effect of wearing a facemask on perceived exertion (primary aim), dyspnea, physical performance, and cardiorespiratory response during a submaximal exercise test in children aged between 8 and 12 years. This study was performed in 2021 in healthy volunteer children from 8 to 12 years. They performed prospectively two 1-min sit-to-stand tests (STST), with or without a surgical facemask. The perceived exertion (modified Borg scale), dyspnea (Dalhousie scale), heart rate, and pulsed oxygen saturation were recorded before and after STST. The STST measured the submaximal performance. Thirty-eight healthy children were recruited (8-9 years: n = 19 and 10-11 years: n = 19). After the STST, the perceived exertion increased with or without a facemask (8-9 years group: + 1 [0.6; 1.4] and + 1.6 [1.0; 2.1] - 10-11 years group: + 1.3 [0.7; 1.8] and + 1.9 [1.3; 2.6]) and it was higher with the facemask. The difference between the two conditions in perceived exertion was not clinically relevant in any group (mBorgf: 0.56 pts and 0.68 pts, respectively). The different domains of dyspnea assessed with Dalhousie scale were not influenced by the facemask. The submaximal performance measured by the STST was not changed by the mask whatever the age group. The cardio-respiratory demand was not clinically modified.Conclusion: The surgical facemask had no impact on dyspnea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise in healthy children.