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Cardiovascular response to body positioning following sub-maximal exercise test among long-COVID individuals
Abstract
This study aimed to observe the effect of cardiovascular response to body positioning after cardiopulmonary exercise testing in post covid individuals. Ninety post covid participants (age group 18-45) were assigned into four groups: standing, sitting, supine, and prone position. All participants were assessed cardiovascular response, VO 2max baseline, post exercise in standing, sitting, supine and prone by using pulse oximeter, digital sphygmomanometer, polar heart rate and Borg scale. In SpO 2 , rate of perceived exertion (RPE), diastolic blood pressure, and heart rate, there was no significant difference between the groups at pre-exercise. However, a significant difference was observed at 1 min post-exercise and at 3 min post-exercise. As for systolic blood pressure, there was no significant difference between the groups at pre-exercise and at 1 min post-exercise, but a significant difference was noted at 3 min post-exercise. The findings of this study suggest that, when comparing standing, sitting, supine, and prone positions, the prone position exhibited faster recovery in terms of oxygen saturation and rate of perceived exertion, while the supine position showed quicker recovery in both systolic and diastolic blood pressure. Additionally, individuals with long-COVID symptoms were observed to have a lower VO 2max .
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Background and aim:
Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome.
Methods:
A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis.
Results:
A total of 200 patients (mean age 48.8 ± 14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8 ± 8.1 mL/min/kg vs. 28.8 ± 9.6 mL/min/kg, p = 0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p < 0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p = 0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders.
Conclusion:
Our data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.
Background: Oxygen saturation is the fraction of oxygen saturated hemoglobin relative to total hemoglobin in blood. Normal oxygen saturation level in humans are 95-100 percent. Breathlessness is an unpleasant sensation of rapid or difficult breathing. The reason behind the subject experiencing breathlessness is that the body demands more oxygen than it supplies. Thus this study is conducted to Evaluate Recovery of Oxygen saturation and Rate of perceived exertion in different body positions after submaximal exercise testing in normal healthy individuals. Methodology: It was Pre and Post Study Design with 6 months duration including 40 healthy students recruited by purposive sampling method. The outcome measure was Recovery of Oxygen saturation and rate of perceived exertion. Result – Using the Paired t test, this shows that fastest recovery of oxygen saturation occurs in prone position that is within 1 min (99±0.96) than supine within 3 min (99±0) than upright sitting within 3 min (99±0) and fastest recovery of rate of perceived exertion occurs in prone position that is within 1 min (0.825±0.99) than supine within 3 min (0±0) than upright sitting within 3 min (0±0). Conclusion - From the present study we evaluate the Recovery of oxygen saturation and RPE in supine, prone, upright sitting position and we found that the fastest recovery of oxygen saturation and Rate of perceived exertion occurs in prone position than supine and upright sitting position after submaximal exercise testing in normal healthy individual.
Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral pathophysiology (both pulmonary and non-pulmonary) and central perceptual processing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activities, focal periods, or alongside other common COPD symptoms), dimensions of breathlessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assessment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multidimensional instruments are available. Borg’s 0–10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field-based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assessment in daily life and in relation to exertion in people with COPD.
The SARS-CoV-2 (COVID-19) pandemic has caused unprecedented morbidity, mortality and global disruption. Following the initial surge of infections, focus shifted to managing the longer-term sequelae of illness in survivors. 'Post-acute COVID' (known colloquially as 'long COVID') is emerging as a prevalent syndrome. It encompasses a plethora of debilitating symptoms (including breathlessness, chest pain, palpitations and orthostatic intolerance) which can last for weeks or more following mild illness. We describe a series of individuals with symptoms of 'long COVID', and we posit that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. We suggest that all physicians should be equipped to recognise such cases, appreciate the symptom burden and provide supportive management. We present our rationale for an underlying impaired autonomic physiology post-COVID-19 and suggest means of management.
