Opinion Using cardiorespiratory fitness assessment to identify pathophysiology in long COVID – Best practice approaches, 2024, Faghy

[The first 2 authors are familiar to me; the second author is leading this ME/CFS study: https://www.s4me.info/threads/inves...-with-me-cfs-sheffield-caroline-dalton.36250/ ]

Free fulltext:
https://www.sciencedirect.com/science/article/pii/S0033062024000276

Progress in Cardiovascular Diseases
Available online 27 February 2024
In Press, Journal Pre-proof

Using cardiorespiratory fitness assessment to identify pathophysiology in long COVID – Best practice approaches

Mark A. Faghy, Caroline Dalton, Rae Duncan, Ross Arena, Ruth E.M. Ashton
a
Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK
b
Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
c
Healthy Living for Pandemic Event Protection Network, Chicago, IL, USA
d
Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
e
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK

Available online 27 February 2024.


https://doi.org/10.1016/j.pcad.2024.02.005Get rights and content
Under a Creative Commons license
open access

Abstract

Cardio-respiratory fitness (CRF) is well-established in the clinical domains as an integrative measure of the body's physiological capability and capacity to transport and utilise oxygen during controlled bouts of physical exertion.

Long COVID is associated with >200 different symptoms and is estimated to affect ~150 million people worldwide.

The most widely reported impact is reduced quality of life and functional status due to highly sensitive and cyclical symptoms that manifest and are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli, more commonly known as post-exertional symptom exacerbation (PESE) which prevents millions from engaging in routine daily activities.

The use of cardiopulmonary exercise testing (CPET) is commonplace in the assessment of integrated physiology; CPET will undoubtedly play an integral role in furthering the pathophysiology and mechanistic knowledge that will inform bespoke Long COVID treatment and management strategies.

An inherent risk of previous attempts to utilise CPET protocols in patients with chronic disease is that these are compounded by PESE and have induced a worsening of symptoms for patients that can last for days or weeks.

To do this effectively and to meet the global need, the complex multi-system pathophysiology of Long COVID must be considered to ensure the design and implementation of research that is both safe for participants and capable of advancing mechanistic understanding.

Keywords
Long COVID
Cardiopulmonary exercise testing
Exertional symptoms

 

I don't think I've seen research that relied on very fit pwLC, when they are clearly not deconditioned yet in the medical sense, and how their performance evolves over time, how they compare with those who recover, and how their physiology changes.

Only the large observational studies are capable of that, it would take a large pool of patients and very attentive and insightful researchers. If they can go in that much detail, we would definitely get some real answers as to what that exertion intolerance is and how it differs from loss of fitness, then true deconditioning. I have very little hope that this is happening, though. It takes a level of attention to detail combined with the resources for it that we just don't see in chronic illness research.

Until then it's mostly poking in the dark, but it's good to have informed analysis like this helping along the way to an actual understanding.