Assessment of functional capacity with cardiopulmonary exercise testing in non-severe COVID-19 patients at three months follow-up

Abstract

IntroductionLong-term effects of Coronavirus Disease of 2019 (COVID-19) and their sustainability in a large number of patients are of the utmost relevance. We aimed to determine: 1)functional capacity of non-severe COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2)those characteristics associated with worse CPET performance.MethodsWe prospectively enrolled the first 150 consecutive subjects with laboratory-confirmed COVID-19 infection discharged alive from March to April 2020 at Azienda Sanitaria Locale (ASL)3, Genoa, Italy. At 3-month from hospital discharge, complete clinical evaluation, trans-thoracic echocardiography, cardiopulmonary exercise testing (CPET), pulmonary function test (PFT), and dominant leg extension (DLE) maximal strength evaluation were performed.ResultsExcluding severe and incomplete/missing cases, 110 patients were analyzed. Median percent predicted peak oxygen uptake (%pVO2) was 90.9(79.2-109.0)%. Thirty-eight(34.5%) patients had %pVO2 below, whereas 72(65.5%) above the 85% predicted value (indicating normality). Median PFT parameters were within normal limits.Eight(21.1%) patients had a mainly respiratory, 9(23.7%) a mainly cardiac, 3(7.9%) a mixed-cardiopulmonary, and 18(47.4%) a non-cardiopulmonary limitation of exercise. Eighty-one(73.6%) patients experimented at least one symptom, without relationship with %pVO2 (p>0.05).Multivariate linear regression analysis showed age (β=0.46, p=0.020), percent weight loss (β=-0.77, p=0.029), active smoke status (β=-7.07, p=0.019), length of hospital stay (β=-0.20, p=0.042), and DLE maximal strength (β=1.65, p=0.039) independently associated with %pVO2.ConclusionsHalf of non-severe COVID-19 survivors show functional capacity limitation mainly explained by muscular impairment, albeit cardiopulmonary causes are possible. These findings call for future research to identify patients at higher risk of long-term effects, that may benefit from careful surveillance and targeted rehabilitation.Take-home messagesat 3-month cardiopulmonary exercise testing 38/110(34.5%) non-severe COVID-19 survivors had percent predicted peak oxygen uptake (%pVO2) < 85% (indicating normality). Half of them had functional capacity limitation mainly explained by muscular impairment.

Cardiorespiratory Fitness in Volleyball Athletes Following a COVID-19 Infection: A Cross-Sectional Study

“…In the context of the COVID-19 aftermath, somewhat similar findings were found in a study by Clavario et al, [19] where 34.5% of the COVID-19-affected participants (non-athletes) had below VO 2max values, whereas 65.5% had above the 85% predicted value, which is indicative of normal values. Furthermore, pulmonary function test parameters were within the normal limits.…”

“…Ever since the coronavirus disease 2019 (COVID- 19) outbreak emerged at the end of 2019 in a multimillion city in central China, patterns of our daily life have been dramatically changed [1]. In the absence of an effective medication or vaccine, the World Health Organization and various governments around the world have emphasized personal efforts such as temporary lockdown, social distancing, face mask wearing, increased hand hygiene, etc., to minimalize the risk of viral spread [2].…”

Pulmonary function and COVID-19

“…This approach was used in the SARS-CoV-1 pandemic and revealed that whilst exercise tolerance was impaired in 57% of patients, a disconnect was often evident between individuals with impaired diffusion capacity, such that those with impaired peak oxygen uptake on CPET were not always the same group of individuals with impaired gas exchange [ 10 ]. In the SARS-CoV-2 pandemic, Clavario et al [ 7 ] utilised CPET in 110 patients (age: 61.7 ± 8 years) and reported impaired aerobic capacity (defined as a peak oxygen consumption of <85% predicted) in 34% of non-severe (defined as those that did not require ITU) patients three months after discharge which was attributed predominantly to muscular impairment. Similarly, one month following discharge, patients demonstrated impaired aerobic capacity which was not explained by pulmonary function changes, but likely attributable to physical deconditioning [ 20 ] and 70% of patients were limited by decreases in peripheral muscle mass [ 21 ].…”

“…There is also increasing recognition that between 30- 60% of individuals report protracted symptoms, such as fatigue and dyspnoea, following resolution of their acute illness [ 5 •• , 6 •• ]; variably termed the ‘long-COVID’ or the post-COVID syndrome. Exertional dyspnoea and exercise intolerance are prominent clinical features reported in this syndrome [ 7 , 8 ] and there is increasing interest in how best to objectively characterise and followed-up this issue with objective tests. Similar concerns were apparent following the first SARS pandemic with SARS-CoV-1 infection, in 2003.…”

A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists

“…The CPET should be performed in situations of medical control, with exhaustive monitoring [ 80 , 81 , 82 ], considered the gold standard [ 83 ], and allows the detection of problems that should be assessed by a specialist. Although it could be too demanding, the 6MWT is an optimal alternative to use, both the CPET and 6MWT are already used in COVID-19 patients [ 84 , 85 ]. When an impairment is found, cardiovascular exercise of moderate intensity [ 32 ], with control of SpO 2 (to stop if values decrease by <90% or a decrease by more than 4% from baseline [ 86 ]) and rate of perceived exertion in the Borg scale between 3 and 5 [ 87 ], is recommended for optimal outcome and safety [ 32 ].…”