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Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Coronaviruses (CoV) and COVID-19 Pandemic".

Deadline for manuscript submissions: closed (15 November 2023) | Viewed by 21166

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Prof. Dr. Elizabeth C. Matsui

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Dell Medical School, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, USA
Interests: environmental exposures; asthma; allergy; immunology

Special Issue Information

Dear Colleagues,

Physical exercise is now considered to be not only a preventive strategy, but also an effective treatment for many chronic conditions. Evidence from observational and intervention studies demonstrates that sustained periods of physical activity, participation in regular exercise, or higher levels of cardiorespiratory fitness modify the risk of cardiorespiratory, metabolic, and mental disorders. This has been particularly evident during the recent COVID-19 pandemic. SARS-CoV-2 had the effect of revealing that individuals with comorbid conditions, who were comparatively sedentary, poorly fit, or some combination of these, had a significantly greater risk of adverse outcomes. The fact that most Western societies are relatively sedentary exacerbated the impact of COVID-19. However, the pandemic provided an opportunity to raise awareness regarding the importance of physical activity on health outcomes related to a wide spectrum of chronic conditions. This Special Issue focuses on original studies or evidence syntheses (e.g., systematic reviews or meta-analyses) that investigate the impact of physical activity patterns and cardiorespiratory fitness on respiratory infections, particularly as they relate to the recent COVID-19 pandemic.

Potential topics include, but are not limited to:

Impact of healthy living on pandemic preparedness;
COVID-19 pandemic and physical activity;
Cardiorespiratory fitness and health outcomes during the COVID-19 pandemic;
Cardiac or pulmonary rehabilitation during COVID-19;
Functional impairment with long COVID or post-COVID;
Physical activity in the management of long COVID or post-COVID symptoms;
Return to exercise post-COVID-19 infection;
Obesity and outcomes in COVID-19;
Effects of exercise on the cardiovascular, metabolic and immune system in the context of COVID-19;
Sedentarism due to COVID-19: impact on neuromuscular, cardiovascular, and metabolic health;
Physical activity and protection against respiratory infections.

Prof. Dr. Elizabeth C. Matsui
Guest Editor

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Keywords

physical activity
exercise
fitness
infection
COVID-19
respiratory
viruses

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Published Papers (9 papers)

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Research

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12 pages, 749 KiB

Open AccessArticle

Effects of Different Protocols of Moderate-Intensity Intermittent Hypoxic Training on Mental Health and Quality of Life in Brazilian Adults Recovered from COVID-19: The AEROBICOVID Double-Blind Randomized Controlled Study

by Eugenio Merellano-Navarro, Marta Camacho-Cardenosa, Gabriel Peinado Costa, Ester Wiggers, Germano Marcolino Putti, Jonatas Evandro Nogueira, Elisangela Aparecida da Silva Lizzi and Átila Alexandre Trapé

Healthcare 2023, 11(23), 3076; https://doi.org/10.3390/healthcare11233076 - 30 Nov 2023

Cited by 3 | Viewed by 1975

Abstract

The aim of this study was to investigate the effects of different protocols of moderate-intensity intermittent hypoxic training in patients who had recovered from COVID-19 on quality of life (QoL) and mental health. The sample of this clinical trial-controlled double-blind study consisted of 67 participants aged 30–69 years, who were organized randomly according to Normoxia, Hypoxia, Hypoxia Recovery or Control Group. Eight weeks of cycle ergometer training were performed with a frequency of three training sessions per week in normoxic or hypoxic conditions (with or without hypoxic recovery). Health-related QoL and Mental Health Status were evaluated by 12-Item Short Form Survey and Depression Anxiety and Stress Scale instruments, respectively. All training groups improved the QoL’s physical dimensions (Baseline–Post: Normoxia Group 42.1 (11.0)–48.7 (7.0), Hypoxia Group 46.9 (11.8)–53.5 (6.6) and Hypoxia Recovery Group 45.8 (9.2)–51.1 (5.3)) and mental dimensions (Baseline–Post: Normoxia Group 48.8 (7.9)–54.6 (4.6), Hypoxia Group 45.2 (7.7)–53.2 (3.8) and Hypoxia Recovery Group 46.5 (9.7)–52.0 (9.9)). Regarding mental health outcomes, all training groups decreased depressive symptoms (66.7% Normoxia, 31.2% Hypoxia Recovery and 31% Hypoxia groups), anxiety symptoms (46.5% Normoxia, 45.9% Hypoxia Recovery and 39.5% in the Hypoxia groups) and stress symptoms (40.6% Normoxia, 36.3% Hypoxia Recovery and 22.1% Hypoxia groups). Significant statistical difference was not found between groups. Normoxic and hypoxic training showed a similar effect on QoL and the mental health of Brazilian adults who had recovered from COVID-19. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

