A Pilot Study on the Effects of Exercise Training on Cardiorespiratory Performance, Quality of Life, and Immunologic Variables in [LC], 2024, Abbasi+

[SNT Gatchaman]

A Pilot Study on the Effects of Exercise Training on Cardiorespiratory Performance, Quality of Life, and Immunologic Variables in Long COVID
Abbasi, Asghar; Gattoni, Chiara; Iacovino, Michelina; Ferguson, Carrie; Tosolini, Jacqueline; Singh, Ashrita; Soe, Kyaw Khaing; Porszasz, Janos; Lanks, Charles; Rossiter, Harry B.; Casaburi, Richard; Stringer, William W.

OBJECTIVES
Fatigue is a prominent feature of long COVID (LC) and may be related to several pathophysiologic mechanisms, including immune hyperstimulation. Aerobic endurance exercise training may be a useful therapy, with appropriate attention to preventing post-exertional malaise.

METHODS
Fourteen participants completed a pilot study of aerobic exercise training (twenty 1.5 h sessions of over 10 weeks). Cardiorespiratory fitness, 6 min walk distance, quality of life, symptoms, 7-day physical activity, immunophenotype, and inflammatory biomarkers were measured before and after exercise training.

RESULTS
The participant characteristics at baseline were as follows: 53.5 ± 11.6 yrs, 53% f, BMI 32.5 ± 8.4, 42% ex-smokers, 15.1 ± 8.8 months since initial COVID-19 infection, low normal pulmonary function testing, V.O2peak 19.3 ± 5.1 mL/kg/min, 87 ± 17% predicted. After exercise training, participants significantly increased their peak work rate (+16 ± 20 W, p = 0.010) and V.O2peak (+1.55 ± 2.4 mL/kg/min, p = 0.030).

Patients reported improvements in fatigue severity (−11%), depression (−42%), anxiety (−29%), and dyspnea level (−46%). There were no changes in 6MW distance or physical activity. The circulating number of CD3+, CD4+, CD19+, CD14++CD16, and CD16++CD14+ monocytes and CD56+ cells (assessed with flow cytometry) increased with acute exercise (rest to peak) and was not diminished or augmented by exercise training. Plasma concentrations of TNF-α, IL-6, IL-8, IL-10, INF-γ, and INF-λ were normal at study entry and not affected by training.

CONCLUSIONS
Aerobic endurance exercise training in individuals with LC delivered beneficial effects on cardiorespiratory fitness, quality of life, anxiety, depression, and fatigue without detrimental effects on immunologic function.

Link | PDF (Journal of Clinical Medicine) [Open Access]

 

[SNT Gatchaman]

Small numbers, high drop-out rate, mean BMI 32.5. Note the subjective improvements reported on questionnaires vs no objective improvements (6MWT 498m -> 505m)

An important point of this pilot study is that CPET prior to an exercise training intervention in those with LC can uncover unexpected comorbidities attributed to LC symptoms (e.g., fatigue, dyspnea, exercise intolerance, PEM, etc.)

Arguments against performing CPET testing or exercise training in LC relate to the findings with other post-viral syndromes (e.g., Myalgic Encephalomyelitis/Chronic Fatigue Syndrome/) where structured exercise may worsen PEM. In this study, we were careful to assess for PEM at entry with a standardized questionnaire (DePaul, retrograde to 6 months) and review any new or worsened symptoms within 48 h of each exercise training session. The recall range of 6 months for the DePaul questionnaire may be judged too wide; however, we wanted to ensure that we had the largest range of understanding of our participant’s symptomatology.

 

[NelliePledge]

Do funders not have to do some kind of due diligence on whether the research proposal is a complete waste of money rehashing previous work.

 

[SNT Gatchaman]

They might have been attempting to assist the 40-50% of LC that isn't ME/CFS. Although 8/14 (57%) that completed were said to have PEM, while 4/7 (57%) dropouts also had PEM. Also not all were said to have exercise intolerance (6/14 completing and 4/7 dropout).

Can one be said to have PEM but not exercise intolerance? Certainly the other way round, but here "exercise intolerance (defined as an abnormally low capacity for endurance exercise)".

 

[forestglip]

but here "exercise intolerance (defined as an abnormally low capacity for endurance exercise)".

Intolerance was assessed by the inability to maintain a pedaling cadence > 50 rpm despite encouragement.

That seems like an odd way to define intolerance. When I hear that someone can't tolerate something, I think "something bad will happen if they do it", not "they physically can't do it". For example, peanut intolerance could mean hives or itching if the person eats them. I wouldn't call someone who isn't fit enough to run a marathon as having a "marathon intolerance".

 

[Hutan]

After exercise training, participants significantly increased their peak work rate (+16 ± 20 W, p = 0.010) and V.O2peak (+1.55 ± 2.4 mL/kg/min, p = 0.030).

I don't know what the +- is, SD? But it doesn't look as though even all the people who didn't drop out experienced a benefit in fitness.

Peak work rate +16 +-20 W suggests that some people had a decline in peak work rate
VO2 peak +1.55 +-2.4 mL/kg/min suggests that some people had a decline in VO2 peak

I should look at the paper, but you know, effort preference.

 

[SNT Gatchaman]

The supplementary materials contains the following —

A paper describing the lack of change in important CPET variables with the two day CPET protocol is currently under review at another journal. Therefore, a portion of the pre-exercise training CPET data from this manuscript may be published subsequently. The post training CPET data, PROs and immunology data in this manuscript have not been published before.

 

[rvallee]

no objective improvements (6MWT 498m -> 505m)

How does that even make sense to someone, that a 10 week exercise program would find no improvement on such a simple test? Yet find nothing wrong with the idea?

I have the same overall issue. Early this year I started being able to do very light exercise, such as light weights and walking. I started with 5 lbs and quickly went up to 15 lbs. Took me about 3-4 weeks. It's not even enough to feel soreness, it doesn't really challenge my muscles. I haven't been able to do more since.

Same with walks. They were very hard at first, but eventually got a bit easier. They're not easy. About 6 months later, I still can't go any longer.

I'm capped on all exercise. Initially I did a mix of things including push-ups, squats, etc. Few reps, scattered throughout the day. I've also been doing one-legged balance exercises for almost a year now.

None of it is any easier. I simply cannot do more, can't handle it physically. I can only do about 2-3 of those per week, or I get PEM, exhaustion, dizziness and palpitations.

This is what almost all those studies have found. There is clearly a blockage somewhere. They all completely ignore the blockage. WTF is wrong with them? This profession is so damn irrational and dysfunctional at times. They will literally refuse to acknowledge what their eyes can see right in front of them. It's maddening.

 

[Mij]

I'm set at 50 minute walks twice a week and maybe an extra 30 minute walk on another day for the last 22 years on a very good week. Some weeks I can't do anything. I can not increase more than that or I will get delayed PEM.