Long COVID can affect how women recover after exercise

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New research explores the link between long-term COVID and women’s ability to exercise. Artur Widak / NurPhoto via Getty Images
  • Long COVID or post-acute COVID syndrome is characterized by a wide range of symptoms that persist beyond the acute phase of 3-4 weeks after receiving the SARS-CoV-2 virus.
  • Women admitted with COVID-19 are more likely to experience persistent deficits in cardiovascular and lung function than men in the months after discharge.
  • A new study showed that even women with mild to moderate COVID-19 may experience slower decreases in their resting heart rate after physical activity in the post-acute phase of SARS-CoV-2 infection.
  • Such deficits in cardiovascular function during exercise are associated with reduced capacity for physical exercise and potentially daily activities.
  • Women with specific long-term COVID symptoms, namely shortness of breath or joint or muscle pain, were also more restricted in their ability to perform a gait test than individuals who had had a SARS-CoV-2 infection but did not experience any persistent symptoms. .

Although the majority of individuals recover within the first 3-4 weeks after receiving COVID-19, a significant number continue to experience persistent symptoms for weeks or months after this initial or acute phase of the disease.

These symptoms, which people collectively refer to as lang COVID or post-acute COVID-19, includes shortness of breath, loss of smell and taste, brain fog, headache and fatigue.

Studies have shown that more than half of the people admitted with COVID-19 in the initial phase of SARS-CoV-2 infection show persistent impairment of cardiovascular and lung function several months after discharge. Furthermore, women hospitalized with severe COVID-19 are more likely than men to exhibit such persistent deficits in cardiovascular and lung function after discharge.

Individuals may show persistent symptoms in the post-acute phase of COVID-19, regardless of the severity of the symptoms in the acute phase of the disease. The effect of mild to moderate COVID-19 on lung and cardiovascular function and subsequently on daily physical function in the post-acute phase is not well understood.

Researchers at Indiana University, Bloomington, recently investigated how mild to moderate COVID-19 affected post-acute exercise capacity or tolerance in women. Exercise tolerance or capacity refers to an individual’s cardiovascular system’s ability to maintain physical activity.

The researchers used a training test called the 6-minute walking test to assess the persistent effects of SARS-CoV-2 infection on cardiovascular function in women in the post-acute phase of the infection.

They found that women with COVID-19, who had mild to moderate disease in the acute phase, showed a slower decrease in their heart rate after the 6-minute walking test than the participants in the control group. This difference was more pronounced in women who actively experienced prolonged COVID symptoms.

Encouragingly, however, they found no statistically significant differences in a number of other measures, including pre- and post-test oxygen saturations, pre- and post-test heart rate, perceived exertional assessments, and perceived shortness of breath assessments.

The study’s lead author, Dr. Stephen Carter, a professor at Indiana University, told Medical news today: “An enigmatic feature of post-acute COVID-19 syndrome is the variable presentation of symptoms that appear to be independent of the severity of the initial disease. Current work shows that even those with mild to moderate initial symptoms may be affected by underlying heart-related irregularities with the potential to affect exercise tolerance and / or daily activities. “

“It is also likely that persistent symptoms, particularly muscle / joint pain and / or shortness of breath, may trigger a maladaptive pattern that accelerates systemic deconditioning. However, further research is needed.”

Dr. Ziyad Al-Aly, Head of Research and Education at Veterans Affairs St. Louis Health Care System, also spoke MNT. Dr. Al-Aly, who was not involved in the study, said: “Studies like these are important to help us understand why some people with long-term COVID experience deep exhaustion fatigue that can limit their ability to exercise and their ability to perform daily activities. ”

The study is published in the journal Experimental physiology.

The study included 29 women who had experienced mild or moderate illness due to COVID-19. These women had received a positive SARS-CoV-2 diagnosis at least 4 weeks before the study, with a mean diagnosis time of 94 days before the study. The control group consisted of 16 women who had never tested positive for a SARS-CoV-2 infection.

