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

Ladlow P; O’Sullivan O; Bennett AN; Barker-Davies R; Houston A; Chamley R; May S; Mills D; Dewson D;
Rogers-Smith K; Ward C; TayloJ;Mulae J; Naylor J; Nicol ED; Holdsworth DA;

Journal of applied physiology (Bethesda, Md. : 1985) [J Appl Physiol (1985)] 2022 May 19.
Date of Electronic Publication: 2022 May 19.

Background: A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high functioning populations ranging from front-line emergency services to professional or amateur/recreational athletes.
Aim: 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.
Methods: 113 participants underwent cardiopulmonary functional tests at a mean 159±7 days (~5 months) 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.
Results: Hospitalized groups had the least favorable body composition (body mass, body mass index and waist circumference) compared to controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇O 2 ) at peak exercise (hospitalized-symptomatic, 29.9±5.0ml/kg/min; community-symptomatic, 34.4±7.2ml/kg/min; vs. control 43.9±3.1ml/kg/min, both p<0.001). Hospitalized-symptomatic individuals had a steeper V̇E/V̇CO 2 slope (lower ventilatory efficiency) (30.5±5.3 vs. 25.5±2.6, p=0.003) vs. controls. Hospitalized-recovered had a significantly lower oxygen uptake at peak (32.6±6.6ml/kg/min vs. 43.9 ±13.1ml/kg/min, p=0.015) compared to controls. No significant differences were reported between community-recovered individuals and controls in any cardiopulmonary parameter.
Conclusion: Medium term findings suggest 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.