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1.
Nutrients ; 14(15)2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1957399

ABSTRACT

COVID-19 is not only a short-term infection, as patients (pts) recovering from SARS-CoV-2 infection complain of persisting symptoms, which may lead to chronic fatigue syndrome. There is currently no evidence that nutritional supplements can assist in the recovery of pts with chronic fatigue syndrome. 1-Methylnicotinamide (1-MNA) is an endogenic substance that is produced in the liver when nicotinic acid is metabolized. 1-MNA demonstrates anti-inflammatory and anti-thrombotic properties. Therefore, we investigated whether 1-MNA supplements could improve exercise tolerance and decrease fatigue among patients recovering from SARS-CoV-2. METHODS: The study population was composed of 50 pts who had recovered from symptomatic COVID-19. The selected pts were randomized into two groups: Gr 1 (NO-1-MNA)-without supplementation; Gr 2 (1-MNA) with 1-MNA supplementation. At the beginning of the study (Phase 0), in both groups, a 6-minute walk test (6MWT) was carried out and fatigue assessment was performed using the Fatigue Severity Scale (FSS). Both FSS and 6MWT were repeated after 1 month. RESULTS: A significant improvement in the mean distance covered in the 6MWT was noted at follow-up in Gr 1-MNA, compared with Gr NO-1-MNA. We also noted that in Gr 1-MNA, the 6MWT distance was significantly higher after 1 month of supplementation with 1-MNA, compared with the beginning of the study (515.18 m in Phase 0 vs. 557.8 m in Phase 1; p = 0.000034). In Gr 1-MNA, significantly more pts improved their distance in the 6MWT (23 out of 25 pts, equal to 92%), by a mean of 47 m, compared with Gr NO-1-MNA (15 of 25 pts, equal to 60%) (p = 0.0061). After one month, significantly more patients in the group without 1-MNA had severe fatigue (FSS ≥ 4) compared with the group with supplementation (Gr 1-MNA = 5 pts (20%) vs. Gr NO-1-MNA = 14pts (56%); p = 0.008). CONCLUSIONS: 1-MNA supplementation significantly improved physical performance in a 6-min walk test and reduced the percentage of patients with severe fatigue after COVID-19. The comprehensive action of 1-MNA, including anti-inflammatory and anticoagulant effects, may be beneficial for the recovery of patients with persistent symptoms of fatigue and low tolerance to exercise after COVID-19.


Subject(s)
COVID-19 , Fatigue Syndrome, Chronic , COVID-19/complications , Exercise Test , Exercise Tolerance , Humans , SARS-CoV-2
2.
Braz J Med Biol Res ; 55: e12118, 2022.
Article in English | MEDLINE | ID: covidwho-1951676

ABSTRACT

The goal of the present study was to compare pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) performance in COVID-19 survivors with a control group (CG). This was a cross-sectional study. Patients diagnosed with COVID-19, without severe signs and symptoms, were evaluated one month after the infection. Healthy volunteers matched for sex and age constituted the control group. All volunteers underwent the following assessments: i) clinical evaluation, ii) PTF; and iii) CPET on a cycle ergometer. Metabolic variables were measured by the CareFusion Oxycon Mobile device. In addition, heart rate responses, peak systolic and diastolic blood pressure, and perceived exertion were recorded. Twenty-nine patients with COVID-19 and 18 healthy control subjects were evaluated. Surviving patients of COVID-19 had a mean age of 40 years and had higher body mass index and persistent symptoms compared to the CG (P<0.05), but patients with COVID-19 had more comorbidities, number of medications, and greater impairment of lung function (P<0.05). Regarding CPET, patients surviving COVID-19 had reduced peak workload, oxygen uptake (V̇O2), carbon dioxide output (V̇CO2), circulatory power (CP), and end-tidal pressure for carbon dioxide (PETCO2) (P<0.05). Additionally, survivors had depressed chronotropic and ventilatory responses, low peak oxygen saturation, and greater muscle fatigue (P<0.05) compared to CG. Despite not showing signs and symptoms of severe disease during infection, adult survivors had losses of lung function and cardiorespiratory capacity one month after recovery from COVID-19. In addition, cardiovascular, ventilatory, and lower limb fatigue responses were the main exercise limitations.


