An exercise immune fitness test to unravel mechanisms of Post-Acute Sequelae of COVID-19

Deng, Mario C.

doi:10.1080/1744666x.2023.2214364

Cited by 3 publications

(7 citation statements)

References 73 publications

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“…Although no data have been supplied to demonstrate adverse events in athletes if exercise is continued, a higher risk could be expected. It has been shown that long-COVID-19 and PASC display persistent inflammatory activity [ 9 , 32 ]. Inflammation is associated with a higher rate of cardiac arrhythmias, such as atrial fibrillation and ectopies [ 34 ], which may further decrease exercise capacity or may even lead to the premature development of heart failure [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although this score has been validated in a general cohort, no data are available on its validity in an athletic population. (9) No follow-up CPET is available for analyzing the resolution of objective limitations over time.…”

Section: Limitationsmentioning

confidence: 99%

“…The post-acute sequelae of COVID-19 (PASC) syndrome subsumes more than 200 symptoms, including fatigue, dyspnea on exertion, headache, orthostatic intolerance, and post-exertional malaise (PEM) [ 9 ]. Although participation in everyday life can be severely compromised in these patients, a physiological definition of this complex is lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Although participation in everyday life can be severely compromised in these patients, a physiological definition of this complex is lacking. Limitations in cardiopulmonary exercise testing (CPET) have been suggested as being able to reveal endothelial damage as a (among others) potential correlate of PASC and PEM, and protocols for identifying these patients have been discovered [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…PEM, which has been described as a manifestation of PASC [ 9 ], may be associated with persistent exercise intolerance as well as the development of long-COVID-19 syndrome [ 11 ]. PEM has been defined as an exacerbation of physical symptoms and a reduction in function after physical work, to an extent, which was not present before the illness [ 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Cardiopulmonary Profiling of Athletes with Post-Exertional Malaise after COVID-19 Infection—A Single-Center Experience

Wernhart

Weihe

Totzeck

et al. 2023

JCM

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(1) Background: Cardiopulmonary exercise testing (CPET) has been suggested by the European Society of Cardiology (ESC) for assessing the exercise limitations of apparently healthy individuals, but data on elite athletes regarding this test are scarce. (2) Methods: We analyzed CPET in elite (n = 43, 21.9 ± 3.7 years) and recreational (n = 40, 34.7 ± 13.0 years) athletes with persistent subjective exercise intolerance and post-exertional malaise (PEM) after COVID-19 infection. The primary outcome was the point prevalence of the adequate cardiopulmonary response (ACPR), defined by the presence of all of the following ESC criteria for apparently healthy individuals: (1) >100% of predicted peak oxygen consumption (predVO2peak), (2) VE/VCO2 < 30, (3) no exercise oscillatory ventilation (EOV), and (4) heart rate recovery of ≥12 beats/minute 1 min after exercise termination (HRR1). Results: ACPR occurred more frequently in elite athletes than in recreational athletes (70.0% vs. 39.5%; p = 0.005), mainly driven by the lower VE/VCO2 (<30: 97.7% vs. 65%, p < 0.001). Elite (11.6%) and recreational athletes (22.5%) showing a plateau of O2 pulse did not display ACPR. Conclusions: ACPR was not observed in all recreational and elite athletes with PEM. In particular, perturbed VE/VCO2 and the plateauing of O2 pulse are suitable for quantifying exercise limitations and may identify a high-risk population with long-COVID-19 syndrome who require their training intensities to be adapted.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiopulmonary Profiling of Athletes with Post-Exertional Malaise after COVID-19 Infection—A Single-Center Experience

Wernhart

Weihe

Totzeck

et al. 2023

JCM

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Body composition and cardiorespiratory fitness of overweight COVID-19 survivors in different severity degrees: a cohort study

