Clinical and Biomarker Profile Responses to Rehabilitation Treatment in Patients with Long COVID Characterized by Chronic Fatigue 2023, Binetti et al

Abstract:
Long COVID (LC) syndrome is a complex multiorgan symptom that persists beyond >12 weeks after SARS-CoV-2 infection. The most frequently associated symptom is fatigue. Physical activity and exercise are recommended, although specific studies are lacking. The objectives of the present work are to analyze the impact of a supervised exercise program on the clinical evolution of LC with fatigue patients and to identify whether certain circulating biomarkers could predict the response to rehabilitation.

The rehabilitation treatment response was analyzed in 14 women diagnosed with LC and fatigue, based on the changes in the 6 min walk test and Borg/Fatigue Impact scales. Patients who showed improvement in the meters walked were considered “responders” to the therapy. A total of 65% of patients responded to the exercise program, with an improvement in the meters walked and in oxygen saturation, with stability in the percentage of meters walked.

Participants with obesity and those double-vaccinated against SARS-CoV-2 presented a lower degree of fatigue. LC patients presented a favorable response to a supervised exercise program.

Differences in creatinine and protein levels were observed between rehabilitation therapy “responders” and “nonresponders”. A good state of protein nutrition was related to a better rehabilitation response. The results are promising regarding possible predictive biomarkers of rehabilitation response, such as creatinine.

https://www.mdpi.com/1999-4915/15/7/1452

 

As above, this seems really bad.

Table 4, n=9 so presumably the <85% predicted 6MWT group. (Where is FIS?)



I don't understand this. "Percentage of meters walked" is presumably percent predicted. (Unless it's percent walked vs crawled !!). How can these 9/14 be at the same time below 85% predicted but also all were "within normal limits" at both time points. How does meters walked increase but percentage of meters walked decrease? Note the HR also increases with very little increased work/distance covered. Borg fatigue and dyspnoea also both increase. Shades of PACE.

Admittedly a reverse comparison, and one where normal is of course zero, rather than say 600m for the 6MWT [ref], but —

If I compared CT scans pre and post 2 cycles of chemotherapy and tried to claim a tumour reduction from 439 mL to 431 mL represented a favourable response, I'd be laughed out of the oncology meeting. Meanwhile the discussion would move on to decisions around escalating therapy...

 

I was puzzling over this predicted 'percentage of metres' walked too. I think it may have come from an equation in the paper in reference no.27 (link below) I've only skim read the paper but I think the original authors rejected the equation as it didn't account for all the variations between populations. Their graphs of distribution curves and histograms are more helpful.

The 6-min walk distance in healthy subjects: reference standards from seven countries, C. Casanova, et al
https://erj.ersjournals.com/content/37/1/150

 

But, if they do that, then they can't do this. See, they prefer some outcomes and that's just that. Especially if it aligns with their prior expectations. And if I got this right, these days it's called being cancelled by the woke mob, or something like that.