Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation.

Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV.NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.

Effects of a 16-week home-based exercise training programme on health-related quality of life, functional capacity, and persistent symptoms in survivors of severe/critical COVID-19: a randomised controlled trial.

BACKGROUND: Long-lasting effects of COVID-19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-related quality of life (HRQoL). We investigated the effects of a home-based exercise training (HBET) programme on HRQoL and health-related outcomes in survivors of severe/critical COVID-19. METHODS: This was a single-centre, single-blinded, parallel-group, randomised controlled trial. Fifty survivors of severe/critical COVID-19 (5±1 months after intensive care unit discharge) were randomly allocated (1:1) to either a 3 times a week (~60-80 min/session), semi-supervised, individualised, HBET programme or standard of care (CONTROL). Changes in HRQoL were evaluated through the 36-Item Short-Form Health Survey, and physical component summary was predetermined as the primary outcome. Secondary outcomes included cardiorespiratory fitness, pulmonary function, functional capacity, body composition and persistent symptoms. Assessments were performed at baseline and after 16 weeks of intervention. Statistical analysis followed intention-to-treat principles. RESULTS: After the intervention, HBET showed greater HRQoL score than CONTROL in the physical component summary (estimated mean difference, EMD: 16.8 points; 95% CI 5.8 to 27.9; effect size, ES: 0.74), physical functioning (EMD: 22.5 points, 95% CI 6.1 to 42.9, ES: 0.83), general health (EMD: 17.4 points, 95% CI 1.8 to 33.1, ES: 0.73) and vitality (EMD: 15.1 points, 95% CI 0.2 to 30.1, ES: 0.49) domains. 30-second sit-to-stand (EMD: 2.38 reps, 95% CI 0.01 to 4.76, ES: 0.86), and muscle weakness and myalgia were also improved in HBET compared with CONTROL (p<0.05). No significant differences were seen in the remaining variables. There were no adverse events. CONCLUSION: HBET is an effective and safe intervention to improve physical domains of HRQoL, functional capacity and persistent symptoms in survivors of severe/critical COVID-19. TRIAL REGISTRATION NUMBER: NCT04615052.

Home-Based Exercise Training During COVID-19 Pandemic in Post-Bariatric Patients: a Randomized Controlled Trial.

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Development and validation of an equation to estimate body fat in elderly women / Desenvolvimento e validação de uma equação para estimar a gordura corporal em mulheres idosas

Abstract The purpose of this present study was to develop and validate a prediction equation for body composition assessment using anthropometric measures of elderly women. This is cross-sectional correlational study with 243 older women ± 64.5 years old and body mass index (BMI) ± 28.70 kg/m². For the development of the equation it was utilized the method of hold-out sample validation. The participants were randomly divided into equation development group (96 elderly women) and a group for validation (147 elderly women). Total body mass, height, waist and hip circumferences, ratio waist-hip ratio and BMI were measured. The whole-body dual-energy X-ray absorptiometry (DXA) assessed body composition (percentage of body fat, fat mass, and fat-free mass). The equations were developed using multiple linear regression, with validation by the stepwise method; the comparison of the equations was analyzed by the paired Student's t test and the analysis of residual scores by the method of Blant and Altman. The New Equation presents a strong correlation (R = 0.83) and (R² = 0.69), and a standard error of estimation equals to 3.21% for percentage body fat prediction. The mean difference between the estimations of percentage body fat from DXA and the New Equation was 0.11% (t(0,180); P = 0.850). Therefore, the New Equation had an accuracy of 93.5% and a total error of 1.8%. The body fat estimation in older women using this New Equation based on BMI and age is valid and accurate.

Resumo O objetivo do presente estudo foi desenvolver e validar uma equação de predição para avaliação da composição corporal utilizando-se medidas antropométricas de idosas. Este é um estudo transversal e correlacional com 243 idosas ± 64.5 anos de idade e índice de massa corporal (IMC) ± 28.70 kg/m². Para o desenvolvimento da equação utilizou-se o método de validação hold-out. As participantes foram divididas aleatoriamente em um grupo para desenvolvimento da equação (96 idosas) e um grupo para validação da equação (147 idosas). Massa corporal total, estatura, circunferências da cintura e quadril, relação cintura-quadril e IMC foram mensurados. A absorciometria por raios-X com dupla energia (DXA) para todo corpo foi utilizada para avaliação da composição corporal (percentual de gordura, massa gorda e massa livre de gordura). As equações foram desenvolvidas utilizando a regressão linear múltipla, com validação pelo método stepwise; a comparação das equações foi realizada pelo Teste T para amostras pareadas e análise dos escores residuais por meio do método de Bland e Waltman. A Nova Equação apresentou uma forte correlação (R = 0.83) e (R2 = 0.69), e uma estimativa de erro padrão de 3.21% para predição do percentual de gordura. A diferença média entre as estimativas de percentual de gordura pelo DXA e Nova Equação foi de 0.11% (t(0,180); P = 0.850). Assim, a Nova Equação teve uma precisão de 93.5% e um erro total de 1.8%. A estimativa do percentual de gordura em idosas usando a Nova Equação baseada no IMC e idade são válidos e precisos.