Subject(s)
COVID-19 , Cardiorespiratory Fitness , Adult , Carbon Dioxide/metabolism , Cross-Sectional Studies , Exercise Test , Exercise Tolerance/physiology , Humans , Middle Aged , Oxygen Consumption/physiology
3.
PLoS One ; 17(5): e0268589, 2022.
Article in English | MEDLINE | ID: covidwho-1933280

ABSTRACT

OBJECTIVES: We aimed to compare the effects of different aerobic exercise training (ET) programs on respiratory performance, exercise capacity, and quality of life in fibrosing interstitial lung diseases (f-ILD). METHODS: A case-control study where 31 patients with f-ILD diagnosis based on chest high-resolution computed tomography were recruited from Main Alexandria University hospital-Egypt. Ten patients were randomly assigned for only lower limbs (LL) endurance training program, and 10 patients for upper limbs, lower limbs, and breathing exercises (ULB) program for consecutive 18 sessions (3 sessions/week for 6 consecutive weeks). Eleven patients who refused to participate in the ET program were considered as control. All patients were subjected for St George's respiratory questionnaire (SGRQ), 6-minute walk test (6-MWT), forced spirometry and cardiopulmonary exercise testing (CPET) before and after ET programs. RESULTS: Fibrosing non-specific interstitial pneumonia (NSIP) and collagenic associated-ILD were the commonest pathologies among the ET groups (30% each) with mean age of 44.4±12.25 and 41.90±7.58 years for LL and ULB groups respectively and moderate-to-severe lung restriction. 6-MWT and SGRQ significantly improved after both ET programs (p<0.001). Peak oxygen consumption (VO2) improved significantly after both LL training (median of 22 (interquartile range (IQR) = 17.0-24.0) vs. 17.5 (IQR = 13.0-23.0) ml/kg/min, p = 0.032) and ULB training (median of 13.5 (IQR = 11.0-21.0) vs. 10.5 (IQR = 5.0-16.0) ml/kg/min, p = 0.018). Further, maximal work load and minute ventilation (VE) significantly improved after both types of ET training (p<0.05); however, neither ventilation equivalent (VE/VCO2) nor FVC% improved after ET (p = 0.052 and 0.259 respectively). There were no statistically significant important differences between LL and ULB training programs regarding 6-MWT, SGRQ or CPET parameters (p>0.05). CONCLUSIONS: ET was associated with improvements in exercise capacity and quality of life in f-ILD patients irrespective of the type of ET program provided.


Subject(s)
Exercise Tolerance , Lung Diseases, Interstitial , Adult , Case-Control Studies , Exercise , Exercise Test , Humans , Lung Diseases, Interstitial/therapy , Middle Aged , Physical Functional Performance , Quality of Life
4.
BMC Pulm Med ; 22(1): 243, 2022 Jun 22.
Article in English | MEDLINE | ID: covidwho-1902376

ABSTRACT

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.


Subject(s)
COVID-19 , Exercise Tolerance , Hospitals , Humans , Lung/diagnostic imaging , Patient Discharge
5.
Vopr Kurortol Fizioter Lech Fiz Kult ; 99(3): 5-9, 2022.
Article in Russian | MEDLINE | ID: covidwho-1893457

