Long COVID May Affect How Women Recover From Exercise

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New research is exploring the link between long COVID and women’s ability to exercise. Artur Widak / NurPhoto via Getty Images
  • Long or post-acute COVID syndrome is characterized by a multitude of symptoms that persist beyond the acute phase 3 to 4 weeks after contracting the SARS-CoV-2 virus.
  • Women hospitalized with COVID-19 are more likely to have persistent deficits in cardiovascular and pulmonary function than men in the months following discharge.
  • A new study has found that even women with mild to moderate COVID-19 may experience a slower drop 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 ability to exercise and, potentially, to activities of daily living.
  • Women with specific long-term COVID symptoms, namely shortness of breath or joint or muscle pain, were also more limited in their ability to take a walk test than people who had had SARS-CoV-2 infection but did not ‘had no persistent symptoms.

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

These symptoms, which people collectively call long COVID or post-acute COVID-19, include shortness of breath, loss of smell and taste, brain fog, headaches, and fatigue.

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

Individuals can exhibit persistent symptoms during the post-acute phase of COVID-19, regardless of the severity of the symptoms during the acute phase of the disease. The effects of mild to moderate COVID-19 on pulmonary and cardiovascular function and, subsequently, on daily physical functioning during the post-acute phase are not well understood.

Researchers at the University of Indiana, Bloomington, recently examined how mild to moderate COVID-19 affects exercise capacity or tolerance during the post-acute phase in women. Tolerance or ability to exercise refers to the ability of an individual’s cardiovascular system to maintain physical activity.

The researchers used a stress test called a 6-minute walk test to assess the lingering effects of SARS-CoV-2 infection on cardiovascular function in women during the post-acute phase of the infection.

They found that women with COVID-19 who had mild to moderate illness during the acute phase had a slower drop in their heart rate after the 6-minute walk test than participants in the control group. This difference was more pronounced in women with active long symptoms of COVID.

Encouragingly, however, they found no statistically significant differences in a range of other measurements, including pre- and post-test oxygen saturations, pre- and post-test heart rate, exercise ratings. perceived and ratings of perceived shortness of breath.

Lead author of the study, Dr. Stephen Carter, professor at Indiana University, said Medical News Today: “A puzzling feature of post-acute COVID-19 syndrome is the variable presentation of symptoms that appear to be independent of the initial severity of the disease. The present work shows that even those with mild to moderate initial symptoms can be affected by underlying heart irregularities that may affect exercise tolerance and / or activities of daily living.

“It is also plausible that persistent symptoms, particularly muscle / joint pain and / or shortness of breath, could trigger an inappropriate regimen that accelerates systemic deconditioning. However, more research is needed. ”

Dr. Ziyad Al-Aly, head of research and education at the St. Louis Veterans Health Care System, also spoke with MNT. Dr Al-Aly, who was not involved in the study, said: “Studies like this are important in helping us understand why some people with long-lasting COVID experience profound exercise fatigue. which may limit their ability to exercise and their ability to perform activities. everyday.

The study appears in the journal Experimental physiology.

The study included 29 women who had suffered from mild or moderate illness due to COVID-19. These women had been diagnosed positive with SARS-CoV-2 at least 4 weeks prior to the study, with an average time to diagnosis of 94 days prior to the study. The control group consisted of 16 women who had never tested positive for SARS-CoV-2 infection.

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

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

The researchers then assessed changes in cardiovascular function during and after the 6-minute walk test. The test measures how far participants walk in 6 minutes at their normal pace, and researchers use it to assess exercise tolerance. The team adjusted the results for age, gender, and body mass index (BMI) to prevent these variables from influencing 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 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 resting heart rate from the heart rate after the test was completed.

Heart rate response during exercise is a measure of cardiovascular function, with a lower heart rate response being a predictor reduced exercise capacity and mortality associated with cardiovascular disease.

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

Additionally, 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 testing than those in the SARS-CoV-2 group. who haven’t. have this symptom.

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

Heart rate tends to drop immediately after strenuous exercise. Heart rate recovery measures the decrease in heart rate after you stop exercising. Concretely, heart rate recovery quantifies the decrease in heart rate at a predefined time interval – usually 1 minute – from the end of physical activity.

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

Participants in the SARS-CoV-2 group 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 women in the SARS-CoV-2 group. Such a delay in heart rate recovery is associated with reduced exercise capacity.

Additionally, women in the SARS-CoV-2 group who had specific symptoms of long COVID 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 did not. had SARS-CoV-2.

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

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

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

Dr Carter acknowledged that the study had some limitations. He said: “Indeed, 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 cannot ignore the possibility of undiagnosed lung abnormalities and / or autonomic dysfunction that existed prior to infection with SARS-CoV-2. In addition, it is conceivable that some controls had an asymptomatic infection with SARS-CoV-2 and / or a previous false-negative diagnostic test for SARS-CoV-2. “

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