The recently emerged novel coronavirus, “severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)”, caused a highly contagious disease called coronavirus disease 2019 (COVID-19). The virus was first reported from Wuhan city in China in December, 2019, which in less than three months spread throughout the globe and was declared a global pandemic by the World Health Organization (WHO) on 11th of March, 2020. So far, the ongoing pandemic severely damaged the world’s most developed countries and is becoming a major threat for low- and middle-income countries. The poorest continent, Africa with the most vulnerable populations to infectious diseases, is predicted to be significantly affected by the ongoing COVID-19 outbreak. Therefore, in this review we collected and summarised the currently available literature on the epidemiology, etiology, vulnerability, preparedness and economic impact of COVID-19 in Africa, which could be useful and provide necessary information on ongoing COVID-19 pandemics in the continent. We also briefly summarised the concomitance of the COVID-19 pandemic and global warming.
[Purpose] This study was undertaken to measure cardiopulmonary function according to body position during the recovery period after maximal exercise and to identify an effective position after high-intensity exercise. [Subjects and Methods] Fifteen male university students in their twenties participated in the study. The subjects were randomly assigned to the supine position, the sitting position, or the trunk forward leaning position during the recovery period following maximal exercise. Oxygen uptake, minute ventilation volume, respiration rate, and heart rate according to posture were measured in a stable state, at maximal exercise loading, and at 1, 3, and 5 minutes after maximal exercise. [Results] Changes of cardiopulmonary function according to posture during the recovery period after maximal exercise showed that minute ventilation volume was smaller in the trunk forward leaning position than in the sitting or supine positions, and oxygen uptake also declined. [Conclusion] The trunk forward leaning position has a more positive effect on pulmonary ventilation after high-intensity exercise.
Background . The assessment of blood pressure (BP) response during exercise test is an important diagnostic instrument in cardiovascular system evaluation. The study aim was to determine normal values of BP response to submaximal, multistage exercise test in healthy adults with regard to their age, gender, and workload. Materials and Methods . The study was conducted in randomly selected normotensive subjects ( n = 1015 ) , 512 females and 498 males, aged 18–64 years (mean age 42.1 ± 12.7 years) divided into five age groups. All subjects were clinically healthy with no chronic diseases diagnosed. Exercise stress tests were performed using Monark bicycle ergometer until a minimum of 85% of physical capacity was reached. BP was measured at rest and at peak of each exercise test stage. Results . The relations between BP, age, and workload during exercise test were determined by linear regression analysis and can be illustrated by the equations: systolic BP (mmHg) = 0.346 × load (W) + 135.76 for males and systolic BP (mmHg) = 0.103 × load (W) + 155.72 for females. Conclusions . Systolic BP increases significantly and proportionally to workload increase during exercise test in healthy adults. The relation can be described by linear equation which can be useful in diagnostics of cardiovascular diseases.
[Purpose] The purpose of this study was to investigate the changes of cardiopulmonary function in normal adults after the Rockport 1 mile walking test. [Subjects and Methods] University students (13 males and 27 females) participated in this study. Before and after the Rockport 1 mile walking test, pulmonary function, respiratory pressure, and maximal oxygen uptake were measured. [Results] Significant improvements in forced vital capacity and maximal inspiratory pressure were observed after the Rockport 1 mile walking test in males, and significant improvements in forced vital capacity, forced expiratory volume at 1 s, maximal inspiratory pressure, and maximal expiratory pressure were observed after the Rockport 1 mile walking test in females. However, the maximal oxygen uptake was not significantly different. [Conclusion] Our findings indicate that the Rockport 1 mile walking test changes cardiopulmonary function in males and females, and that it may improve cardiopulmonary function in middle-aged and older adults and provide basic data on cardiopulmonary endurance.