Out of the 29 participants in the test group, 17 women reported that they experienced at least one long COVID symptom at the time of the study. These long-lasting COVID symptoms included shortness of breath, fatigue, cough, muscle or joint pain, loss of smell or taste, and skin irritation.

The researchers administered lung function tests to assess various aspects of lung function. They found that the women who tested positive for SARS-CoV-2 showed reduced total lung capacity compared to those in the control group.

The researchers then evaluated changes in cardiovascular function during and after the 6-minute walk test. The test measures the distance that participants walk in 6 minutes at their normal pace, and researchers use it to assess training tolerance. The team adjusted the results for age, sex, and body mass index (BMI) to prevent these variables from affecting the test results.

There was no significant difference between the distances traveled by the two groups during the test.

However, women with SARS-CoV-2 who experienced shortness of breath or joint or muscle pain had a lower adjusted distance value than those with SARS-CoV-2 who did not experience these long-term COVID symptoms.

The researchers assessed blood pressure, heart rate and blood oxygen or oxygen saturation levels before and immediately after the 6-minute walk test. They calculated the heart rate response during exercise by subtracting the heart rate at rest from the heart rate after the end of the test.

The heart rate response during exercise is a measure of cardiovascular function, where a lower heart rate response is a predictor of reduced exercise capacity and cardiovascular disease-associated mortality.

The women in the SARS-CoV-2 group showed a lower heart rate response than those in the control group.

In addition, participants in the SARS-CoV-2 group who reported shortness of breath as a long COVID symptom at the time of the study had a lower heart rate response during the test than those in the SARS-CoV-2 group who did not have this symptom.

The researchers also measured heart rate recovery, which is another indicator of cardiovascular health and mortality of all causes.

The heart rate tends to drop immediately after strenuous exercise. Heart rate recovery measures the decrease in heart rate after cessation of exercise. Specifically, heart rate recovery quantifies the decrease in heart rate with a predefined time interval – generally 1 minute – from the end of the physical activity.

In the current study, the researchers measured participants’ heart rate at the end of each minute during the 5-minute recovery period after the 6-minute walking test.

The SARS-CoV-2 group participants showed a less significant decrease in heart rate 1 minute after the end of the test than those in the control group. This suggests that the decrease in heart rate occurred more gradually in the women in the SARS-CoV-2 group. Such a delay in the recovery of the heart rate is associated with decreased training capacity.

In addition, women in the SARS-CoV-2 group who exhibited specific prolonged COVID symptoms at the time of the study had reduced heart rate recovery compared to participants in the SARS-CoV-2 group without these symptoms.

Specifically, women in the SARS-CoV-2 group with symptoms such as fatigue, loss of taste or smell, joint and muscle pain, or shortness of breath had reduced heart rate recovery compared to women who had not had SARS-CoV-2.

Many long COVID-19 patients are placed in rehabilitation programs designed for non-COVID-19 patients. These programs may not be suitable for long COVID patients. It is important to understand that people with long-term COVID need for programs designed for them (pace, etc.). Results from this study and others should be taken into account when designing rehabilitation programs for people with long-term COVID-19, “said Dr. Al-Aly.

Dr. Carter noted: “SARS-CoV-2 participants and [people without the infection] were matched for age, BMI, smoking status, and history of heart-lung disease. As such, we have better assurance that reported differences were attributed to SARS-CoV-2 as opposed to another comorbidity. ”

“A strength of the work is that comparisons were made among women – who appear to be susceptible to persistent SARS-CoV-2-related symptoms – during and after a 6-minute walk test.”

Dr. Carter acknowledged that the study had a few limitations. He said: “In fact, the 6-minute walk test is a widely used clinical tool that provides insight into exercise capacity and walking autonomy. However, it should be noted that we can not ignore the possibility of undiagnosed pulmonary abnormalities and / or autonomic dysfunction that existed before a SARS-CoV-2 infection. In addition, it is conceivable that some controls may have had an asymptomatic SARS-CoV-2 infection and / or a previous false-negative diagnostic test for SARS-CoV-2. “

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