Cardiopulmonary Exercise Testing in Post-COVID-19 Patients: Where Does Exercise Intolerance Come From? 2023 Milani et al

Background: Post-COVID-19 exercise intolerance is poorly understood. Cardiopulmonary exercise testing (CPET) can identify the underlying exercise limitations.

Objectives: To evaluate the source and magnitude of exercise intolerance in post-COVID-19 subjects.

Methods: Cohort study assessing subjects with different COVID-19 illness severities and a control group selected by propensity score matching. In a selected sample with CPET prior to viral infection, before and after comparisons were performed. Level of significance was 5% in the entire analysis.

Results: One hundred forty-four subjects with COVID-19 were assessed (median age: 43.0 years, 57% male), with different illness severities (60% mild, 21% moderate, 19% severe). CPET was performed 11.5 (7.0, 21.2) weeks after disease onset, with exercise limitations being attributed to the peripheral muscle (92%), and the pulmonary (6%), and cardiovascular (2%) systems. Lower median percent-predicted peak oxygen uptake was observed in the severe subgroup (72.2%) as compared to the controls (91.6%). Oxygen uptake differed among illness severities and controls at peak and ventilatory thresholds. Conversely, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse were similar. Subgroup analysis of 42 subjects with prior CPET revealed significant reduction in only peak treadmill speed in the mild subgroup and in oxygen uptake at peak and ventilatory thresholds in the moderate/severe subgroup. By contrast, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse did not change significantly.

Conclusions: Peripheral muscle fatigue was the most common exercise limitation etiology in post-COVID-19 patients regardless of the illness severity. Data suggest that treatment should emphasize comprehensive rehabilitation programs, including aerobic and muscle strengthening components.

Open access, https://abccardiol.org/article/test...d-19-de-onde-vem-a-intolerancia-ao-exercicio/

 

pdf in english
https://abccardiol.org/wp-content/u.../0066-782X-abc-120-02-e20220150-en.x55156.pdf

 

Is this an unexpected result? Is the limitation not usually in cardiovascular fitness rather than in the muscles?

 

The data do not, actually, suggest that. The researchers are suggesting that. Somehow. And they basically completely ignore the patients' experience, or basic reality.

I guess this means medicine basically doesn't actually know anything about deconditioning at all? If they can't ever tell the difference? It's not normal to be this confused. They don't even seem aware that this is the current treatment model, or that this model doesn't even have evidence. It's just completely detached from reality, the model is all, above reality itself.

It really looks as if what they had all this time is simply the same simple-but-wrong answers to complex problems and they never bothered beyond that. They sometimes work. They sometimes don't. But clearly, they can't even tell the difference anyway.

Because it's well-known that most people don't meet the recommendations for recreational exercise. Most people aren't physically fit, but they are still healthy. So using controls, they are comparing with people who aren't necessarily fit. Not being fit does not look the same as this clearly different process.

It's the lack of validity that is so infuriating. There is no concern with making sense or account for reality, even less concern with aligning with the patients' experience. There is always some magical wishy-washing to account for anything that falsifies.

 

This!