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13 pages, 310 KiB

Open AccessArticle

Telerehabilitation Intervention in Transitional Care for People with COVID-19: Pre-Post Study with a Non-Equivalent Control Group

by Neuza Reis, Maria José Costa Dias, Luís Sousa, Filipa Canedo, Miguel Toscano Rico, Maria Adriana Henriques and Cristina Lavareda Baixinho

Healthcare 2023, 11(18), 2561; https://doi.org/10.3390/healthcare11182561 - 16 Sep 2023

Cited by 2 | Viewed by 1992

Abstract

SARS-CoV-2 infection and its resulting sequelae have increased the prevalence of people with respiratory symptoms, with impacts on functional capacity, quality of life, anxiety, depression, and mental health. To mitigate this problem, one challenge has been the design and implementation of interventions that simultaneously allow for education, rehabilitation, and monitoring of people with long COVID, at a time when health services were on the verge of rupture due to the volume of people with active COVID and in need of intensive care. Telerehabilitation emerged as a mode for providing rehabilitative care that brought professionals closer to patients and enabled continuity of care. The present study aimed to evaluate the results of a telerehabilitation intervention for people with injuries associated with SARS-CoV-2 infection in hospital-community transitions, considering their degree of dependence in performing activities of daily living, respiratory symptoms, fatigue, gait capacity, muscle strength, and experience with anxiety and depression. A pre-post study with a non-equivalent control group was carried out with a total of 49 participants (intervention group n = 24; control group n = 25). The post-intervention results showed an increase in saturation, a decrease in heart rate, an improvement in the impact of post-COVID functionality, a decrease in fatigue, a decrease in perceived effort, and a decrease in depressive and anxiety symptoms. The telerehabilitation intervention, which combined educational strategies with respiratory and motor rehabilitation, helped improve global functionality and self-care, with clinical and functional impacts. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

11 pages, 528 KiB

Open AccessArticle

Differences of Disabling Symptoms between Previously Hospitalized or Non-Hospitalized Currently Working Long-COVID Survivors One Year after Infection: A Descriptive Study

by Laura López-López, Andrés Calvache-Mateo, Araceli Ortiz-Rubio, María Granados-Santiago, Alejandro Heredia-Ciuró, Javier Martín-Núñez and Marie Carmen Valenza

Healthcare 2023, 11(16), 2306; https://doi.org/10.3390/healthcare11162306 - 16 Aug 2023

Cited by 3 | Viewed by 1370

Abstract

This study aimed to describe the presence of disabling symptoms in currently working Long-COVID survivors by comparing the hospitalized and non-hospitalized one year after infection. Patients with Long-COVID syndrome (LCS) that have been infected by COVID-19 a year ago and were actually working were included. Participants that had been hospitalized due to COVID-19 were included in the LCS hospitalized group, and participants that had not been hospitalized were included in the LCS non-hospitalized group. The eligible patients were prompted to complete the latest self-report version of the COVID-19 Yorkshire Rehabilitation Screening Tool (C19-YRS). A total of 465 subjects were included in the study. Participants in the LCS hospitalized group were significantly older, had a significantly higher BMI, and had a significantly higher prevalence of women compared to the LCS non-hospitalized group. Additionally, participants in the LCS hospitalized group had obtained significantly worse results in symptom severity, functional disability, and global health perceived subscales of C19-YRS compared to the participants included in the LCS non-hospitalized group. We concluded that disabling symptoms are presented in patients with LCS at working age one year after infection and are higher in LCS hospitalized patients compared to LCS non-hospitalized patients. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

