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. 2023 Sep 1;325(3):R269-R279.
doi: 10.1152/ajpregu.00111.2023. Epub 2023 Jul 14.

Neurovascular and hemodynamic responses to mental stress and exercise in severe COVID-19 survivors

Diego Faria  1   2 , Renata Moll-Bernardes  1 , Laura Testa  2 , Camila M V Moniz  2 , Erika C Rodrigues  1 , Jose M Mota  2 , Francis R Souza  3 , Maria Janieire N N Alves  3 , Bruna E Ono  1   2 , João E Izaias  1   2 , Artur O Sales  1   2 , Thais S Rodrigues  3 , Vera M C Salemi  3 , Camila P Jordão  3 , Katia De Angelis  4 , Daniel H Craighead  5 , Matthew J Rossman  5 , Luiz A Bortolotto  3 , Fernanda M Consolim-Colombo  3 , Maria C C Irigoyen  3 , Douglas R Seals  5 , Carlos E Negrão  3   6 , Allan R K Sales  1   2   3
Affiliations

Neurovascular and hemodynamic responses to mental stress and exercise in severe COVID-19 survivors

Diego Faria et al. Am J Physiol Regul Integr Comp Physiol. .

Abstract

Previous studies show that COVID-19 survivors have elevated muscle sympathetic nerve activity (MSNA), endothelial dysfunction, and aortic stiffening. However, the neurovascular responses to mental stress and exercise are still unexplored. We hypothesized that COVID-19 survivors, compared with age- and body mass index (BMI)-matched control subjects, exhibit abnormal neurovascular responses to mental stress and physical exercise. Fifteen severe COVID-19 survivors (aged: 49 ± 2 yr, BMI: 30 ± 1 kg/m2) and 15 well-matched control subjects (aged: 46 ± 3 yr, BMI: 29 ± 1 kg/m2) were studied. MSNA (microneurography), forearm blood flow (FBF), and forearm vascular conductance (FVC, venous occlusion plethysmography), mean arterial pressure (MAP, Finometer), and heart rate (HR, ECG) were measured during a 3-min mental stress (Stroop Color-Word Test) and during a 3-min isometric handgrip exercise (30% of maximal voluntary contraction). During mental stress, MSNA (frequency and incidence) responses were higher in COVID-19 survivors than in controls (P < 0.001), and FBF and FVC responses were attenuated (P < 0.05). MAP was similar between the groups (P > 0.05). In contrast, the MSNA (frequency and incidence) and FBF and FVC responses to handgrip exercise were similar between the groups (P > 0.05). MAP was lower in COVID-19 survivors (P < 0.05). COVID-19 survivors exhibit an exaggerated MSNA and blunted vasodilatory response to mental challenge compared with healthy adults. However, the neurovascular response to handgrip exercise is preserved in COVID-19 survivors. Overall, the abnormal neurovascular control in response to mental stress suggests that COVID-19 survivors may have an increased risk to cardiovascular events during mental challenge.

Keywords: exercise; mental stress; peripheral blood flow; sympathetic activity; vascular conductance.

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Conflict of interest statement

No conflicts of interest, financial or otherwise, are declared by the authors.

Figures

Figure 1.
Figure 1.
Original recordings of muscle sympathetic neve activity during mental stress in one control subject and in one COVID-19 survivor.
Figure 2.
Figure 2.
Sympathetic neural responses to mental stress in COVID-19 survivors. Muscle sympathetic nerve activity (MSNA) burst frequency during mental stress (MS) in control subjects and in severe COVID-19 survivors (A); delta MSNA burst frequency (B); MSNA burst incidence (C); and delta MSNA burst incidence (D). BL, baseline; Rec, recovery. *P < 0.05 vs. BL; †P < 0.05 vs. control subjects.
Figure 3.
Figure 3.
Vascular responses to mental stress in COVID-19 survivors. Forearm blood flow (FBF) during mental stress (MS) in control subjects and in severe COVID-19 survivors (A); delta FBF (B); forearm vascular conductance (FVC) (C); and delta FVC (D). BL, baseline; Rec, recovery. *P < 0.05 vs. BL; †P < 0.05 vs. control subjects.
Figure 4.
Figure 4.
Pressure responses to mental stress in COVID-19 survivors. Systolic blood pressure (SBP) during mental stress (MS) in control subjects and in severe COVID-19 survivors (A); delta SBP (B); diastolic blood pressure (DBP) (C); delta DBP (D); mean arterial pressure (MAP) (E); delta MAP (F); heart rate (HR) (G); and delta HR (H). BL, baseline; Rec, recovery. *P < 0.05 vs. control subjects.
Figure 5.
Figure 5.
Original recordings of muscle sympathetic neve activity during isometric handgrip exercise in one control and in one COVID-19 survivor.
Figure 6.
Figure 6.
Sympathetic neural responses to isometric handgrip exercise in COVID-19 survivors. Muscle sympathetic nerve activity (MSNA) burst frequency during isometric handgrip exercise (HG) in control subjects and in severe COVID-19 survivors (A); delta MSNA burst frequency (B); MSNA burst incidence (C); and delta burst MSNA incidence (D). BL, baseline; Rec, recovery.
Figure 7.
Figure 7.
Vascular responses to isometric handgrip exercise in COVID-19 survivors. Forearm blood flow (FBF) during isometric handgrip exercise (HG) in control subjects and severe COVID-19 survivors (A); delta FBF (B); forearm vascular conductance (FVC) (C); and delta FVC (D). BL, baseline; Rec, recovery.
Figure 8.
Figure 8.
Pressure responses to isometric handgrip exercise in COVID-19 survivors. Systolic blood pressure (SBP) during isometric handgrip exercise (HG) in control subjects and severe COVID-19 survivors (A); delta SBP (B); diastolic blood pressure (DBP) (C); delta DBP (D); mean arterial pressure (MAP) (E); delta MAP (F); heart rate (HR) (G); and delta HR (H). BL, baseline; Rec, recovery. *P < 0.05 vs. control subjects.
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