Exercise Limitation after Critical Versus Mild COVID-19 Infection: A Metabolic Perspective

Abstract

Exercise limitation in COVID-19 survivors is poorly explained. In this retrospective study, cardiopulmonary exercise testing (CPET) was coupled with an oxidative stress assessment in COVID-19 critically ill survivors (ICU group). Thirty-one patients were included in this group. At rest, their oxygen uptake (VO₂) was elevated (8 [5.6-9.7] mL/min/kg). The maximum effort was reached at low values of workload and VO₂ (66 [40.9-79.2]% and 74.5 [62.6-102.8]% of the respective predicted values). The ventilatory equivalent for carbon dioxide remained within normal ranges. Their metabolic efficiency was low: 15.2 [12.9-17.8]%. The 50% decrease in VO₂ after maximum effort was delayed, at 130 [120-170] s, with a still-high respiratory exchange ratio (1.13 [1-1.2]). The blood myeloperoxidase was elevated (92 [75.5-106.5] ng/mL), and the OSS was altered. The CPET profile of the ICU group was compared with long COVID patients after mid-disease (MLC group) and obese patients (OB group). The MLC patients (n = 23) reached peak workload and predicted VO₂ values, but their resting VO₂, metabolic efficiency, and recovery profiles were similar to the ICU group to a lesser extent. In the OB group (n = 15), no hypermetabolism at rest was observed. In conclusion, the exercise limitation after a critical COVID-19 bout resulted from an altered metabolic profile in the context of persistent inflammation and oxidative stress. Altered exercise and metabolic profiles were also observed in the MLC group. The contribution of obesity on the physiopathology of exercise limitation after a critical bout of COVID-19 did not seem relevant.

Keywords: COVID-19; cardiopulmonary exercise testing; critical illness; hypermetabolism; inflammation; long COVID; obesity; oxidative stress; survivors.