DECREASED EXERCISE CAPACITY AS A SEQUELA OF COVID-19: INSIGHTS FROM CARDIOPULMONARY RESPONSES TO MAXIMAL EXERCISE BEFORE AND AFTER RECOVERY FROM THE DISEASE

ABSTRACT

SESSION TITLE Outcomes Across COVID-19 SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/19/2022 1115 am - 1215 pm PURPOSE: SARS-CoV-2 infection can lead to persistent, long-term sequelae after recovery from the acute disease process. One such reported sequelae is reduced exercise capacity (i.e., low peak pulmonary O2uptake;V̇O2peak). However, only cross-sectional approaches that did not account for baseline (i.e., before COVID-19) V̇O2peak support this assumption. As such, whether reduced exercise capacity is a consequence of or in fact predates SARS-CoV-2 infection remains unknown. Accordingly, we compared the cardiopulmonary responses to maximal incremental exercise (CPET) before and after COVID-19. Specifically, we determined whether COVID-19 is associated with a decrease in V̇O2peak. METHODS: We retrospectively reviewed CPET data collected across the Mayo Clinic Enterprise between Oct 2018 and Mar 2022. 42 individual patients who completed a CPET before and after a COVID-19 diagnosis were included (36, 4, and 2 patients experienced mild, moderate, or severe illness, respectively). In addition, we included a control group of 25 individual patients who performed two separate CPETs but did not contract SARS-CoV-2 (CTL). All patients were clinically stable between the two CPETs, defined as no worsening/change in disease status or medication, and performed the same CPET protocol for both tests. A mixed within- and between-subjects design was used to examine differences in cardiopulmonary responses to CPET both across time and between the COVID-19 and CTL groups. RESULTS: The COVID-19 and CTL groups were matched for sex (36 vs. 32% female;P = 0.757), age (49 ± 15 vs. 50 ± 16 y, P = 0.652), BMI (29.1 ± 5.4 vs. 29.7 ± 5.2 kg/m2;P = 0.868), and time between the two CPETs (489 ± 225 vs. 534 ± 257 days, P = 0.662). In the COVID-19 group, the first and second CPET were performed 312 ± 232 days before and 176 ± 110 days after SARS-CoV-2 infection, respectively. Exercise time, peak heart rate, peak systolic pressure, O2pulse (V̇O2/heart rate), anaerobic threshold, peak ventilation, and ventilatory efficiency (V̇E/V̇CO2 slope) were not different between the groups. There was a small but significant reduction in V̇O2peak from before to after SARS-CoV-2 infection (−1.4 ± 0.5 mL/Kg/min, P = 0.038);however, the change in V̇O2peak between the two CPETs was not different between COVID-19 vs. CTL (−5 ± 13 vs. −3 ± 15%, P = 0.585). The change in V̇O2peak in the groups likely falls within the normal error of the measurement during CPET. CONCLUSIONS: Accounting for baseline measures of V̇O2peak, we find no substantial evidence for decreased exercise capacity within one to 15 months after SARS-CoV-2 infection, especially when compared to patients who did not suffer COVID-19. CLINICAL IMPLICATIONS Our findings suggest that care may need to be taken when reporting a consequential impairment in exercise capacity secondary to COVID-19 when prior baseline (i.e., before COVID-19) data are not available. DISCLOSURES No relevant relationships by Arvind Balavenkataraman No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes no disclosure on file for Scott Helgeson;No relevant relationships by Neal Patel Competitive research grant recipient relationship with Gilead Sciences Inc. Please note 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support