Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 2;61(2):2200745.
doi: 10.1183/13993003.00745-2022. Print 2023 Feb.

Changes in cardiopulmonary exercise capacity and limitations 3-12 months after COVID-19

Charlotte Björk Ingul  1   2   3 , Anne Edvardsen  1   4 , Turid Follestad  5 , Divna Trebinjac  1 , Odd Andre Wathne Ankerstjerne  1 , Eivind Brønstad  2   6 , Øystein Rasch-Halvorsen  2   6 , Bernt Aarli  7   8 , Håvard Dalen  2   9   10 , Bjarne Martens Nes  2 , Tøri Vigeland Lerum  11   12 , Gunnar Einvik  4   12 , Knut Stavem  4   12   13 , Ingunn Skjørten  1   14
Affiliations

Changes in cardiopulmonary exercise capacity and limitations 3-12 months after COVID-19

Charlotte Björk Ingul et al. Eur Respir J. .

Abstract

Rationale: To describe cardiopulmonary function during exercise 12 months after hospital discharge for coronavirus disease 2019 (COVID-19), assess the change from 3 to 12 months, and compare the results with matched controls without COVID-19.

Methods: In this prospective, longitudinal, multicentre cohort study, hospitalised COVID-19 patients were examined using a cardiopulmonary exercise test (CPET) 3 and 12 months after discharge. At 3 months, 180 performed a successful CPET, and 177 did so at 12 months (mean age 59.3 years, 85 females). The COVID-19 patients were compared with controls without COVID-19 matched for age, sex, body mass index and comorbidity. Main outcome was peak oxygen uptake (V'O2 peak).

Results: Exercise intolerance (V'O2 peak <80% predicted) was observed in 23% of patients at 12 months, related to circulatory (28%), ventilatory (17%) and other limitations including deconditioning and dysfunctional breathing (55%). Estimated mean difference between 3 and 12 months showed significant increases in V'O2 peak % pred (5.0 percentage points (pp), 95% CI 3.1-6.9 pp; p<0.001), V'O2 peak·kg-1 % pred (3.4 pp, 95% CI 1.6-5.1 pp; p<0.001) and oxygen pulse % pred (4.6 pp, 95% CI 2.5-6.8 pp; p<0.001). V'O2 peak was 2440 mL·min-1 in COVID-19 patients compared to 2972 mL·min-1 in matched controls.

Conclusions: 1 year after hospital discharge for COVID-19, the majority (77%), had normal exercise capacity. Only every fourth had exercise intolerance and in these circulatory limiting factors were more common than ventilator factors. Deconditioning was common. V'O2 peak and oxygen pulse improved significantly from 3 months.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: C.B. Ingul has received lecture fees from Bayer AS, unrelated to the current study. I. Skjørten has provided lectures for doctors’ education paid by Norwegian Directorate of Health and Norwegian Medical Association. G. Einvik has received research grants from AstraZeneca to perform the current study. A. Edvardsen has received payment or honoraria for lectures, presentations or educational events from GlaxoSmithKline and Chiesi. K. Stavem has received consulting fees from UCB Pharma and MSD, unrelated to the present study. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Flow chart of the study population. COVID-19: coronavirus disease 2019; CPET: cardiopulmonary exercise testing. #: 22 patients from one hospital were only examined at 12 months.
FIGURE 2
FIGURE 2
Cardiopulmonary exercise capacity and limitations 1 year after coronavirus disease 2019. PROLUN: Patient-Reported Outcomes and Lung Function after Hospitalization for COVID-19; ICU: intensive care unit; V′O2 peak: peak oxygen uptake.
FIGURE 3
FIGURE 3
Peak oxygen uptake (V′O2 peak) % predicted and oxygen pulse % pred, and expired ventilation (V′E)/carbon dioxide output (V′CO2) slope according to a) dyspnoea, b) intensive care unit (ICU) status, c) obesity and d) comorbidity status at 3 and 12 months.
See this image and copyright information in PMC

Comment in

References

    1. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med 2021; 27: 601–615. doi: 10.1038/s41591-021-01283-z - DOI - PMC - PubMed
    1. European Centre for Disease Prevention and Control . SARS-CoV-2 Variants of Concern as of 9 June 2022. www.ecdc.europa.eu/en/covid-19/variants-concern Date last accessed: 29 June 2022.
    1. Carfi A, Bernabei R, Landi F, et al. Persistent symptoms in patients after acute COVID-19. JAMA 2020; 324: 603–605. doi: 10.1001/jama.2020.12603 - DOI - PMC - PubMed
    1. Clavario P, De Marzo V, Lotti R, et al. Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up. Int J Cardiol 2021; 340: 113–118. doi: 10.1016/j.ijcard.2021.07.033 - DOI - PMC - PubMed
    1. Skjørten I, Ankerstjerne OAW, Trebinjac D, et al. Cardiopulmonary exercise capacity and limitations 3 months after COVID-19 hospitalisation. Eur Respir J 2021; 58: 2100996. doi: 10.1183/13993003.00996-2021 - DOI - PMC - PubMed

Publication types