The effect of medium-term recovery status after COVID-19 illness on cardiopulmonary exercise capacity in a physically active adult population

Peter Ladlow, Oliver O'Sullivan, Alexander N Bennett, Robert Barker-Davies, Andrew Houston, Rebecca Chamley, Samantha May, Daniel Mills, Dominic Dewson, Kasha Rogers-Smith, Christopher Ward, John Taylor, Joseph Mulae, Jon Naylor, Edward D Nicol, David A Holdsworth

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22 Citations (SciVal)

Abstract

A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high-functioning populations ranging from frontline emergency services to professional or amateur/recreational athletes. The aim of the study is to describe the medium-term cardiopulmonary exercise profiles of individuals with “persistent symptoms” and individuals who feel “recovered” after hospitalization or mild-moderate community infection following COVID-19 to an age, sex, and job-role matched control group. A total of 113 participants underwent cardiopulmonary functional tests at a mean of 159 ± 7 days (∼5 mo) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered); and 26 controls. Hospitalized groups had the least favorable body composition (body mass, body mass index, and waist circumference) compared with controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V _ O 2) at peak exercise (hospitalized-symptomatic, 29.9 ± 5.0 mL/kg/min; community-symptomatic, 34.4 ± 7.2 mL/kg/min; vs. control 43.9 ± 3.1 mL/ kg/min, both P < 0.001). Hospitalized-symptomatic individuals had a steeper V _ E/V _ CO 2 slope (lower ventilatory efficiency) (30.5 ± 5.3 vs. 25.5 ± 2.6, P = 0.003) versus. controls. Hospitalized-recovered had a significantly lower oxygen uptake at peak (32.6 ± 6.6 mL/kg/min vs. 43.9 ± 13.1 mL/kg/min, P = 0.015) compared with controls. No significant differences were reported between community-recovered individuals and controls in any cardiopulmonary parameter. In conclusion, medium-term findings suggest that community-recovered individuals did not differ in cardiopulmonary fitness from physically active healthy controls. This suggests their readiness to return to higher levels of physical activity. However, the hospitalized-recovered group and both groups with persistent symptoms had enduring functional limitations, warranting further monitoring, rehabilitation, and recovery. NEW & NOTEWORTHY At 5 mo postinfection, community-treated individuals who feel recovered have comparable cardiopulmonary exercise profiles to the physically trained and active controls, suggesting a readiness to return to higher intensity/volumes of exercise. However, both symptomatic groups and the hospital-recovered group have persistent functional limitations when compared with active controls, supporting the requirement for ongoing monitoring, rehabilitation, and recovery.

Original languageEnglish
Pages (from-to)1525-1535
Number of pages11
JournalJournal of applied physiology (Bethesda, Md. : 1985)
Volume132
Issue number6
Early online date19 May 2022
DOIs
Publication statusPublished - 1 Jun 2022

Acknowledgements

The authors thank the participants who volunteered for the Military COVID-19 Observational Outcome in a Viral Infectious Disease (M-COVID) study for determination and positive engagement during the cardiopulmonary exercise test. The authors also acknowledge the tireless efforts of all the research support staff at the UK Defense Medical Rehabilitation Centre (DMRC), Stanford Hall for the role in ensuring this study could be delivered during challenging circumstances. The study was supported by a grant from the Defense Medical Services Research Steering Group.

Keywords

  • cardiopulmonary exercise testing
  • exercise capacity
  • long COVID
  • recovery

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

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