David Debeaumont1,2, Fairuz Boujibar3,4, Eglantine Ferrand-Devouge2,5,6, Elise Artaud-Macari7,8,9, Fabienne Tamion10,11, Francis-Edouard Gravier7,8,12, Pauline Smondack12, Antoine Cuvelier7,8,9, Jean-François Muir7,8,9,12, Kevin Alexandre13,14, Tristan Bonnevie7,8,12. 1. Department of Respiratory and Exercise Physiology, Rouen University Hospital, Rouen, France. 2. Centre d'Investigation Clinique-Centre de Recherche Biologique 1404, Rouen University Hospital, Rouen, France. 3. Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France. 4. Institut National de la Santé et de la Recherche Médicale U1096, Rouen University Hospital, Rouen, France. 5. Department of General Practice, Normandie University, UNIROUEN, Rouen, France. 6. INSERM U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" Institut Blood and Brain @ Caen-Normandie, Cyceron, Normandie University, UNICAEN, Caen, France. 7. Unité Propre de Recherche de l'Enseignement Supérieur, Equipe d'accueil 3830 (Groupe de Recherche sur le Handicap Ventilatoire), Normandie University Rouen, Rouen, France. 8. Rouen Institute for Research and Innovation in Biomedicine, Rouen, France. 9. Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France. 10. Normandie University, UNIROUEN, Inserm U1096, FHU- REMOD-VHF, Rouen, France. 11. Medical Intensive Care Unit, Rouen University Hospital, Rouen, France. 12. ADIR Association, Rouen University Hospital, Rouen, France. 13. Infectious Diseases Department, Rouen University Hospital, Rouen, France. 14. Equipe d'accueil 2656 (GRAM 2.0), Institute for Research and Innovation in Biomedicine, Normandie University, Unirouen, Rouen, France.
Abstract
OBJECTIVE: The aim of this pilot study was to assess physical fitness and its relationship with functional dyspnea in survivors of COVID-19 6 months after their discharge from the hospital. METHODS: Data collected routinely from people referred for cardiopulmonary exercise testing (CPET) following hospitalization for COVID-19 were retrospectively analyzed. Persistent dyspnea was assessed using the modified Medical Research Council dyspnea scale. RESULTS: Twenty-three people with persistent symptoms were referred for CPET. Mean modified Medical Research Council dyspnea score was 1 (SD = 1) and was significantly associated with peak oxygen uptake (VO2peak; %) (rho = -0.49). At 6 months, those hospitalized in the general ward had a relatively preserved VO2peak (87% [SD = 20]), whereas those who had been in the intensive care unit had a moderately reduced VO2peak (77% [SD = 15]). Of note, the results of the CPET revealed that, in all individuals, respiratory equivalents were high, power-to-weight ratios were low, and those who had been in the intensive care unit had a relatively low ventilatory efficiency (mean VE/VCO2 slope = 34 [SD = 5]). Analysis of each individual showed that none had a breathing reserve <15% or 11 L/min, all had a normal exercise electrocardiogram, and 4 had a heart rate >90%. CONCLUSION: At 6 months, persistent dyspnea was associated with reduced physical fitness. This study offers initial insights into the mid-term physical fitness of people who required hospitalization for COVID-19. It also provides novel pathophysiological clues about the underlaying mechanism of the physical limitations associated with persistent dyspnea. Those with persistent dyspnea should be offered a tailored rehabilitation intervention, which should probably include muscle reconditioning, breathing retraining, and perhaps respiratory muscle training. IMPACT: This study is the first, to our knowledge, to show that a persistent breathing disorder (in addition to muscle deconditioning) can explain persistent symptoms 6 months after hospitalization for COVID-19 infection and suggests that a specific rehabilitation intervention is warranted.
OBJECTIVE: The aim of this pilot study was to assess physical fitness and its relationship with functional dyspnea in survivors of COVID-19 6 months after their discharge from the hospital. METHODS: Data collected routinely from people referred for cardiopulmonary exercise testing (CPET) following hospitalization for COVID-19 were retrospectively analyzed. Persistent dyspnea was assessed using the modified Medical Research Council dyspnea scale. RESULTS: Twenty-three people with persistent symptoms were referred for CPET. Mean modified Medical Research Council dyspnea score was 1 (SD = 1) and was significantly associated with peak oxygen uptake (VO2peak; %) (rho = -0.49). At 6 months, those hospitalized in the general ward had a relatively preserved VO2peak (87% [SD = 20]), whereas those who had been in the intensive care unit had a moderately reduced VO2peak (77% [SD = 15]). Of note, the results of the CPET revealed that, in all individuals, respiratory equivalents were high, power-to-weight ratios were low, and those who had been in the intensive care unit had a relatively low ventilatory efficiency (mean VE/VCO2 slope = 34 [SD = 5]). Analysis of each individual showed that none had a breathing reserve <15% or 11 L/min, all had a normal exercise electrocardiogram, and 4 had a heart rate >90%. CONCLUSION: At 6 months, persistent dyspnea was associated with reduced physical fitness. This study offers initial insights into the mid-term physical fitness of people who required hospitalization for COVID-19. It also provides novel pathophysiological clues about the underlaying mechanism of the physical limitations associated with persistent dyspnea. Those with persistent dyspnea should be offered a tailored rehabilitation intervention, which should probably include muscle reconditioning, breathing retraining, and perhaps respiratory muscle training. IMPACT: This study is the first, to our knowledge, to show that a persistent breathing disorder (in addition to muscle deconditioning) can explain persistent symptoms 6 months after hospitalization for COVID-19infection and suggests that a specific rehabilitation intervention is warranted.
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