Effects of pulmonary rehabilitation on major symptoms of long COVID (post-COVID-19 syndrome)

Several months after COVID-19 infection, a high proportion of patients complains of persistent symptoms (long COVID). Regardless of acute disease severity, dyspnea and fatigue are part of major symptoms. Spontaneous recovery is unlikely without any intervention. Thus, our aim was to assess the feasibility and efficacy of a pulmonary rehabilitation (PR) program to relieve these symptoms. 39 patients with a documented COVID-19 infection and suffering from persistent symptoms were included. They took part in PR program between Feb.-Dec. 2021. The program comprised, at the very least, 18 endurance and 10 resistance training sessions and 6 educational sessions (dyspnea management, psychological support and counselling). Exercise tolerance (ET), dyspnea (D-12), fatigue (MFI-20) and quality of life (QoL) were assessed by questionnaires before (T1) and after (T2) PR. Main delay between first symptoms and PR enrolment was 297+/-131 days. Main symptoms were dyspnea (n=34), fatigue (n=29), concentration disorders (n=16) and musculoskeletal pain (n=15). After PR, D-12 and MFI-20 decreased significantly (T1:15.5+/-8;T2: 8.3+/-5.6;p<.05 and T1: 65.6+/-14.3;T2:53.2+/-12.8;p<.05, respectively). In addition, QoL, through physical (PCS) and mental (MCS) dimensions, and ET significantly improved (PCS (T1): 34.8+/-9.7;PCS (T2): 42.7+/-8.3;p<.01;MCS (T1): 40.3+/-9.3;MCS (T2): 48.8+/-8.5;p<.01 and T1: 516.6+/-131.6 m;T2: 602.6+/-118.8 m;p<.05, respectively). PR appears to be a safe, feasible and efficient therapy to relieve dyspnea and fatigue in patients with residual symptoms of COVID-19 several months after initial infection. In addition, PR allows a significant improvement in ET and QoL for these patients.

Tolerability and safety of high-intensity continuous and intermittent exercise in COVID-19

Aim: We assessed safety of high-intensity [IV1] constant-load exercise (CLE) and intermittent exercise (HIIT) in 14 post-severe-COVID-19 patients (63+/-13 years;78.6% male;BMI: 28+/-5, without comorbidities) between July 2020 and April 2021 after 55+/-22 days of COVID-induced acute respiratory failure. Method(s): The crossover study balanced exercise intensity between CLE at 70% of peak work rate (WRpeak) to the limit of tolerance (Tlim) and HIIT including 1 min exercise at 100% WRpeak, alternated with 1 min at 40% WRpeak to Tlim. Gas exchange, ventilation, electrocardiography and symptoms were assessed. Result(s): Exercise endurance time and total work output were not different between HITT and CLE (Table 1). At Tlim, none of the ventilatory or cardiovascular responses differed between HITT and CLE and there was no difference in the intensity of symptoms (Table 1). Conclusion(s): Individuals with ongoing symptomatic COVID-19 could safely undertake high intensity exercise performed continuously or intermittently.

Exercise effects on cardiovascular disease: from basic aspects to clinical evidence.

Cardiovascular (CV) disease (CVD) remains the leading cause of major morbidity and CVD- and all-cause mortality in most of the world. It is now clear that regular physical activity (PA) and exercise training (ET) induces a wide range of direct and indirect physiologic adaptations and pleiotropic benefits for human general and CV health. Generally, higher levels of PA, ET, and cardiorespiratory fitness (CRF) are correlated with reduced risk of CVD, including myocardial infarction, CVD-related death, and all-cause mortality. Although exact details regarding the ideal doses of ET, including resistance and, especially, aerobic ET, as well as the potential adverse effects of extreme levels of ET, continue to be investigated, there is no question that most of the world's population have insufficient levels of PA/ET, and many also have lower than ideal levels of CRF. Therefore, assessment and promotion of PA, ET, and efforts to improve levels of CRF should be integrated into all health professionals' practices worldwide. In this state-of-the-art review, we discuss the exercise effects on many areas related to CVD, from basic aspects to clinical practice.

Effects of endurance training on the expression of host proteins involved in SARS-CoV-2 cell entry in C57BL/6J mouse.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is threatening people's lives and impacting their health. It is still unclear whether people engaged in physical activity are at an increased risk of SARS-CoV-2 infection and severe forms of COVID-19. In order to provide data to help answer this question, we, therefore, investigated the effects of endurance training on the levels of host proteins involved in SARS-CoV-2 infection in mice. Eight-week-old C57BL/6J mice were subjected to treadmill running (17-25 m/min, 60-90 min, 5 sessions/week, 8 weeks). After the intervention, the levels of angiotensin-converting enzyme 2 (ACE2; host receptor for SARS-CoV-2), transmembrane protease serine 2 (TMPRSS2; host protease priming fusion of SARS-CoV-2 to host cell membranes), FURIN (host protease that promotes binding of SARS-CoV-2 to host receptors), and Neuropilin-1 (host coreceptor for SARS-CoV-2) were measured in 10 organs that SARS-CoV-2 can infect (larynx, trachea, lung, heart, jejunum, ileum, colon, liver, kidney, and testis). Six organs (heart, lung, jejunum, liver, trachea, and ileum) showed changes in the levels of at least one of the proteins. Endurance training increased ACE2 levels in heart (+66.4%), lung (+37.1%), jejunum (+24.7%) and liver (+27.4%), and FURIN in liver (+17.9%) tissue. In contrast, endurance training decreased Neuropilin-1 levels in liver (-39.7%), trachea (-41.2%), and ileum (-39.7%), and TMPRSS2 in lung (-11.3%). Taken together, endurance training altered the levels of host proteins involved in SARS-CoV-2 cell entry in an organ-dependent manner.