Unraveling the Mechanisms Behind Exercise Intolerance and Recovery in Long COVID - 25/05/24

Doi : 10.1016/j.amjmed.2024.04.023

Patricia Palau, MD, PhD ^a,^{^{⁎
Both authors contributed equally.},}^⁎ , Beatriz Calvo ^a,^{⁎
Both authors contributed equally.}, Clara Sastre, BSN, RN ^b, Eloy Domínguez, MD, PhD ^a,^c, Paloma Marín, PhD ^a,^d, Cristina Flor, PhD ^e, Julio Núñez, MD, PhD ^a,^f, Laura López, PhD ^a,^e
^a Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
^b Hospital Francesc de Borja, Gandía, Spain
^c Universitat Jaume I, Castellón, Spain
^d Facultad de Enfermería, Universitat de València, Valencia, Spain
^e Facultad de Fisioterapia, Universitat de València, Valencia, Spain
^f CIBER Cardiovascular

^⁎⁎Requests for reprints should be addressed to Patricia Palau, MD, PhD, Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia-SpainAv. de Blasco Ibáñez, 15, 46010, Valencia, Spain.Servicio de CardiologíaHospital Clínico UniversitarioINCLIVAUniversitat de ValenciaValencia-SpainAv. de Blasco Ibáñez, 15Valencia46010Spain

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Abstract

Background

Patients suffering from long COVID may exhibit autonomic dysregulation. However, the association between autonomic dysregulation and exercise intolerance and the impact of therapeutic interventions on its modulation remains unclear. This study investigated the relationship between heart rate recovery at the first minute (HRR1), a proxy for autonomic imbalance, and exercise intolerance in patients with long COVID. Additionally, the study aimed to assess the effects of a 12-week home-based inspiratory muscle training program on autonomic modulation in this patient population.

Methods

This study is a post hoc subanalysis of a randomized trial in which 26 patients with long COVID were randomly assigned to receive either a 12-week inspiratory muscle training program or usual care alone (NCT05279430). The data were analyzed using Pearson's correlation and linear mixed regression analysis.

Results

The mean age was 50.4 ± 12.2 years, and 11 (42.3%) were women. Baseline HRR1 was significantly correlated with maximal functional capacity (peakVO₂) (r = 0.402, P = .041). Patients with lower baseline HRR1 (≤22 bpm) exhibited higher resting heart rates and lower peakVO₂. Inspiratory muscle training led to a more substantial increase in peakVO₂ in patients with lower HRR1 at baseline (P = .019). Additionally, a significant improvement in HRR1 was observed in the IMT group compared to the usual care group after 12-week (Δ +9.39, 95% CI = 2.4-16.4, P = .010).

Conclusion

Lower baseline HRR1 is associated with exercise intolerance in long COVID patients and may serve as a valuable criterion for identifying individuals likely to benefit more from a home-based inspiratory muscle training program.

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Keywords : Exercise tolerance, Heart rate recovery, Inspiratory muscle training, Long COVID

Plan

	Funding: This work was supported in part by a grant from Sociedad Española de Cardiología, Investigación Clínica en Cardiología, grant no. SEC 2021.
	Conflicts of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
	Authorship: All authors had access to the data and a role in writing the manuscript. PP: Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing. BC: Data curation, Software, Writing – review & editing. CS: Data curation, Investigation, Writing – review & editing. ED: Investigation, Methodology, Supervision, Writing – review & editing. PM: Data curation, Writing – review & editing, CF: Data curation, Writing – review & editing, JN: Data curation, Writing – review & editing, Conceptualization, Formal analysis, Methodology. LL: Data curation, Investigation, Methodology, Project administration, Writing – review & editing.