The hypothesis was tested that changing the direction of the transverse gravitational stress in horizontal humans modulates cardiovascular and renal variables. On different study days, 14 healthy males were placed for 6 h in either the horizontal supine or prone position following 3 h of being supine. Eight of the subjects were in addition investigated in the horizontal left lateral position. Compared with supine, the prone position slightly increased free water clearance (349 +/- 38 vs. 447 +/- 39 ml/6 h, P = 0.05) and urine output (1,387 +/- 55 vs. 1,533 +/- 52 ml/6 h, P = 0.06) with no statistically significant effect on renal sodium excretion (69 +/- 3 vs. 76 +/- 5 mmol/6 h, P = 0.21). Mean arterial pressure and left atrial diameter were similar comparing effects of supine with prone. The prone position induced an increase in heart rate (54 +/- 2 to 58 +/- 2 beats/min, P < 0.05), total peripheral vascular resistance (13 +/- 1 to 16 +/- 1 mmHg. min(-1). l(-1), P < 0.05), forearm venous plasma concentration of norepinephrine (97 +/- 9 to 123 +/- 16 pg/ml, P < 0.05), and atrial natriuretic peptide (49 +/- 4 to 79 +/- 12 pg/ml, P < 0.05), whereas stroke volume decreased (122 +/- 5 to 102 +/- 3 ml, P < 0.05, n = 6). The left lateral position had no effect on renal variables, whereas left atrial diameter increased (32 +/- 1 to 35 +/- 1 mm, P < 0.05) and mean arterial pressure decreased (90 +/- 2 to mean value of 85 +/- 2 mmHg, P < 0.05). In conclusion, the prone position reduced stroke volume and increased sympathetic nervous activity, possibly because of mechanical compression of the thorax with slight impediment of arterial filling. The mechanisms of the slightly augmented urine output in prone position require further experimentation.
Analysis of rhythmic patterns embedded within beat-to-beat variations in heart rate (heart rate variability) is a tool used to assess the balance of cardiac autonomic nervous activity and may be predictive for prognosis of some medical conditions, such as myocardial infarction. It has also been used to evaluate the impact of manipulative therapeutics and body position on autonomic regulation of the cardiovascular system. However, few have compared cardiac autonomic activity in supine and prone positions, postures commonly assumed by patients in manual therapy. We intend to redress this deficiency.
Heart rate, heart rate variability, and beat-to-beat blood pressure were measured in young, healthy non-smokers, during prone, supine, and sitting postures and with breathing paced at 0.25 Hz. Data were recorded for 5 minutes in each posture: Day 1 - prone and supine; Day 2 - prone and sitting. Paired t-tests or Wilcoxon signed-rank tests were used to evaluate posture-related differences in blood pressure, heart rate, and heart rate variability.
Prone versus supine: blood pressure and heart rate were significantly higher in the prone posture (p < 0.001). Prone versus sitting: blood pressure was higher and heart rate was lower in the prone posture (p < 0.05) and significant differences were found in some components of heart rate variability.
Cardiac autonomic activity was not measurably different in prone and supine postures, but heart rate and blood pressure were. Although heart rate variability parameters indicated sympathetic dominance during sitting (supporting work of others), blood pressure was higher in the prone posture. These differences should be considered when autonomic regulation of cardiovascular function is studied in different postures.
Background
: Single studies support the presence of several post-COVID-19 symptoms; however, no meta-analysis differentiating hospitalized and non-hospitalized patients has been published to date. This meta-analysis analyzes the prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized patients recovered from COVID-19
. Methods
: MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were searched up to March 15, 2021. Peer-reviewed studies or preprints reporting data on post-COVID-19 symptoms collected by personal, telephonic or electronic interview were included. Methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. We used a random-effects models for meta-analytical pooled prevalence of each post-COVID-19 symptom, and I² statistics for heterogeneity. Data synthesis was categorized at 30days, 60days, and ≥90 days after
. Results
: From 15,577 studies identified, 29 peer-reviewed studies and 4 preprints met inclusion criteria. The sample included 15,244 hospitalized and 9,011 non-hospitalized patients. The methodological quality of most studies was fair. The results showed that 63.2%, 71.9% and 45.9% of the sample exhibited ≥one post-COVID-19 symptom at 30, 60, or ≥90days after onset/hospitalization. Fatigue and dyspnea were the most prevalent symptoms with a pooled prevalence ranging from 35% to 60% depending on the follow-up. Other post-COVID-19 symptoms included cough (20-25%), anosmia (10-20%), ageusia (15-20%) or joint pain (15-20%). Time trend analysis revealed a decreased prevalence 30days after with an increase after 60days
. Conclusion
: This meta-analysis shows that post-COVID-19 symptoms are present in more than 60% of patients infected by SARS-CoV‑2. Fatigue and dyspnea were the most prevalent post-COVID-19 symptoms, particularly 60 and ≥90 days after.