ABSTRACT

PURPOSE OF THE STUDY: Evaluation of the effectiveness of sanatorium-and-spa treatment of patients who have undergone a new coronavirus infection (COVID-19), taking into account the polymorphism of symptom complexes. MATERIAL AND METHODS: The study included 56 patients (22 men, 34 women; mean age 64.9±8.21 and 64.76±9.12 years, respectively) who had COVID-19 and were treated at a spa. The mandatory program of rehabilitation and rehabilitation sanatorium treatment included: exercise therapy with elements of breathing exercises, general massage with an emphasis on the chest, halo and speleotherapy, hydrotherapy, inhalations, as well as psychotherapeutic methods. The length of stay in the sanatorium was at least 2 weeks. We assessed the dynamics of indicators characterizing the activity of the cardiovascular and respiratory systems (BP, heart rate, Stange test), exercise tolerance (6-minute walk test), as well as psycho-emotional state (test «Health, Activity, Mood¼, SAN) up to and after treatment. RESULTS: Against the background of sanatorium-and-spa treatment in patients who underwent COVID-19, the number of complaints significantly decreased: in men from 6.2±2.4 to 3.4±1.3, in women from 7.7±1.5 to 4.12±1.5 (p≤0.05). A similar dynamics of indicators characterizing the activity of the cardiovascular system was noted: the level of systolic blood pressure in men decreased by 7.3%, in women - by 10.3%; the level of diastolic blood pressure - by 4.1 and 1.4%, respectively. Heart rate in men decreased from 83.69±15.2 to 75.54±12.24 beats/min; in women - from 92.16±14.16 to 76.4±11.68 beats/min. The distance traveled for men (6-minute walk test) increased from 384.15±108.78 to 408.92±97.30 m; in women - from 371.84±75.9 to 397.12±76.2 m (p≤0.05). The breath holding time on inspiration (Stange test) in men increased from 38.00±10.64 to 45.69±9.51 s; in women - from 39.96±9.31 to 43.60±6.93 s. The values of the «Well-being¼ indicator (SAN test) in men significantly increased - from 4.5±1.8 to 5.1±0.9 points (p≤0.05); «Activity¼ - from 4.8±0.8 to 5.4±0.5 points (p≤0.05); «Mood¼ - from 4.7±1.4 to 5.4±0.6 points. Similar dynamics were observed in women. CONCLUSION: Against the background of the sanatorium stage of treatment, a stable positive dynamics of the indicators of the functional state of the body was noted in both men and women. The analysis carried out confirms the need to develop and implement rehabilitation programs in sanatorium-resort conditions for patients who have had a new coronavirus infection.


Subject(s)
COVID-19 , Aged , Exercise Therapy/methods , Exercise Tolerance , Female , Humans , Lung , Male , Middle Aged
6.
Future Cardiol ; 18(7): 577-584, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1879382

ABSTRACT

Aim: To analyze the impact of obesity on cardiopulmonary response to exercise in people with chronic post-COVID-19 syndrome. Patients & methods: Consecutive subjects with chronic post-COVID syndrome 6 months after nonsevere acute infection were included. All patients received a complete clinical evaluation, lung function tests and cardiopulmonary exercise testing. A total of 51 consecutive patients diagnosed with chronic post-COVID-19 were enrolled in this study. Results: More than half of patients with chronic post-COVID-19 had a significant alteration in aerobic exercise capacity (VO2peak) 6 months after hospital discharge. Obese long-COVID-19 patients also displayed a marked reduction of oxygen pulse (O2pulse). Conclusion: Obese patients were more prone to have pathological pulmonary limitation and pulmonary gas exchange impairment to exercise compared with nonobese COVID-19 patients.


In this study, the cardiopulmonary response to exercise in people with chronic post-COVID-19 syndrome was analyzed. More than half of patients diagnosed with chronic post-COVID-19 had reduced exercise capacity 6 months after hospital discharge. In addition, patients with chronic post-COVID-19 syndrome who were overweight or obese displayed exaggerated hyperventilation along with an impairment of oxygenation at peak exercise.


Subject(s)
COVID-19 , COVID-19/complications , Exercise/physiology , Exercise Test , Exercise Tolerance/physiology , Humans , Obesity/complications , Oxygen Consumption/physiology
7.
Med Sci Monit ; 28: e936069, 2022 May 30.
Article in English | MEDLINE | ID: covidwho-1876158

ABSTRACT

BACKGROUND Face masks have become an important part of the COVID-19 prevention approach. This study aimed to explore the effect of wearing masks on exercise ability and ventilatory anaerobic threshold (VAT). MATERIAL AND METHODS Thirty-four young, healthy volunteers were included in this study, consisting of 18 men and 16 women. The subjects were randomized to perform 2 cardiopulmonary exercise tests (CPET) on a cycle ergometer with gas exchange analysis, one with and another without wearing a face mask (cross-over design). The general data for all subjects and indicators from the 2 exercise tests performed with and without wearing a face mask were collected. RESULTS In cardiopulmonary exercise tests, wearing a mask significantly (P<0.05) decreased peak indexes (eg, work rate (WR), oxygen consumption per kg body weight (VO2/kg), heart rate (HR), ventilation per minute (VE) and carbon dioxide ventilation equivalent (VE/VCO2)) and anaerobic threshold indexes (eg, WR, HR, VE, breath frequency (BF), dead space ratio (VD/VT), and VE/VCO2). However, the PETCO2 at peak was significantly higher. There was a positive linear correlation between WR difference and VO2 difference at VAT (abbreviated as deltaWR@VAT and deltaVO2@VAT, respectively) (r=0.495, P=0.003). Subgroup analysis of the VAT indexes showed that WR, VO2/kg, and VE were significantly decreased in the advanced VAT group with mask compared with the stable VAT group with mask (P<0.05). Logistic regression showed that deltaVE, deltaBF, and deltaVE/VCO2 had independent influences on VAT. CONCLUSIONS Wearing masks advances VAT in healthy young subjects during CPET. The advanced VAT was associated with changes in VE, BF, and VE/VCO2 while wearing masks.