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13 pages, 285 KiB

Open AccessArticle

Does Physical Activity Affect Clinical Symptoms and the Quality of Life of Mild-Infected Individuals with COVID-19 in China? A Cross-Sectional Study

by Rong Wang, Yuanyuan Jia, Tingting Sun, Bing Ruan, Huixuan Zhou, Laikang Yu and Xiao Hou

Healthcare 2023, 11(15), 2163; https://doi.org/10.3390/healthcare11152163 - 30 Jul 2023

Cited by 1 | Viewed by 1426

Abstract

Background: Few studies have identified the links between physical activity (PA), clinical symptoms, and the quality of life (QoL) among mildly infected individuals with COVID-19. This cross-sectional study aims to evaluate how PA levels before infections affect the infectious symptoms and the QoL in mildly infected patients with COVID-19. Methods: An online questionnaire link including participants’ sociodemographic and anthropometric characteristics, clinical symptoms during the COVID-19 infectious period, the QoL of the worst symptomatic day, and PA in the last seven days before COVID-19 infections was disclosed. Logistic regression and multiple linear regression analyses were applied to assess the relationships between PA levels in the last seven days before infections and COVID-19-related outcomes. The level of statistical significance was set at p < 0.05. Results: Compared to the low-PA-level group, the moderate-PA-level group presented a higher risk of headaches (OR = 1.34, 95% CI = 1.03 to 1.75, and p = 0.03) and the high-PA-level group presented a higher risk of muscle/body aches (OR = 1.42, 95% CI = 1.04 to 1.93, and p = 0.03). The adjusted linear regression analysis showed that no associations were found between PA levels in the last seven days before infections and the QoL index value on the worst symptomatic day (moderate-PA-level group: β = −0.04, and p = 0.08; high-PA-level group: β = −0.04, and p = 0.17). However, for the mobility and usual activities dimensions of EQ-5D-5L, the lower-PA-level group had a lower burden of QoL than the higher-PA-level group did on the worst-symptomatic day. Conclusions: Among mildly infected patients with COVID-19, a higher PA level is associated with a higher risk of experiencing clinical symptoms and a lower QoL. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

13 pages, 601 KiB

Open AccessArticle

The Effect of Physical Exercise during COVID-19 Lockdown

by Pasquale Ricci, Margherita Pallocci, Michele Treglia, Serafino Ricci, Rosaria Ferrara, Claudia Zanovello, Pierluigi Passalacqua and Felice Marco Damato

Healthcare 2023, 11(11), 1618; https://doi.org/10.3390/healthcare11111618 - 1 Jun 2023

Cited by 1 | Viewed by 1643

Abstract

The COVID-19 pandemic has exerted an effect on the general population that went over every expectation. To explore the effect of physical exercise (PE) during the national lockdown in Italy, a survey was drawn up and administered to a sample composed of 208 subjects. The questionnaire comprised 81 multiple-choice items, including sociodemographic data, health-related questions, and assessment of physical exercise, satisfaction with life, depression, and personality. The purpose of this study is to explore the role of physical exercise during the outbreak following the present hypothesis: first, if a link exists between the time spent on physical exercise during the lockdown and the perceived health condition, depressive and somatic symptomatology, and life satisfaction; second, to find associations among the SF-12 component summaries and the other psychological outcomes; and finally, to explore how physical and psychological variables are predictive of PCS-12 and MCS-12. The results showed that both vigorous and moderate physical exercise was strongly correlated with psychological variables, with statistically significant negative correlations found between age and physical exercise. Additionally, significant positive correlations were observed between physical exercise and mental health indices, such as MCS-12 and SWLS, whereas negative correlations were found with BDI, PCS-12, and SOM-H. The correlation analysis also revealed that physical and individual mental health summaries were associated with psychological outcomes, with statistically significant negative correlations found between PCS-12 and MCS, PCS-12 and SOM-H, and MCS-12 and BDI scores. Regression analysis showed that physical activities and psychological status both had a direct influence on perceived mental and physical well-being during the lockdown, accounting for 56.7% and 35.5% of the variance, respectively. The p-values for the significant correlations ranged from <0.05 to <0.01. Overall, these findings highlight the importance of physical exercise and psychological well-being in maintaining good health during the pandemic. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