Cardiorespiratory fitness (CRF) is a vital sign and being physically active is a preventive and therapeutic strategy to prevent and treat disease, especially cardiovascular disease. Cardiopulmonary exercise testing (CPET), when performed according to recommended guidelines by qualified personnel, is the gold standard for assessing CRF and is a valuable, although underutilized tool in the prescription of aerobic exercise. With the population in many countries living longer lives, individuals are living with cardiovascular disease (CVD) and other chronic conditions for a longer time, placing more importance on the extension of time free of the deleterious effects of chronic disease and a higher quality of life. CVD remains the leading cause of morbidity and mortality in the western world and the leading cause of preventive death. Although physical activity meets the highest standards for American Heart Association (AHA) recommendations for CV health, most people still do not exercise or meet the guidelines of 150 minutes per week of moderate to high intensity exercise. Many begin an exercise program only to stop exercising after a short time. Individuals cease exercise programs because of lack of time and/or enjoyment, discomfort and/or injury. Regular physical activity is an established component of secondary prevention and therapy in patients with CVD (i.e., cardiac rehabilitation). Those with CVD who do exercise tend to exercise at either too low or too high exercise intensities and volumes. An individualized exercise prescription based on the results of CPET may have the potential to resolve some of these issues while also increasing safety and improving health and fitness outcomes for those with and without CVD. This chapter reviews the available evidence and strategies on CPET and exercise prescription for those with and without CVD.
Objective: To summarize the data presented in CARDIA study that examined the association between aerobic fitness (AF) and CVD risk factors; to describe the effect of AF in young age on advancing age; to report the implications of these results to Indian context. Methods: PubMed search engine was used and search term “CARDIA study” [title/abstract] used in advanced search on April 2017. 8 articles from 481 titles were selected for review. Results: Baseline data showed that high AF was superior to low AF in terms of CVD risk factors. High baseline AF lowers the incidence of hypertension, diabetes and mortality. AF decreased over the timeline
with high fitness group lost the maximum. Rate of decline was equal in both males and females; both high and low risk group. Conclusion: Observational cohort based on AF, interventional cohort to improve AF should be started in Indian population to confirm CARDIA findings.
Keywords: Cardiorespiratory fitness (CRF); Aerobic endurance; Cohort; Adults; Review
We hypothesized that muscle sympathetic nerve activity (MSNA) and cardiovascular responses to the conventional head-up tilt (HUT) are different from those to head-up suspension (HUS) because of antigravity muscle activity. The MSNA from the tibial nerve, heart rate, blood pressure, stroke volume, cardiac output, and calf blood flow were measured in 13 healthy young subjects. Left atrial diameter was measured by two-dimensional echocardiography in another nine subjects. The resting MSNA and cardiovascular responses at a low level (20 degrees) of orthostasis were similar during both modes. At higher levels (40 and 60 degrees), the responses of MSNA, heart rate, stroke volume, and cardiac output were significantly stronger and there was a smaller reduction in calf blood flow during HUT than during HUS (P < 0.05). Left atrial diameter was decreased significantly from the resting values during HUT and HUS without any significant difference between the modes of orthostasis. The results provide evidence that the engagement of antigravity muscles during HUT may have additive effects on sympathetic vasoconstrictor and cardiovascular responses to orthostatic stress.
Effect of obesity on cardiovascular responses to submaximal treadmill exercise in adult males
- A B H Itagi
- M K Jayalakshmi
- G Y Yunus
- Itagi, A.B.H.