Subject(s)
Anaerobic Threshold , COVID-19 , Exercise Tolerance , Female , Healthy Volunteers , Humans , Male , Masks
8.
Sci Rep ; 12(1): 8801, 2022 05 25.
Article in English | MEDLINE | ID: covidwho-1864766

ABSTRACT

After acute infection with the SARS-CoV-2 virus, a considerable number of patients remains symptomatic with pathological changes in various organ systems. This study aimed to relate the physical and mental burden of symptoms of long COVID patients to the findings of a somatic evaluation. In patients with persistent long COVID symptoms three months after acute infection we assessed physical and mental health status using the SF-36 questionnaire. The cohort was dichotomised by the results (upper two quartiles vs. lower to quartiles) and compared with regard to transthoracic echocardiography, body plethysmography (including diffusion capacity), capillary blood gas analysis and 6-min walk test (6-MWT). From February 22 to September 13, 2021, 463 patients were prospectively examined, of which 367 completed the SF-36 questionnaire. A positive correlation between initial disease severity (need for hospitalization, intensive care medicine) and resulting symptom burden at follow-up could be demonstrated. Patients with impaired subjective physical and mental status were significantly more likely to be women. There was a significant correlation between symptom severity and reduced exercise tolerance in the 6-MWT (495.6 ± 83.7 m vs 549.7 ± 71.6 m, p < 0.001) and diffusion capacity for carbon monoxide (85.6 ± 14.3% of target vs 94.5 ± 14.4, p < 0.001). In long COVID patients, initial disease severity is correlated with symptom burden after at least 3 months of follow-up. Highly symptomatic long COVID patients show impaired diffusion capacity and 6-MWT despite average or mildly affected mechanical lung parameters. It must be further differentiated whether this corresponds to a transient functional impairment or whether it is a matter of defined organ damage.


Subject(s)
COVID-19 , COVID-19/complications , Exercise Tolerance , Female , Humans , Lung , Male , SARS-CoV-2
9.
J Appl Physiol (1985) ; 132(6): 1525-1535, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1861687

ABSTRACT

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.


Subject(s)
COVID-19 , Heart Failure , Adult , Exercise Test , Exercise Tolerance , Humans , Oxygen , Oxygen Consumption
10.
Eur J Pediatr ; 181(6): 2311-2317, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1844372

ABSTRACT

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.


Subject(s)
Exercise Test , Masks , Child , Dyspnea/etiology , Exercise Tolerance/physiology , Humans , Physical Exertion/physiology
11.
Blood Adv ; 6(13): 4041-4048, 2022 07 12.
Article in English | MEDLINE | ID: covidwho-1840938

ABSTRACT

Post-COVID syndrome (PCS), or long COVID, is an increasingly recognized complication of acute SARS-CoV-2 infection, characterized by persistent fatigue, reduced exercise tolerance, chest pain, shortness of breath, and cognitive slowing. Acute COVID-19 is strongly linked with an increased risk of thrombosis, which is a prothrombotic state quantified by an elevated von Willebrand factor (VWF) antigen (Ag)/ADAMTS13 ratio that is associated with severity of acute COVID-19 infection. We investigated whether patients with PCS also had evidence of a prothrombotic state associated with symptom severity. In a large cohort of patients referred to a dedicated post-COVID-19 clinic, thrombotic risk, including VWF(Ag)/ADAMTS13 ratio, was investigated. An elevated VWF(Ag)/ADAMTS13 ratio (≥1.5) was present in nearly one-third of the cohort and was 4 times more likely to be present in patients with impaired exercise capacity, as evidenced by desaturation ≥3% and/or an increase in lactate level >1 from baseline on a 1-minute sit-to-stand test and/or a 6-minute walk test (P < .0001). Of 276 patients, 56 (20%) had impaired exercise capacity, of which 55% (31/56) had a VWF(Ag)/ADAMTS13 ratio ≥1.5 (P < .0001). Factor VIII and VWF(Ag) were elevated in 26% and 18%, respectively, and support a hypercoagulable state in some patients with PCS. These findings suggest possible ongoing microvascular/endothelial dysfunction in the pathogenesis of PCS and suggest a role for antithrombotic therapy in the treatment of these patients.