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17 pages, 349 KiB

Open AccessArticle

Physical Activity Levels, Eating Habits, and Well-Being Measures in Students of Healthcare Degrees in the Second Year of the COVID-19 Pandemic

by José Luis Maté-Muñoz, Juan Hernández-Lougedo, Jaime Ruiz-Tovar, Rafael Olivares-Llorente, Pablo García-Fernández and Irene Zapata

Healthcare 2023, 11(11), 1570; https://doi.org/10.3390/healthcare11111570 - 26 May 2023

Cited by 4 | Viewed by 1823

Abstract

Background: When the first cases of COVID-19 (caused by SARS-CoV-2 virus infection) were discovered, exceptional norms to fight the spread of the virus were established by applying movement restrictions (lockdown) in many countries. These unprecedented norms led to sedentary behaviours and less healthy diets which could persist for much longer after lockdown. The aim of this study was to analyse the physical activity, eating habits, self-perceived well-being, and toxic habits, as well as the perceived changes of these habits with respect to the pre-pandemic period, in a population of university students in the second year of the COVID-19 pandemic. Methods: A single-centre, cross-sectional study was conducted in a population of university students of healthcare degrees. A total of 961 students (639 (66.5%) women and 322 (33.5%) men) signed the informed consent and completed the questionnaire. The study was conducted through an anonymous survey, which was voluntarily self-completed by the students on an online platform. The questionnaire was based on the Spanish Health Survey and it was divided into six main parts: demographic and anthropometric characteristics, physical activity, eating habits, well-being measures (sleeping habits, health state, and stress), toxic habits, and perception of the influence of the COVID-19 pandemic on the variables described. Results and conclusions: The results showed that, during the second year of the pandemic, statistically significant dependence was identified for those students that showed higher levels of physical activity with greater perceived physical activity (p < 0.05), healthier eating habits (p < 0.05), and a better self-perceived health state (p < 0.05), with respect to the 12 months before the COVID-19 pandemic. On the other hand, there was a negative correlation between the sedentary students and greater perceived physical activity (p < 0.05). With regard to toxic habits and physical activity, a significant correlation was only detected between sedentary behaviour and cocaine consumption (p < 0.05). Analysing eating habits, it was observed that the students who smoked, consumed alcohol, and binge drank had low adherence to the Mediterranean diet (p < 0.05). In addition, those students with high stress levels slept less than 7 h (p < 0.05). Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

12 pages, 1155 KiB

Open AccessArticle

Cardiorespiratory Response to Six-Minute Step Test in Post COVID-19 Patients—A Cross Sectional Study

by Amna Omar, Arthur de Sá Ferreira, Fatma A. Hegazy and Gopala Krishna Alaparthi

Healthcare 2023, 11(10), 1386; https://doi.org/10.3390/healthcare11101386 - 11 May 2023