Perli,

Sordi,

Lemos

et al. 2023

Sci Rep

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COVID-19 sequelae are varied, and whether they are temporary or permanent is still unknown. Identifying these sequelae may guide therapeutic strategies to improve these individuals' recovery. This prospective cohort aimed to assess body composition, cardiopulmonary fitness, and long-term symptoms of overweight individuals affected by COVID-19. Participants (n = 90) were divided into three groups according to the severity of acute COVID-19: mild (no hospitalization), moderate (hospitalization, without oxygen support), and severe/critical cases (hospitalized in Intensive Care Unit). We assessed body composition with a tetrapolar multifrequency bioimpedance, hemodynamic variables (heart rate, blood pressure, and peripheral oxygen saturation-SpO2) at rest, and the Bruce test with direct gas exchange. Two assessments with a one-year interval were performed. The most prevalent long-term symptoms were memory deficit (66.7%), lack of concentration (51.7%), fatigue (65.6%), and dyspnea (40%). Bruce test presented a time effect with an increase in the distance walked after 1 year just for severe/critical group (p < 0.05). SpO2 was significantly lower in the severe/critical group up to 5 min after the Bruce test when compared to the mild group, and diastolic blood pressure at the end of the Bruce test was significantly higher in the severe/critical group when compared to mild group (p < 0.05; for all comparisons). A time effect was observed for body composition, with increased lean mass, skeletal muscle mass, fat-free mass, and lean mass just for the severe/critical group after 1 year (p < 0.05). Cardiopulmonary fitness parameters did not differ among the groups, except for respiratory quotient with higher values for the severe/critical group when compared to itself after 1 year. All COVID-19 patients might present long-term sequelae, regardless of the acute disease severity. Reassessing and identifying the most prevalent long-term sequelae are essential to perform more precise health promotion interventions.

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An Exercise Immune Fitness Test to Unravel Disease Mechanisms—A Proof-of-Concept Heart Failure Study

Bondar,

Mahapatra,

Bao

et al. 2024

JCM

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Background: Cardiorespiratory fitness positively correlates with longevity and immune health. Regular exercise may provide health benefits by reducing systemic inflammation. In chronic disease conditions, such as chronic heart failure and chronic fatigue syndrome, mechanistic links have been postulated between inflammation, muscle weakness, frailty, catabolic/anabolic imbalance, and aberrant chronic activation of immunity with monocyte upregulation. We hypothesize that (1) temporal changes in transcriptome profiles of peripheral blood mononuclear cells during strenuous acute bouts of exercise using cardiopulmonary exercise testing are present in adult subjects, (2) these temporal dynamic changes are different between healthy persons and heart failure patients and correlate with clinical exercise-parameters and (3) they portend prognostic information. Methods: In total, 16 Heart Failure (HF) patients and 4 healthy volunteers (HV) were included in our proof-of-concept study. All participants underwent upright bicycle cardiopulmonary exercise testing. Blood samples were collected at three time points (TP) (TP1: 30 min before, TP2: peak exercise, TP3: 1 h after peak exercise). We divided 20 participants into 3 clinically relevant groups of cardiorespiratory fitness, defined by peak VO2: HV (n = 4, VO2 ≥ 22 mL/kg/min), mild HF (HF1) (n = 7, 14 < VO2 < 22 mL/kg/min), and severe HF (HF2) (n = 9, VO2 ≤ 14 mL/kg/min). Results: Based on the statistical analysis with 20–100% restriction, FDR correction (p-value 0.05) and 2.0-fold change across the three time points (TP1, TP2, TP3) criteria, we obtained 11 differentially expressed genes (DEG). Out of these 11 genes, the median Gene Expression Profile value decreased from TP1 to TP2 in 10 genes. The only gene that did not follow this pattern was CCDC181. By performing 1-way ANOVA, we identified 8/11 genes in each of the two groups (HV versus HF) while 5 of the genes (TTC34, TMEM119, C19orf33, ID1, TKTL2) overlapped between the two groups. We found 265 genes which are differentially expressed between those who survived and those who died. Conclusions: From our proof-of-concept heart failure study, we conclude that gene expression correlates with VO2 peak in both healthy individuals and HF patients, potentially by regulating various physiological processes involved in oxygen uptake and utilization during exercise. Multi-omics profiling may help identify novel biomarkers for assessing exercise capacity and prognosis in HF patients, as well as potential targets for therapeutic intervention to improve VO2 peak and quality of life. We anticipate that our results will provide a novel metric for classifying immune health.

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An exercise immune fitness test to unravel mechanisms of Post-Acute Sequelae of COVID-19

Cited by 3 publications

References 73 publications

Cardiopulmonary Profiling of Athletes with Post-Exertional Malaise after COVID-19 Infection—A Single-Center Experience

Cardiopulmonary Profiling of Athletes with Post-Exertional Malaise after COVID-19 Infection—A Single-Center Experience

Body composition and cardiorespiratory fitness of overweight COVID-19 survivors in different severity degrees: a cohort study

An Exercise Immune Fitness Test to Unravel Disease Mechanisms—A Proof-of-Concept Heart Failure Study

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