Subject(s)
COVID-19 , Thrombosis , ADAM Proteins , ADAMTS13 Protein , COVID-19/complications , Exercise Tolerance , Humans , SARS-CoV-2 , von Willebrand Factor
13.
Int J Environ Res Public Health ; 19(8)2022 04 13.
Article in English | MEDLINE | ID: covidwho-1809872

ABSTRACT

We examined whether post-exercise yogurt intake reduced cardiovascular strain during outdoor interval walking training (IWT) in older people during midsummer. The IWT is a training regimen repeating slow and fast walking at ~40% and ≥70% peak aerobic capacity, respectively, for 3 min each per set, ≥5 sets per day, and ≥4 days/wk. We randomly divided 28 male and 75 female older people (~73 yr), who had performed IWT ≥12 months, into a carbohydrate group (CHO-G) consuming jelly (45 g CHO, 180 kcal) and a yogurt group (YGT-G) consuming a yogurt drink (9.3 g protein, 39 g CHO, 192 kcal) immediately after daily IWT for 56 days while monitoring exercise intensity and heart rate (HR) with portable devices. We analyzed the results in 39 subjects for the CHO-G and 37 subjects for the YGT-G who performed IWT ≥ 4 days/wk, ≥60 min total fast walking/wk, and ≥4 sets of each walk/day. We found that the mean HR for fast walking decreased significantly from the baseline after the 30th day in the YGT-G (p < 0.03), but not in the CHO-G (p = 1.00). There were no significant differences in training achievements between the groups. Thus, post-exercise yogurt intake might reduce cardiovascular strain during outdoor walking training in older people.


Subject(s)
Walking , Yogurt , Aged , Exercise Tolerance/physiology , Female , Heart Rate , Humans , Male , Walking/physiology
14.
J Am Heart Assoc ; 11(9): e024207, 2022 05 03.
Article in English | MEDLINE | ID: covidwho-1807754

ABSTRACT

Background Ongoing exercise intolerance of unclear cause following COVID-19 infection is well recognized but poorly understood. We investigated exercise capacity in patients previously hospitalized with COVID-19 with and without self-reported exercise intolerance using magnetic resonance-augmented cardiopulmonary exercise testing. Methods and Results Sixty subjects were enrolled in this single-center prospective observational case-control study, split into 3 equally sized groups: 2 groups of age-, sex-, and comorbidity-matched previously hospitalized patients following COVID-19 without clearly identifiable postviral complications and with either self-reported reduced (COVIDreduced) or fully recovered (COVIDnormal) exercise capacity; a group of age- and sex-matched healthy controls. The COVIDreducedgroup had the lowest peak workload (79W [Interquartile range (IQR), 65-100] versus controls 104W [IQR, 86-148]; P=0.01) and shortest exercise duration (13.3±2.8 minutes versus controls 16.6±3.5 minutes; P=0.008), with no differences in these parameters between COVIDnormal patients and controls. The COVIDreduced group had: (1) the lowest peak indexed oxygen uptake (14.9 mL/minper kg [IQR, 13.1-16.2]) versus controls (22.3 mL/min per kg [IQR, 16.9-27.6]; P=0.003) and COVIDnormal patients (19.1 mL/min per kg [IQR, 15.4-23.7]; P=0.04); (2) the lowest peak indexed cardiac output (4.7±1.2 L/min per m2) versus controls (6.0±1.2 L/min per m2; P=0.004) and COVIDnormal patients (5.7±1.5 L/min per m2; P=0.02), associated with lower indexed stroke volume (SVi:COVIDreduced 39±10 mL/min per m2 versus COVIDnormal 43±7 mL/min per m2 versus controls 48±10 mL/min per m2; P=0.02). There were no differences in peak tissue oxygen extraction or biventricular ejection fractions between groups. There were no associations between COVID-19 illness severity and peak magnetic resonance-augmented cardiopulmonary exercise testing metrics. Peak indexed oxygen uptake, indexed cardiac output, and indexed stroke volume all correlated with duration from discharge to magnetic resonance-augmented cardiopulmonary exercise testing (P<0.05). Conclusions Magnetic resonance-augmented cardiopulmonary exercise testing suggests failure to augment stroke volume as a potential mechanism of exercise intolerance in previously hospitalized patients with COVID-19. This is unrelated to disease severity and, reassuringly, improves with time from acute illness.


