Impaired Endothelial Function in Individuals With Post-Acute Sequelae of COVID-19 Effects of Combined Exercise Training, 2025, Choi et al

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Impaired Endothelial Function in Individuals With Post-Acute Sequelae of COVID-19 Effects of Combined Exercise Training

Choi, Tae Gu MS; Kim, Jae Yeop MS; Seong, Joon Youp BS; Min, Ho Jeong BS; Jung, Yong Joon MS; Kim, Yun Wook MS; Cho, Min Jeong PhD; Kim, Hyun Jeong PhD; Kunutsor, Setor K. PhD; Heffernan, Kevin S. PhD; Jae, Sae Young PhD

Purpose
We investigated the presence of impaired endothelial function in individuals with post-acute sequelae of coronavirus disease-2019 (PASC) compared to healthy individuals and explored the efficacy of combined exercise training in restoring or improving endothelial function in those with PASC.

Methods
Study I was a cross-sectional study which compared endothelial function between individuals with PASC (n = 29, mean age 22.9 ± 3.9 year) and healthy individuals (n = 42, mean age 21.7 ± 2.0 year). Study II, an intervention design, explored if combined exercise training (n = 14) could reverse the decline in endothelial function associated with PASC compared to controls (n = 14). The combined exercise program included aerobic, resistance, and inspiratory muscle training administered for 8 weeks. We measured endothelial function using flow-mediated dilation of the brachial artery and assessed peak oxygen uptake (VO2peak), dyspnea, and fatigue before and after the intervention.

Results
Individuals with PASC exhibited significantly lower endothelial function compared to healthy controls (4.95 ± 2.0% vs 8.00 ± 2.4%, P < .001). The exercise group showed a significant increase in endothelial function (4.73 ± 1.5% to 7.98 ± 2.4%) as opposed to the control group (5.31 ± 2.5% to 6.30 ± 2.5%) (interaction effect: P = .008), reaching levels similar to those in healthy individuals. Additionally, the exercise group demonstrated improvement in VO2peak (38.3 ± 6.4 ml/min/kg to 42.8 ± 7.3 ml/min/kg, P < .001) and a reduction in dyspnea and fatigue compared to the control group (P < .001).

Conclusions
Having PASC is associated with impaired endothelial function, but combined exercise training effectively restores it, making it a promising lifestyle intervention for vascular function in PASC.

Link (Journal of Cardiopulmonary Rehabilitation and Prevention) [Paywall]
 
Having PASC is associated with impaired endothelial function, but combined exercise training effectively restores it, making it a promising lifestyle intervention for vascular function in PASC.
Sounds wonderful, but it is probably worth looking into the details.
Mostly Korean, with authors from the UK, US and Canada.

Just from the abstract:
It's a very small study. In particular, the exercise intervention only has 14 PASC and 14 PASC controls. I think there is likely to be a lot of self-selection as to who signs up for 8 weeks of exercise - possibly mainly those who are feeling a bit better (a Garner situation). Also, there is no followup. It would be good to see the changes for individual participants.

Edited to note the exercise intervention consisted of two groups, both of PASC participants, with one group getting the exercise intervention
 
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