Do overweight people show reduced cardiopulmonary fitness after recovery from COVID-19?

In a recent study published in Nature’s Scientific reportsteam of scientists investigated factors such as cardiopulmonary fitness, body composition, and long-term symptoms associated with the consequences of coronavirus disease 2019 (COVID-19) in individuals who had recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections .

study: Body composition and cardiorespiratory fitness of overweight COVID-19 survivors of varying degrees of severity: a cohort study. Image credit: Billion Photos/Shutterstock.com

Background

A large body of evidence indicates that COVID-19 is not only a respiratory disease, but also a multisystem syndrome. Like many other viral diseases, the end of acute SARS-CoV-2 infections is characterized by persistent symptoms of COVID-19 that affect the cardiovascular, pulmonary, neurocognitive, muscular, and digestive systems.

These symptoms are collectively known as prolonged coronavirus disease (long COVID) or post-acute complications of COVID-19 (PASC) and can vary widely depending on environmental and lifestyle factors such as age, ethnicity, gender, comorbidities and factors for hospitalization.

Two broad categories have emerged in the classification of long-term COVID—one related to tissue damage that affects major organs such as the lungs, heart, and neurological tissue, and the other related to chronic inflammation that leads to autoimmunity, dysbiosis, viral persistence, and lymphopenia.

Studies show that individuals with higher fat mass, neuropathies, myopathies, and lower cardiopulmonary fitness are at increased risk of being admitted to intensive care units due to severe COVID-19.

Therefore, understanding how overweight individuals are affected by various long-term symptoms of COVID is essential for developing effective treatment and rehabilitation strategies.

About the research

In the current study, the team aimed to assess the cardiopulmonary fitness, body composition, and persistent long-term symptoms of COVID in individuals who had SARS-CoV-2 infections and compare symptoms with the severity of infection. They also examined hemodynamic and cardiopulmonary recovery after a stress test during the one-year follow-up.

Participants were categorized by severity of COVID-19 into mental, moderate, and critically ill or severe, and detailed information on medication use, medical history, hospitalization and respiratory support requirements, and persistent long-term symptoms of COVID was collected.

The test includes individuals between the ages of 18 and 65 who have had a positive diagnosis of COVID-19 based on a positive reverse transcription polymerase chain reaction (RT-PCR) test.

Participants were also overweight or obese according to their body mass index (BMI). They had to have received at least one dose of the COVID-19 vaccine and had medical clearance to undergo the stress test. Reduced mobility or any disabling neurological disorders were grounds for exclusion.

Baseline assessments included anthropometric and body composition measurements and a Bruce test to determine systolic and diastolic blood pressure, heart rate, and oxygen saturation. Self-reported medical history, SARS-CoV-2 infection characteristics, lifestyle habits, persistent long-term symptoms of COVID, and physical activity levels were also recorded.

Bioelectrical impedance analysis was used to assess measures of body composition such as body mass, lean mass, skeletal muscle mass, fat mass, fat-free mass, and body fat, and these values, along with height measurements, were used to calculate BMI.

An adapted Bruce test was used to monitor vital signs such as heart rate, oxygen saturation, and blood pressure during the stress test. These assessments were repeated after one year.

Results

The results reported that the most common long-term symptoms after COVID-19 in overweight or obese people were memory deficits, lack of concentration, fatigue and dyspnea, in that order.

The Bruce test showed that oxygen saturation was significantly lower for nearly 5 minutes and diastolic blood pressure was significantly higher in the critically ill group than in the mildly ill group.

Body composition measurements also showed an effect of time, with individuals in the critically ill or severely ill COVID-19 group showing increases in skeletal muscle mass, lean mass, and fat-free mass after one year.

Cardiopulmonary fitness did not appear to be significantly different between groups, and the respiratory quotient of the critically ill group was higher after one year compared to themselves. However, hemodynamic responses after exercise remained worse in individuals in the critically ill group.

Higher fat mass values ​​in critical or severe cases compared to mild cases indicate obesity, which is due to low-grade inflammation.

Given that the prevalence of persistent long-term symptoms of COVID was not significantly different in the three groups, the authors believe that a treatment and recovery approach consisting of regular physical activity and a balanced diet is essential for all patients with long-term COVID.

Conclusions

To summarize, the findings report that overall cardiopulmonary fitness does not vary significantly with the severity of COVID-19. Body composition assessments show increased adiposity associated with low-grade inflammation in critically ill patients with COVID-19.

However, the prevalence of long-term symptoms of COVID did not vary with the severity of COVID-19, with memory deficits, difficulty concentrating, fatigue, and dyspnea being the most common symptoms.