Subject(s)
COVID-19 , Heart Failure , Case-Control Studies , Exercise Test/methods , Exercise Tolerance , Humans , Magnetic Resonance Spectroscopy , Oxygen , Oxygen Consumption , Stroke Volume
15.
J Phys Act Health ; 19(5): 351-357, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1784759

ABSTRACT

BACKGROUND: This study investigated the effects of mobility restrictions (MRs) during the COVID-19 epidemic on physical activity, body composition, and exercise tolerance in patients with obesity. METHODS: We analyzed data of obesity patients participating in a 6-month weight loss program in February 2020, and after, when the epidemic was considered to have had some effect on outdoor activity in Osaka, Japan (MR group). MR group patients were compared to patients with obesity attending the program in 2018 and 2019 (non-MR group) who had a similar number of months as MR group. Changes in physical activity, body composition, and exercise tolerance (O2 consumption; VO2) owing to the weight loss program were analyzed between both groups using analysis of covariance and logistic regression analysis. RESULTS: Decreases in body fat were significantly higher in MR group than in non-MR group. However, increases in physical activity, VO2 at anaerobic threshold, and peak VO2 were significantly lower in MR group; however, increases in peak VO2 owing to the weight loss program were less likely to be achieved in MR group (odds ratio, 0.21; 95% confidence interval, 0.06-0.81). CONCLUSION: MR during the COVID-19 epidemic may have affected the exercise tolerance of patients with obesity.


Subject(s)
COVID-19 , Exercise Tolerance , Body Composition , Exercise , Humans , Obesity/epidemiology , Obesity/therapy , Oxygen Consumption , Retrospective Studies
16.
BMJ Open Respir Res ; 9(1)2022 03.
Article in English | MEDLINE | ID: covidwho-1769924

ABSTRACT

BACKGROUND: 'Long COVID'-associated dyspnoea may persist for months after SARS-CoV-2 infection. Among the causes of persistent dyspnoea, dysfunctional breathing (DB), defined as an erratic or inappropriate ventilation at rest or exercise, has been observed, but little is known about its occurrence and pathophysiology among individuals with 'long COVID'. We aimed to describe the occurrence and identify clinical predictors of DB among patients following SARS-CoV-2 infection. METHODS: Cardiopulmonary exercise testing (CPET) was performed in 51 SARS-CoV-2 patients (median age, 64 years (IQR, 15)); male, 66.7%) living with 'long COVID' and persistent dyspnoea. CPET was classified into three dominant patterns: respiratory limitation with gas exchange abnormalities (RL); normal CPET or O2 delivery/utilisation impairment (D); and DB. Non-parametric and χ2 tests were applied to analyse the association between CPET dominant patterns and demographics, pulmonary function tests and SARS-CoV-2 severity. RESULTS: Among 51 patients, DB mostly without hyperventilation was found in 29.4% (n=15), RL in 54.9% (n=28) and D in 15.7% (n=8). When compared with RL individuals, patients with DB were younger, had significantly less severe initial infection, a better transfer capacity for carbon monoxide (median 85% (IQR, 28)), higher oxygen consumption (22.9 mL/min/kg (IQR, 5.5)), a better ventilatory efficiency slope (31.6 (IQR, 12.8)), and a higher SpO2 (95% (IQR, 3)). CONCLUSIONS: Our findings suggest that DB without hyperventilation could be an important pathophysiological mechanism of disabling dyspnoea in younger outpatients following SARS-CoV-2 infection, which appears to be a feature of COVID-19 not described in other viral diseases.


