Exercise Limitation 3 Months Post Severe COVID-19 Lung Infection

At 3 months following a severe COVID-19 pulmonary infection, a third of patients enrolled in a cohort study report a limitation in exercise capacity, which is associated with decreased pulmonary function, reduced skeletal muscle mass and function, but no significant impairment in cardiac function. The ongoing prospective, monocentric COVulnerability study was conducted at Henri Mondor Hospital, APHP, Creteil, France. Results of the analysis were published in the journal Respiratory Research.

The researchers sought to establish the frequency of long-term exercise capacity limitation among survivors of COVID-19 pulmonary infection and the factors that are associated with the impairment. Patients were enrolled between March 2020 and July 2021 who had been diagnosed with a severe COVID-19 pulmonary infection, hospitalized at an intensive care unit or at a conventional care unit for more than 7 days, and had received oxygen therapy during hospitalization (>3 L/min).

Of the 220 survivors of a severe COVID-19 pulmonary infection included in the COVulnerability cohort, 105 agreed to undergo a follow-up assessment at 3 months following hospital discharge. The participants underwent cardiopulmonary exercise testing, pulmonary function tests, echocardiography, and skeletal muscle mass evaluation.

Results of the study showed that among the 105 participants, 35% had a reduced exercise capacity (peak oxygen uptake [VO2peak] <80% predicted). Patients with reduced exercise capacity, compared with those with normal exercise capacity, were more often men (89.2% vs 67.6%, respectively; P =.015), were significantly more likely to have been diagnosed with diabetes (45.9% vs 17.6%, respectively; P =.002), were significantly more likely to have been diagnosed with renal dysfunction (21.6% vs 17.6%, respectively; P =.006), and had a significantly lower body mass index (25.79±3.68 kg/m2 vs 29.07±5.24 kg/m2, respectively; P =.001). The participants did not differ, however, with respect to initial acute disease severity.

Altered exercise capacity was associated with impaired pulmonary function, as evaluated by a significant decrease in forced vital capacity (FVC; P <.0001), forced expiratory volume in 1 second (FEV1; P <.0001), total lung capacity (P <.0001), and diffusing capacity of the lung for carbon monoxide (DLCO; P =.015).

Further, a significant decrease in muscular mass index and grip test (P =.001 and P =.047, respectively) was observed in the reduced exercise capacity group. Overall, 38.9% of participants with low exercise capacity had a sarcopenia compared with 10.9% of those with normal exercise capacity (P =.001).

Myocardial function was normal, with similar systolic and diastolic parameters reported between the groups, whereas the presence of reduced exercise capacity was associated with a slightly shorter pulmonary acceleration time, despite the lack of pulmonary hypertension.

A limitation of the current study is the absence of any preexisting assessment of the participants prior to the acute phase of the disease.

The researchers concluded that the use of adapted rehabilitation among those patients who experience impairment in exercise capacity following a severe COVID-19 pulmonary infection might help to decrease the global sequelae of this disease.

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures. 


Ribeiro Baptista B, d’Humières T, Schlemmer F, et al. Identification of factors impairing exercise capacity after severe COVID-19 pulmonary infection: a 3-month follow-up of prospective COVulnerability cohort. Respir Res. 2022;23(1):68. doi:10.1186/s12931-022-01977-z