Cited by 4 | Viewed by 3151

Abstract

Background and purpose: New coronavirus disease 2019 (COVID-19) can cause persistent symptoms and physical weakness that can lead to a limitation in activities of daily living (ADL). There is a lack of evidence about the performance in the six-minute step test (6MST) of post-COVID-19 patients and healthy subjects. The aim of this study is to investigate the cardiorespiratory response induced by the 6MST in post-COVID-19 patients and compare it with the response of the six-minute walk test (6MWT). Methods: This cross-sectional study was conducted on 34 post-COVID-19 patients and 33 healthy subjects. The assessment was performed at one month from a non-severe SARS-CoV-2 infection. Both groups were assessed by using the 6MST, 6MWT, and the pulmonary function test (PFT). Post COVID functional status (PCFS) scale was used for the post-COVID-19 group to assess functional status. Physiological responses; heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), blood pressure (BP), and Borg scale for fatigue and dyspnea were recorded before and after the 6MST and 6MWT. Results: the performance of the post-COVID-19 group was worse than the healthy group in both tests. In 6MWT, the distance walked by the post-COVID-19 group (423 ± 7) was 94 m less than the healthy group, and the number of climbed steps in the 6MST (121 ± 4) was 34 steps less than the healthy group. Both results were statistically significant (p < 0.001). There was a moderate positive correlation between the 6MST and 6MWT in walked distance versus steps number (r = 0.5, p < 0.001). In addition, there was a moderate correlation between the two tests in the post (HR, RR, SpO₂, systolic blood pressure SBP, diastolic blood pressure DBP, dyspnea, and fatigue) with p < 0.001. Conclusions: Six-minute step tests produced similar cardiorespiratory responses when compared to a 6MWT. The 6MST can be used as an assessment tool for COVID-19 patients to evaluate their functional capacity and ADL. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

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Review

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14 pages, 684 KiB

Open AccessReview

Exercise Training in Non-Hospitalized Patients with Post-COVID-19 Syndrome—A Narrative Review

by Johanna Sick and Daniel König

Healthcare 2023, 11(16), 2277; https://doi.org/10.3390/healthcare11162277 - 12 Aug 2023

Cited by 5 | Viewed by 1898

Abstract

Post COVID-19 Syndrome (PCS) is the persistence of symptoms after an infection with SARS-CoV-2 in both hospitalized and non-hospitalized COVID-19 survivors. Exercise was proposed as a rehabilitation measure for PCS and early studies focused on patients post-hospital discharge. The objective of this review is to summarize the results of trials investigating exercise interventions in non-hospitalized subjects with PCS and propose practical recommendations concerning safe exercise programming. A literature search in the databases MEDLINE and Scopus was conducted until 26 July 2023 and resulted in seven studies that met the criteria. In total, 935 subjects with PCS were investigated. Exercise enhanced aerobic fitness and physical function and relieved symptoms of dyspnea, fatigue and depression. Participants reported lower Post COVID-19 Functional Status scores post-intervention. The exercise programs were well tolerated with no adverse events. To ensure safety, medical examinations should take place in advance and there should be a regular evaluation of the individual responses to the training. Caution is advised when working with patients suffering from post-exertional malaise or diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome. There is a growing need for additional randomized controlled trials to investigate the effectiveness and safety of exercise in individuals with PCS. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

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18 pages, 767 KiB

Open AccessSystematic Review

Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies

by Hyo-Weon Suh, Chan-Young Kwon and Boram Lee

Healthcare 2023, 11(8), 1095; https://doi.org/10.3390/healthcare11081095 - 11 Apr 2023

Cited by 13 | Viewed by 5046

Abstract

Coronavirus disease 2019 (COVID-19) sequelae (or long COVID) has become a clinically significant concern. Several studies have reported the relationship between heart rate variability (HRV) parameters and COVID-19. This review investigates the long-term association between COVID-19 and HRV parameters. Four electronic databases were searched up to 29 July 2022. We included observational studies comparing HRV parameters (measurement durations: 1 min or more) in participants with and without a history of COVID-19. We used assessment tools developed by the National Heart, Lung, and Blood Institute group to evaluate the methodological quality of included studies. Eleven cross-sectional studies compared HRV parameters in individuals who recovered from acute COVID-19 infection to controls (n = 2197). Most studies reported standard deviation of normal-to-normal intervals (SDNN) and root mean square of the successive differences. The methodological quality of the included studies was not optimal. The included studies generally found decreased SDNN and parasympathetic activity in post-COVID-19 individuals. Compared to controls, decreases in SDNN were observed in individuals who recovered from COVID-19 or had long COVID. Most of the included studies emphasized parasympathetic inhibition in post-COVID-19 conditions. Due to the methodological limitations of measuring HRV parameters, the findings should be further validated by robust prospective longitudinal studies. Full article

(This article belongs to the Special Issue Physical Activity, Cardiorespiratory Fitness, Respiratory Infections, COVID-19, and “Long COVID”)

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