Subject(s)
COVID-19 , COVID-19/complications , COVID-19/diagnosis , Dyspnea/diagnosis , Dyspnea/etiology , Exercise Test , Exercise Tolerance/physiology , Humans , Male , Middle Aged , Respiration , SARS-CoV-2
17.
Respir Res ; 23(1): 68, 2022 Mar 22.
Article in English | MEDLINE | ID: covidwho-1759751

ABSTRACT

BACKGROUND: Patient hospitalized for coronavirus disease 2019 (COVID-19) pulmonary infection can have sequelae such as impaired exercise capacity. We aimed to determine the frequency of long-term exercise capacity limitation in survivors of severe COVID-19 pulmonary infection and the factors associated with this limitation. METHODS: Patients with severe COVID-19 pulmonary infection were enrolled 3 months after hospital discharge in COVulnerability, a prospective cohort. They underwent cardiopulmonary exercise testing, pulmonary function test, echocardiography, and skeletal muscle mass evaluation. RESULTS: Among 105 patients included, 35% had a reduced exercise capacity (VO2peak < 80% of predicted). Compared to patients with a normal exercise capacity, patients with reduced exercise capacity were more often men (89.2% vs. 67.6%, p = 0.015), with diabetes (45.9% vs. 17.6%, p = 0.002) and renal dysfunction (21.6% vs. 17.6%, p = 0.006), but did not differ in terms of initial acute disease severity. An altered exercise capacity was associated with an impaired respiratory function as assessed by a decrease in forced vital capacity (p < 0.0001), FEV1 (p < 0.0001), total lung capacity (p < 0.0001) and DLCO (p = 0.015). Moreover, we uncovered a decrease of muscular mass index and grip test in the reduced exercise capacity group (p = 0.001 and p = 0.047 respectively), whilst 38.9% of patients with low exercise capacity had a sarcopenia, compared to 10.9% in those with normal exercise capacity (p = 0.001). Myocardial function was normal with similar systolic and diastolic parameters between groups whilst reduced exercise capacity was associated with a slightly shorter pulmonary acceleration time, despite no pulmonary hypertension. CONCLUSION: Three months after a severe COVID-19 pulmonary infection, more than one third of patients had an impairment of exercise capacity which was associated with a reduced pulmonary function, a reduced skeletal muscle mass and function but without any significant impairment in cardiac function.


Subject(s)
COVID-19/complications , Exercise Tolerance/physiology , Pneumonia/physiopathology , Aged , COVID-19/physiopathology , Cohort Studies , Echocardiography/methods , Echocardiography/statistics & numerical data , Exercise Test/methods , Exercise Test/statistics & numerical data , Exercise Tolerance/immunology , Female , Follow-Up Studies , France , Humans , Lung/physiopathology , Male , Middle Aged , Pneumonia/etiology , Prospective Studies , Respiratory Function Tests/methods , Respiratory Function Tests/statistics & numerical data , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology
18.
Heart Lung ; 54: 1-6, 2022.
Article in English | MEDLINE | ID: covidwho-1734427

ABSTRACT

BACKGROUND: Individuals who suffer from coronavirus disease 2019 (COVID-19) pneumonia may experience pulmonary dysfunction during the chronic period due to pulmonary parenchymal damage after acute disease. OBJECTIVES: The aim of the present study was to evaluate the pulmonary function and exercise capacity of patients treated for COVID 19 pneumonia after discharge. METHODS: In this cross-sectional study, 79 people who were hospitalized with COVID-19 between March and October 2020 were evaluated at least two months after discharge. A pulmonary function test and a six-minute walk test were administered to the individuals included in the study. RESULTS: Restrictive-type disorder was detected in 21.5% of the individuals who were evaluated at least two months after discharge. The forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) values of the pulmonary function tests were significantly lower in the individuals with severe/critical clinical disease compared to those with moderate disease (p = 0.004 and p = 0.001, respectively). Although the six-minute walk test (6MWT) distances were lower in the severe/critical group than in the moderate group, the difference was not statistically significant (p > 0.05). CONCLUSIONS: Individuals who are discharged after hospitalization for COVID-19 pneumonia may develop a restrictive type of pulmonary dysfunction. Therefore, survivors of COVID-19 pneumonia should be evaluated for pulmonary function and rehabilitation needs and should be provided with treatment as required.


