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

• Published in: Journal of applied physiology (1985) 2022-06, Vol.132 (6), p.1525-1535
• Main Authors: Ladlow, Peter, O'Sullivan, Oliver, Bennett, Alexander N, Barker-Davies, Robert, Houston, Andrew, Chamley, Rebecca, May, Samantha, Mills, Daniel, Dewson, Dominic, Rogers-Smith, Kasha, Ward, Christopher, Taylor, John, Mulae, Joseph, Naylor, Jon, Nicol, Edward D, Holdsworth, David A
• Format: Article
• Language: English
• Subjects: Active control; Adult; Athletes; Body composition; Body mass; Body mass index; Body size; Carbon dioxide; Coronaviruses; COVID-19; Exercise; Exercise Test; Exercise Tolerance; Functional testing; Heart Failure; Hospitalization; Humans; Illnesses; Oxygen; Oxygen Consumption; Oxygen uptake; Physical activity; Physical fitness; Physical training; Recovery; Rehabilitation; Signs and symptoms; Viral diseases
• ISSN: 8750-7587; 1522-1601
• DOI: 10.1152/japplphysiol.00138.2022

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 (V̇o ) 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 < 0.001). Hospitalized-symptomatic individuals had a steeper V̇e/V̇co slope (lower ventilatory efficiency) (30.5 ± 5.3 vs. 25.5 ± 2.6, = 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, = 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. 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 persist