Severe loss of mechanical efficiency in COVID-19 patients

Abstract

Background: There is limited information about the impact of coronavirus disease (COVID-19) on the muscular dysfunction, despite the generalized weakness and fatigue that patients report after overcoming the acute phase of the infection. This study aimed to detect impaired muscle efficiency by evaluating delta efficiency (DE) in patients with COVID-19 compared with subjects with chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), and control group (CG).

Methods: A total of 60 participants were assigned to four experimental groups: COVID-19, COPD, IHD, and CG (n = 15 each group). Incremental exercise tests in a cycle ergometer were performed to obtain peak oxygen uptake (VO₂ peak). DE was obtained from the end of the first workload to the power output where the respiratory exchange ratio was 1.

Results: A lower DE was detected in patients with COVID-19 and COPD compared with those in CG (P ≤ 0.033). However, no significant differences were observed among the experimental groups with diseases (P > 0.05). Lower VO₂ peak, peak ventilation, peak power output, and total exercise time were observed in the groups with diseases than in the CG (P < 0.05). A higher VO₂ , ventilation, and power output were detected in the CG compared with those in the groups with diseases at the first and second ventilatory threshold (P < 0.05). A higher power output was detected in the IHD group compared with those in the COVID-19 and COPD groups (P < 0.05) at the first and second ventilatory thresholds and when the respiratory exchange ratio was 1. A significant correlation (P < 0.001) was found between the VO₂ peak and DE and between the peak power output and DE (P < 0.001).

Conclusions: Patients with COVID-19 showed marked mechanical inefficiency similar to that observed in COPD and IHD patients. Patients with COVID-19 and COPD showed a significant decrease in power output compared to IHD during pedalling despite having similar response in VO₂ at each intensity. Resistance training should be considered during the early phase of rehabilitation.

Keywords: COPD; Cardiopulmonary exercise test; Ischaemic heart disease; Muscular dysfunction; SARS-CoV-2.

Figure 1

Comparisons in delta efficiency (A), VO₂ when the RER was 1 (B), and peak power when the RER was 1 (C) between the experimental groups. Abbreviations: CG, healthy control group; COPD, chronic obstructive pulmonary disease; DE, delta efficiency; IHD, ischaemic heart disease; RER, respiratory exchange ratio; VO₂, oxygen uptake. ^aHigher DE, VO₂, and peak power were detected in the healthy control group compared with the COVID‐19 and COPD groups (P < 0.05). (n = 15 each experimental group).

Figure 2

Correlations between delta efficiency (DE) and peak oxygen uptake (VO₂peak) (r = 0.64, P < 0.001) (A); peak power output in watts (W) (r = 0.61, P < 0.001) (B) (all participants, n = 60).