Subject(s)
COVID-19 , Pneumonia , COVID-19/complications , Cross-Sectional Studies , Exercise Tolerance , Forced Expiratory Volume , Humans , Lung , Vital Capacity
19.
Can Respir J ; 2022: 2466789, 2022.
Article in English | MEDLINE | ID: covidwho-1723957

ABSTRACT

Background: Following COVID-19, patients often present with ongoing symptoms comparable to chronic fatigue and subjective deterioration of exercise capacity (EC), which has been recently described as postacute COVID-19 syndrome. Objective: To objectify the reduced EC after COVID-19 and to evaluate for pathologic limitations. Methods: Thirty patients with subjective limitation of EC performed cardiopulmonary exercise testing (CPET). If objectively limited in EC or deteriorated in oxygen pulse, we offered cardiac stress magnetic resonance imaging (MRI) and a follow-up CPET. Results: Eighteen male and 12 female patients were included. Limited relative EC was detected in 11/30 (36.7%) patients. Limitation correlated with reduced body weight-indexed peak oxygen (O2) uptake (peakV̇O2/kg) (mean 74.7 (±7.1) % vs. 103.6 (±14.9) %, p < 0.001). Reduced peakV̇O2/kg was found in 18/30 (60.0%) patients with limited EC. Patients with reduced EC widely presented an impaired maximum O2 pulse (75.7% (±5.6) vs. 106.8% (±13.9), p < 0.001). Abnormal gas exchange was absent in all limited EC patients. Moreover, no patient showed signs of reduced pulmonary perfusion. Using cardiac MRI, diminished biventricular ejection fraction was ruled out in 16 patients as a possible cause for reduced O2 pulse. Despite noncontrolled training exercises, follow-up CPET did not reveal any exercise improvements. Conclusions: Deterioration of EC was not associated with ventilatory or pulmonary vascular limitation. Exercise limitation was related to both reduced O2 pulse and peakV̇O2/kg, which, however, did not correlate with the initial severity of COVID-19. We hypothesize that impaired microcirculation or limited peripheral O2 utilization might be causative for prolonged deterioration of EC following acute COVID-19 infection.


Subject(s)
COVID-19 , Exercise Test , Exercise Tolerance , Female , Humans , Lung , Male , Oxygen Consumption , SARS-CoV-2
20.
Respiration ; 101(6): 593-601, 2022.
Article in English | MEDLINE | ID: covidwho-1702931

ABSTRACT

BACKGROUND: COVID-19 survivors face the risk of long-term sequelae including fatigue, breathlessness, and functional limitations. Pulmonary rehabilitation has been recommended, although formal studies quantifying the effect of rehabilitation in COVID-19 patients are lacking. METHODS: We conducted a prospective observational cohort study including consecutive patients admitted to an outpatient pulmonary rehabilitation center due to persistent symptoms after COVID-19. The primary endpoint was change in 6-min walk distance (6MWD) after undergoing a 6-week interdisciplinary individualized pulmonary rehabilitation program. Secondary endpoints included change in the post-COVID-19 functional status (PCFS) scale, Borg dyspnea scale, Fatigue Assessment Scale, and quality of life. Further, changes in pulmonary function tests were explored. RESULTS: Of 64 patients undergoing rehabilitation, 58 patients (mean age 47 years, 43% women, 38% severe/critical COVID-19) were included in the per-protocol-analysis. At baseline (i.e., in mean 4.4 months after infection onset), mean 6MWD was 584.1 m (±95.0), and functional impairment was graded in median at 2 (IQR, 2-3) on the PCFS. On average, patients improved their 6MWD by 62.9 m (±48.2, p < 0.001) and reported an improvement of 1 grade on the PCFS scale. Accordingly, we observed significant improvements across secondary endpoints including presence of dyspnea (p < 0.001), fatigue (p < 0.001), and quality of life (p < 0.001). Also, pulmonary function parameters (forced expiratory volume in 1 s, lung diffusion capacity, inspiratory muscle pressure) significantly increased during rehabilitation. CONCLUSION: In patients with long COVID, exercise capacity, functional status, dyspnea, fatigue, and quality of life improved after 6 weeks of personalized interdisciplinary pulmonary rehabilitation. Future studies are needed to establish the optimal protocol, duration, and long-term benefits as well as cost-effectiveness of rehabilitation.


Subject(s)
COVID-19 , Pulmonary Disease, Chronic Obstructive , COVID-19/complications , Dyspnea , Exercise Tolerance/physiology , Fatigue/etiology , Female , Functional Status , Humans , Male , Middle Aged , Outpatients , Prospective Studies , Quality of Life
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