Mechanisms of exercise intolerance after COVID-19: new perspectives beyond physical deconditioning

Ferreira, Eloara Vieira Machado; Oliveira, R.

doi:10.36416/1806-3756/e20210406

Cited by 8 publications

(3 citation statements)

References 13 publications

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“…However, this physical deconditioning cannot explain the persistent impairments in physical exercise-related parameters after at least 3 months post-infection, and many of them with mild symptoms may resume physical exercise shortly after recovery. 63 In this systematic review, we also identified pulmonary impairments in COVID-19 survivors by exercise testing, which suggested a non-deconditioning mechanism underlying exercise intolerance. More importantly, reconditioning shortly after COVID-19 may exacerbate the PASC.…”

Section: Discussionmentioning

confidence: 92%

Physical exercise-related manifestations of long COVID: A systematic review and meta-analysis

Zheng,

Chen,

Dai

et al. 2024

Journal of Exercise Science & Fitness

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Section: Discussionmentioning

confidence: 92%

Physical exercise-related manifestations of long COVID: A systematic review and meta-analysis

Zheng,

Chen,

Dai

et al. 2024

Journal of Exercise Science & Fitness

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“…Other mechanisms may be associated with chronic fatigue in individuals with PCS. For example, reduced peak oxygen uptake, mitochondrial oxygen supply, and actin/myosin ratio (i.e., myosin loss) may promote primary myopathy, inducing chronic fatigue in these individuals (Ferreira & Oliveira, 2021; Rodriguez et al., 2021). In this sense, IMT is a viable therapy for PCS.…”

Section: Discussionmentioning

confidence: 99%

Effects of a cardiopulmonary rehabilitation protocol on functional capacity, dyspnea, fatigue, and body composition in individuals with post‐COVID‐19 syndrome: A randomized controlled trial

Gomes dos Santos,

Vieira da Costa,

Cordeiro de Souza

et al. 2024

Physiotherapy Res Intl

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Background and ObjectiveReduced functional capacity, dyspnea, fatigue, and changes in body composition are common in patients with post‐COVID‐19 syndrome (PCS), and cardiopulmonary rehabilitation may improve these parameters. Thus, the present study verified the effects of cardiopulmonary rehabilitation (respiratory, aerobic, and resistance muscle training) on submaximal exercise tolerance, dyspnea, fatigue, and body composition.MethodsThis controlled and randomized clinical trial applied a six‐week outpatient intervention protocol in individuals over 18 years old (n = 33) with a diagnosis of COVID‐19 confirmed by polymerase chain reaction. These individuals were allocated to cardiopulmonary rehabilitation (n = 17) or control groups (i.e., educational lectures; n = 16). The cardiopulmonary rehabilitation group performed respiratory, aerobic, and resistance muscle training. Submaximal exercise tolerance, dyspnea, fatigue, and body composition were assessed before and after the protocol.ResultsAfter 6 weeks, the cardiopulmonary rehabilitation group increased the tolerance to submaximal exercise, with a difference of 100.46 m (95% confidence interval [CI]: 7.40–193 m) in the distance walked on the six‐minute walk test, reduced dyspnea (−1.45, 95% CI: −1.98–−0.92) in the modified Medical Research Council, and increased 0.63 kg (95% CI: 0.09–1.18 kg) of muscle mass in the upper limbs compared with the control group.ConclusionThe six‐week cardiopulmonary rehabilitation protocol improved functional capacity, reduced dyspnea, and increased muscle mass in the upper limbs in individuals with PCS. Thus, these results supported the protocol use in this population and encourage further studies to assess its effectiveness in a large sample.

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“…Together, these data suggest that diminished skeletal muscle mass, muscle strength, and aerobic capacity are likely contributors to longterm impairments in physical function. The mechanisms responsible for these effects are not well understood (Ferreira and Oliveira, 2021;Seixas et al, 2022;Serviente et al, 2022) and may be multifactorial including factors associated with general critical illness (i.e., extended periods of inactivity, pharmacological therapies, malnutrition) and/or mechanisms specific to COVID-19 pathophysiology (i.e., direct viral infiltration, renin angiotensin system dysregulation, systemic inflammation, and oxidative stress).…”

Section: Introductionmentioning

confidence: 99%

Blood flow restriction as a potential therapy to restore physical function following COVID-19 infection

et al. 2023

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Accumulating evidence indicates that some COVID-19 survivors display reduced muscle mass, muscle strength, and aerobic capacity, which contribute to impairments in physical function that can persist for months after the acute phase of illness. Accordingly, strategies to restore muscle mass, muscle strength, and aerobic capacity following infection are critical to mitigate the long-term consequences of COVID-19. Blood flow restriction (BFR), which involves the application of mechanical compression to the limbs, presents a promising therapy that could be utilized throughout different phases of COVID-19 illness. Specifically, we hypothesize that: 1) use of passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to high-intensity exercise without BFR for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. The various applications of BFR may also serve as a targeted therapy to address the underlying pathophysiology of COVID-19 and provide benefits to the musculoskeletal system as well as other organ systems affected by the disease. Consequently, we present a theoretical framework with which BFR could be implemented throughout the progression from acute illness to outpatient rehabilitation with the goal of improving short- and long-term outcomes in COVID-19 survivors. We envision that this paper will encourage discussion and consideration among researchers and clinicians of the potential therapeutic benefits of BFR to treat not only COVID-19 but similar pathologies and cases of acute critical illness.

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Mechanisms of exercise intolerance after COVID-19: new perspectives beyond physical deconditioning

Cited by 8 publications

References 13 publications

Physical exercise-related manifestations of long COVID: A systematic review and meta-analysis

Physical exercise-related manifestations of long COVID: A systematic review and meta-analysis

Effects of a cardiopulmonary rehabilitation protocol on functional capacity, dyspnea, fatigue, and body composition in individuals with post‐COVID‐19 syndrome: A randomized controlled trial

Blood flow restriction as a potential therapy to restore physical function following COVID-19 infection

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