Deconditioning as main mechanism of impaired exercise response in COVID-19 survivors

Rinaldo, Rocco Francesco; Mondoni, Michele; Parazzini, Elena Maria; Pitari, Federica; Brambilla, Elena; Luraschi, Simone; Balbi, Maurizio; Papa, G; Sotgiu, Giovanni; Guazzi, Marco; Marco, Fabiano Di; Centanni, Stefano

doi:10.1183/13993003.00870-2021

Cited by 170 publications

(188 citation statements)

References 18 publications

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confidence: 83%

“…The prevalence of exercise limitation in our cohort was much higher than in a study by Rinaldo et al [ 7 ]. In accordance with previous report [ 7 ], reduced exercise capacity in our cohort was mostly due to peripheral deconditioning. However, our study also found an elevated V'E/V'CO 2 slope in one third of the study participants, suggesting a high incidence of inadequate exercise hyperventilation.…”

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confidence: 83%

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Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors

et al. 2021

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confidence: 83%

contrasting

confidence: 83%

Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors

et al. 2021

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“…Of note, a decrease of capillary paO 2 > 3 mmHg or increased AaDO2 > 25 mmHg after cycle ergometry occurred after mild disease courses (8 of 23, 35% and 7 of 23, 30%), revealing gas exchange abnormalities even in some patients who did not require hospitalization. Rinaldo et al [ 36 ] recently performed cardiopulmonary exercise testing (CPET) with maximal exercise in 75 COVID-19 survivors three months after discharge. The researchers mainly reported impaired exercise capacity probably caused by muscular deconditioning in 41 patients (54.7%) compared to 34 patients with normal exercise capacity while mean AaDO2 was 26 in both groups.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, patients with preexisting lung conditions (COPD), former or active smokers, and patients with persistent pulmonary symptoms (cough, dyspnea, fatigue) might profit from pulmonary assessment. If after diagnostic evaluation (lung function, CT scan, echocardiography and others) persistent symptoms remain unclear, CPET might be an option to discriminate deconditioning from severe other causes [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary function impairment of asymptomatic and persistently symptomatic patients 4 months after COVID-19 according to disease severity

et al. 2021

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Objective Evaluation of pulmonary function impairment after COVID-19 in persistently symptomatic and asymptomatic patients of all disease severities and characterisation of risk factors. Methods Patients with confirmed SARS-CoV-2 infection underwent prospective follow-up with pulmonary function testing and blood gas analysis during steady-state cycle exercise 4 months after acute illness. Pulmonary function impairment (PFI) was defined as reduction below 80% predicted of DLCOcSB, TLC, FVC, or FEV1. Clinical data were analyzed to identify risk factors for impaired pulmonary function. Results 76 patients were included, hereof 35 outpatients with mild disease and 41 patients hospitalized due to COVID-19. Sixteen patients had critical disease requiring mechanical ventilation, 25 patients had moderate–severe disease. After 4 months, 44 patients reported persisting respiratory symptoms. Significant PFI was prevalent in 40 patients (52.6%) occurring among all disease severities. The most common cause for PFI was reduced DLCOcSB (n = 39, 51.3%), followed by reduced TLC and FVC. The severity of PFI was significantly associated with mechanical ventilation (p < 0.001). Further risk factors for DLCO impairment were COPD (p < 0.001), SARS-CoV-2 antibody-Titer (p = 0.014) and in hospitalized patients CT score. A decrease of paO2 > 3 mmHg during cycle exercise occurred in 1/5 of patients after mild disease course. Conclusion We characterized pulmonary function impairment in asymptomatic and persistently symptomatic patients of different severity groups of COVID-19 and identified further risk factors associated with persistently decreased pulmonary function. Remarkably, gas exchange abnormalities were revealed upon cycle exercise in some patients with mild disease courses and no preexisting pulmonary condition.

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“…In the largest study in the field, 75 patients with COVID-19 of various severity were recruited, approximately 3–4 months after discharge; of these, 55% established a reduced peak VO 2 . Patients with exercise impairment presented with a significantly lower anaerobic threshold, peak oxygen pulse, slope of oxygen uptake to work rate relationship, and peak work rate, compared to the rest, but they had similar peak ventilation and ventilatory reserve, compared to patients without exercise limitation [ 40 ]. No differences were noted in age, disease severity, and respiratory function parameters between the groups with normal and reduced exercise capacity.…”

Section: Persistent Functional Limitation and Mechanisms Of Establishmentmentioning

confidence: 99%

Long COVID-19 Pulmonary Sequelae and Management Considerations

Boutou

Asimakos

Kortianou

et al. 2021

JPM

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The human coronavirus 2019 disease (COVID-19) and the associated acute respiratory distress syndrome (ARDS) are responsible for the worst global health crisis of the last century. Similarly, to previous coronaviruses leading to past pandemics, including severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), a growing body of evidence support that a substantial minority of patients surviving the acute phase of the disease present with long-term sequelae lasting for up to 6 months following acute infection. The clinical spectrum of these manifestations is widespread across multiple organs and consists of the long-COVID-19 syndrome. The aim of the current review is to summarize the current state of knowledge on the pulmonary manifestations of the long COVID-19 syndrome including clinical symptoms, parenchymal, and functional abnormalities, as well as highlight epidemiology, risk factors, and follow-up strategies for early identification and timely therapeutic interventions. The literature data on management considerations including the role of corticosteroids and antifibrotic treatment, as well as the therapeutic potential of a structured and personalized pulmonary rehabilitation program are detailed and discussed.

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Deconditioning as main mechanism of impaired exercise response in COVID-19 survivors

Cited by 170 publications

References 18 publications

Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors

Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors

Pulmonary function impairment of asymptomatic and persistently symptomatic patients 4 months after COVID-19 according to disease severity

Long COVID-19 Pulmonary Sequelae and Management Considerations

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