Salmam Imane, Dubé Marc-Olivier, Zahouani Imane, Ramos Alexis, Desmeules François, Best Krista L, Roy Jean-Sébastien
Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, Quebec, Canada.
School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.
PLoS One. 2025 Jun 4;20(6):e0318707. doi: 10.1371/journal.pone.0318707. eCollection 2025.
Since the emergence of COVID-19, millions worldwide have continued to experience persistent symptoms months after infection. Among these, physical and cardiorespiratory impairments are frequently reported, but remain poorly understood. This systematic review aimed to identify and synthesize evidence regarding physical and cardiorespiratory impairments in individuals with long COVID, defined as symptoms persisting for at least three months post-infection.
A structured search was conducted across the MEDLINE, Embase, CINAHL, and Web of Science databases to identify cross-sectional and longitudinal cohort studies on physical and cardiorespiratory deficits in adults with long COVID. Twenty-two studies involving 3,041 adults with long COVID were included. Critical appraisal using the JBI-APT indicated that most studies had clear inclusion criteria (17/22), well-defined study populations (17/22), and valid exposure measurements (16/22), though confounding factors were often unaddressed (9/22 unclear or not reported). Findings indicate that while adults with long COVID displayed normal pulmonary function at rest, including Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1), Total Lung Capacity (TLC), and resting Arterial oxygen saturation (SpO2), significant impairments in exercise capacity were identified. Notably, all studies assessing the 6-minute walk test (6MWT) reported reduced distances, consistently falling below the 50th percentile of normative values. Additionally, VO₂peak was decreased in most studies (7/10), falling below 80% of the predicted value, indicating impaired aerobic capacity. Lower Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) values were observed in three out of six studies, with values below 75% of predicted, suggesting impaired gas exchange efficiency during exertion.
Despite preserved resting lung function, these findings highlight significant physical deconditioning in Long COVID adults, with substantial reduction in exercise capacity. Routine assessments should include more sensitive measures, such as the 6MWT and VO₂peak, to detect subtle exercise limitations, even in patients with normal resting SpO₂, to better inform rehabilitation interventions.
自新冠病毒病（COVID-19）出现以来，全球数百万人在感染数月后仍持续出现症状。其中，身体和心肺功能受损的情况屡有报道，但仍了解不足。本系统评价旨在识别和综合关于长期新冠病毒感染（定义为感染后症状持续至少三个月）个体身体和心肺功能受损的证据。
在MEDLINE、Embase、CINAHL和科学网数据库中进行了结构化检索，以识别关于长期新冠病毒感染成人身体和心肺功能缺陷的横断面和纵向队列研究。纳入了22项涉及3041名长期新冠病毒感染成人的研究。使用JBI-APT进行的批判性评价表明，大多数研究有明确的纳入标准（17/22）、定义明确的研究人群（17/22）和有效的暴露测量（16/22），尽管混杂因素往往未得到解决（9/22不清楚或未报告）。研究结果表明，虽然长期新冠病毒感染成人在静息状态下肺功能正常，包括用力肺活量（FVC）、第一秒用力呼气容积（FEV1）、肺总量（TLC）和静息动脉血氧饱和度（SpO2），但运动能力存在显著受损。值得注意的是，所有评估6分钟步行试验（6MWT）的研究均报告步行距离缩短，始终低于正常参考值的第50百分位数。此外，大多数研究（7/10）中峰值摄氧量（VO₂peak）降低，低于预测值的80%，表明有氧能力受损。六项研究中有三项观察到较低的一氧化碳弥散量（DLCO）值，低于预测值的75%，提示运动时气体交换效率受损。
尽管静息肺功能保持正常，但这些研究结果凸显了长期新冠病毒感染成人存在显著的身体机能下降，运动能力大幅降低。常规评估应包括更敏感的指标，如6MWT和VO₂peak，以检测细微的运动限制，即使是静息SpO₂正常的患者，以便更好地为康复干预提供依据。
