Laboratório de Performance Humana, Rio de Janeiro, Brazil.
Casa de Saúde São José, Rio de Janeiro, Brazil.
Eur J Sport Sci. 2023 May;23(5):829-839. doi: 10.1080/17461391.2022.2054363. Epub 2022 Apr 9.
The multisystem impairment promoted by COVID-19 may be associated with a reduction in exercise capacity. Cardiopulmonary abnormalities can change across the acute disease severity spectrum. We aimed to verify exercise physiology differences between COVID-19 survivors and SARS-CoV-2-naïve controls and how illness severity influences exercise limitation. A single-centre cross-sectional analysis of prospectively collected data from COVID-19 survivors who underwent cardiopulmonary exercise testing (CPET) in their recovery phase ( = 50[36;72] days). Patients with COVID-19 were stratified according to severity as mild [M-Cov (outpatient)] vs severe/critical [SC-Cov(inpatients)] and were compared with SARS-CoV-2-naïve controls (N-Cov). Collected information included demographics, anthropometrics, previous physical exercise, comorbidities, lung function test and CPET parameters. A multivariate logistic regression analysis was performed to identify low aerobic capacity (LAC) predictors post COVID-19. Of the 702 included patients, 310 (44.2%), 305 (43.4%) and 87 (12.4%) were N-Cov, M-Cov and SC-Cov, respectively. LAC was identified in 115 (37.1%), 102 (33.4%), and 66 (75.9%) of N-CoV, M-CoV and SC-CoV, respectively ( < 0.001). SC-Cov were older, heavier with higher body fat, more sedentary lifestyle, more hypertension and diabetes, lower forced vital capacity, higher prevalence of early anaerobiosis, ventilatory inefficiency and exercise-induced hypoxia than N-Cov. M-Cov had lower weight, fat mass, and coronary disease prevalence and did not demonstrate more CEPT abnormalities than N-Cov. After adjustment for covariates, SC-Cov was an independent predictor of LAC (OR = 2.7; 95% CI, 1.3-5.6). Almost two months after disease onset, SC-CoV presented several exercise abnormalities of oxygen uptake, ventilatory adaptation and gas exchange, including a high prevalence of LAC. Weeks after the acute disease phase, one-third of mild and three-quarters of severe and critical patients with COVID-19 presented a reduced aerobic capacity. Previous studies including SARS-CoV-1 survivors observed much lower values.A severe or critical COVID-19 case was an independent predictor for low aerobic capacity.In our sample, pre-COVID-19 exercise significantly reduced the odds of post-COVID-19 low aerobic capacity. Even severe or critical patients who exercised regularly had a prevalence of low aerobic capacity 2.5 times lower than those who did not have this routine before sickening.
新型冠状病毒病引起的多系统损伤可能与运动能力下降有关。心肺异常可在急性疾病严重程度谱中发生变化。我们旨在验证新型冠状病毒病幸存者与新型冠状病毒 2 未感染者之间运动生理学的差异，以及疾病严重程度如何影响运动受限。这是一项单中心前瞻性研究，对新型冠状病毒病幸存者在恢复期进行心肺运动测试（CPET）的数据进行了横断面分析（ = 50[36;72]天）。根据严重程度将新型冠状病毒病患者分为轻症[M-Cov（门诊）]与重症/危重症[SC-Cov（住院）]，并与新型冠状病毒 2 未感染者（N-Cov）进行比较。收集的信息包括人口统计学、人体测量学、既往体力活动、合并症、肺功能检查和 CPET 参数。采用多元逻辑回归分析确定新型冠状病毒病后低有氧能力（LAC）的预测因素。在纳入的 702 例患者中，分别有 310 例（44.2%）、305 例（43.4%）和 87 例（12.4%）为 N-Cov、M-Cov 和 SC-Cov。N-Cov、M-Cov 和 SC-Cov 中分别有 115 例（37.1%）、102 例（33.4%）和 66 例（75.9%）出现 LAC（ < 0.001）。SC-Cov 年龄较大，体重较重，体脂较多，生活方式久坐不动，高血压和糖尿病更多，用力肺活量较低，早期无氧、通气效率和运动诱导性缺氧的发生率较高。M-Cov 体重、体脂和冠心病的患病率较低，CPET 异常较 N-Cov 少。调整协变量后，SC-Cov 是 LAC 的独立预测因素（OR=2.7；95%CI，1.3-5.6）。疾病发病后近 2 个月，SC-CoV 出现了摄氧量、通气适应和气体交换的多项运动异常，包括 LAC 高发病率。急性疾病阶段数周后，三分之一的轻症和四分之三的重症和危重症新型冠状病毒病患者出现有氧能力降低。以前包括 SARS-CoV-1 幸存者在内的研究观察到的数值要低得多。严重或危重症新型冠状病毒病病例是低有氧能力的独立预测因素。在我们的样本中，新型冠状病毒病发病前的运动显著降低了新型冠状病毒病发病后低有氧能力的几率。即使是经常运动的重症或危重症患者，其低有氧能力的患病率也比患病前没有这种常规运动的患者低 2.5 倍。
