There is increasing evidence that patients who were infected with SARS-CoV-2 may experience adverse health outcomes months after the acute infection has resolved including reduction in aerobic capacity and fatigue. In this study, we compared aerobic capacity and exercise performance of 28 unvaccinated participants to 15 vaccinated ones who performed a symptom limited cardio-pulmonary exercise test (CPET) after acute COVID-19. We identified a significant difference in aerobic capacity between vaccinated and unvaccinated individuals, with a lower V'O2 peak percentage of predicted in the unvaccinated group. In addition, the unvaccinated group had a reduction in the peak-exercise heart rate and lower ventilation values. Our results suggest objective limitations to exercise capacity in the months following acute COVID19 illness, mitigated by vaccination
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Background: Left Ventricular Assist Device (LVAD) implantation is an optional therapy for patients with end stage heart failure. Physical rehabilitation after an LVAD implantation is beneficial for the patient's recovery. A detailed protocol for and our experience with a very early post LVAD implantation individualized physical rehabilitation is presented. Method:Twelve patients who underwent LVAD implantations between April 2010 and April 2011 were included in the study. As soon as the patients were able to walk by themselves (7-10 days post-op), they started aerobic exercise on a treadmill and on the Nustep: combining hand and leg aerobic exercise. Exercise was started at low intensity and for short intervals. The target was to increase intensity and duration. Progress was based on Both Subjective (Borg Scale) and objective (6 Minutes Walk Test: 6MWT) parameters. Results:Walking time and speed on the treadmill was increased from two 2-4 minutes intervals to one continuous 10 minutes exercise. The time and intensity on the Nustep increased from two intervals of 1-3 minutes to one continuous 16 minutes exercise and from 10-20 watts to 30 watts, respectively. An improvement was seen in the 6MWT from baseline to hospital discharge: 131 ± 91 meters to 262 ± 84 meters respectively (p<0.01) and from discharge to the first LVAD clinic visit: 251 ± 80 meters to 307 ± 88 m meters respectively (p<0.01). All patients reported improvement in carrying the 2-2.5 Kg of battery weight (from difficult to tolerable). Discussion:A very early stage rehabilitation program after LVAD implantation is feasible and may improve the functional capacity and the ability to carry the LVAD batteries of the LVAD supported patient. Larger studies are needed to determine the optimal time to start rehabilitation program post LVAD implantation.
Funding Acknowledgements Type of funding sources: None. Background Cardiopulmonary exercise testing (CPX) is established in the evaluation of patients with cardiac and pulmonary diseases, and its clinical utility seems to be expanding. Currently the most important diagnostic and prognostic ventilatory metrics of CPX rely on the exercise phase. Nevertheless, a consistent body of evidence suggests that important information can be derived from the recovery phase, especially in the first few minutes after exercise. In this context, patients with heart failure (HF) demonstrate a slower recovery of the oxygen consumption (VO2) compared with healthy individuals. Purpose: To comprehensively investigate the behavior of respiratory gases during recovery from CPX in a diverse cohort of HF patients. Methods: All individuals who performed CPX at the department of cardiology of Stanford University Hospital were eligible for the study. Patients were included in the experimental group if they (i) were recorded for five minutes after the exercise phase of CPX and (ii) had documented heart failure. They were excluded if they had other clinical diagnoses which may be responsible for exercise intolerance or symptoms or were unable to give informed consent. Healthy controls were recruited from the local community and were included if they did not have documented or suspected disease. Respiratory gases were collected on a breath-by-breath basis and analysed after applying a 30 second rolling average filter. Metrics were analyzed as absolute values, percentage change from peak and the half-time of recovery (T ½; i.e. the duration until a metric had returned to ½ of its value at peak). Data was analyzed over time within patients and averages between groups using parametric statistical methods. In accordance with previous studies, the amount of change in a metric after exercise is presented as the "magnitude" of overshoot. Results: 32 patients with HF (11 Female, 47 ± 13 yrs) and 30 healthy subjects (14 Female, 43 ± 12 yrs) were included. A comparison of ventilatory metrics during recovery between HF and controls is depicted in Figure 1. Peak VO2 was 1135 ± 419 mL/min (13.5 ± 3.8 mL/Kg/min) vs 2408 ± 787 mL/min (32.5 ± 9.0 mL/Kg/min); P <0.01. A significant difference between patients with HF and healthy subjects was found in T ½ of VO2 (111.3 ± 51.0s vs 58.0 ± 13.2s, p < 0.01) and VCO2 (132.0 ± 38.8s vs 74.3 ± 21.1s, p < 0.01). The magnitude of the overshoot was also found to be significantly reduced in patients with HF for VE/VO2 (41.9 ± 29.1% vs 62.1 ± 17.7%, P < 0.01), RQ (25.0 ± 13.6% vs 38.7 ± 15.1%, p < 0.01) and PETO2 (7.2 ± 3.3% vs 10.1 ± 4.6%, p < 0.01). Finally, the magnitude of the RQ overshoot showed a moderate correlation with peak VO2 (ϱ=0.58, p < 0.01). Conclusions: We observed that ventilatory kinetics measured in early recovery after CPX differ significantly between healthy subjects and patients with HF. The assessment of post exercise respiratory gases in a clinical setting may add to the prognostic and diagnostic value of CPX in heart failure. Abstract Figure.
METHODS:Otherwise healthy, young adults (COV+: 6M/6F, 21 ± 1 y, 24 ± 3 kgᐧm -2 ) who tested positive for SARS-CoV-2 three-to-four weeks prior to the testing date completed standardized spirometry. Subsequently, the flow-volume loop with the greatest sum of forced vital capacity (FVC) and forced expiratory volume in one second was chosen for analyses. The angle β and flow ratio were calculated using standard pulmonary function parameters. Slope ratios at increments of 5% of FVC were determined from 80% to 20% FVC. Additionally, the total area under the maximum expiratory flow-volume curve was calculated. Data were compared to sex-, age-, and BMI-matched control participants (CON: 6M/6F, 21 ± 2 y, 23 ± 3 kgᐧm -2 ). RESULTS: The angle β was significantly lower in COV+ compared with CON (COV+: 182.1 ± 10.6°, CON: 194.8 ± 15.3°; p = 0.02). Flow ratios were similar between groups (COV+: 20.5 ± 25.9%, CON: 12.9 ± 19.1%; p = 0.42). With exception at 75% FVC (COV+: 1.42 ± 0.92, CON: 0.76 ± 0.40; p = 0.047), the slope ratios were similar between groups. While not statistically different, the slope ratio at 80% FVC approached significance (p = 0.06). The total area under the maximum flow-volume curve was not different between COV+ and CON participants (COV+: 21.1 ± 6.2, CON: 24.8 ± 9.4; p = 0.27). CONCLUSIONS: These data suggest that SARS-CoV-2 infection may result in damage, albeit minor, to the airways, which may result in alterations to the shape of the maximum expiratory flow-volume curve, especially at higher lung volumes. However, the data still may be classified as normal, and thus, longitudinal investigation may be warranted to examine if these parameters change throughout recovery following SARS-CoV-2 infection.
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