Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients

Abstract

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.

Poor Nutritional Status and Dynapenia Are Highly Prevalent in Post-Acute COVID-19

“…Finally, the prevalence of malnutrition was related to the number of comorbidities only for MNA but not for CONUT (data not shown), in partial disagreement with previous studies (32,36). As for BC, while obesity and increased FM have frequently been associated with disease severity, length of hospital stay, ICU admission, and death (3,20,(37)(38)(39)(40)(41)(42)(43)(44), only a few studies have yielded data on muscle wasting, low FFM, and appendicular skeletal muscle in COVID-19 patients (4,7,8,14); for instance, a low pectoralis muscle area was found to be a predictor of poor prognosis (45). According to the data of this study, low FFMI and low SMI (by BIA) were observed in 17% and 31% of the whole sample, respectively (no previous evidence is available in the literature), being more common in malnourished patients as identified by MNA.…”

“…The evaluation of body composition (BC) and muscle function plays a major role in the assessment of nutritional status. Considering the clinical setting, bioelectrical impedance analysis (BIA) is a non-invasive and widely used method, already applied in COVID-19 patients, which gives estimates of fatfree mass (FFM) and other body compartments such as skeletal muscle mass (SM) (7,8). In addition, directly measured raw BIA variables (phase angle = PhA and impedance ratio = IR) yield information on inherent characteristics of FFM or muscle mass that may be related to body cell mass (BCM) and the ratio between extracellular water and total body water (ECW/TBW).…”

“…In addition, directly measured raw BIA variables (phase angle = PhA and impedance ratio = IR) yield information on inherent characteristics of FFM or muscle mass that may be related to body cell mass (BCM) and the ratio between extracellular water and total body water (ECW/TBW). Actually, low PhA has been observed in different categories of hospitalized COVID-19 patients and related to disease severity, length of stay, and mortality (9)(10)(11), with little evidence available in post-acute COVID-19 (8,12).…”

A Custom-Made Electronic Dynamometer for Evaluation of Peak Ankle Torque after COVID-19

“…Muscle strength reduction and sarcopenia was attributed as one of the SARS CoV-2 infection manifestations [45]. Other physio-pathological implications could also be involved in muscle wasting in patients assessed on hospital admission and after recovering from COVID-19.…”

Two years of COVID-19: Trends in rehabilitation

“…COVID-19 has several extrapulmonary manifestations of rehabilitative interest, including neurological, physical, and functional limitations 4 , 5 , 6 , 7 which can last even months after the acute illness phase. 8 , 9 Over time, an increasing number of studies have been published reporting data about rehabilitative therapies adopted and implemented in COVID-19 settings.…”