Exercise capacity following SARS-CoV-2 infection is related to changes in cardiovascular and lung function in military personnel

Rebecca R Chamley; Jennifer L Holland; Jonathan Collins; Kayleigh Pierce; William D Watson; Peregrine G Green; David O'Brien; Oliver O'Sullivan; Robert Barker-Davies; Peter Ladlow; Stefan Neubauer; Alexander Bennett; Edward D Nicol; David A Holdsworth; Oliver J Rider

doi:10.1016/j.ijcard.2023.131594

Exercise capacity following SARS-CoV-2 infection is related to changes in cardiovascular and lung function in military personnel

Int J Cardiol. 2024 Jan 15:395:131594. doi: 10.1016/j.ijcard.2023.131594. Epub 2023 Nov 17.

Authors

Affiliations

¹ University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Medicine, Birmingham, UK; Royal Centre for Defence Medicine (South), Oxford, UK.
² University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom.
³ Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Royal Centre for Defence Medicine (South), Oxford, UK.
⁴ Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; Royal Centre for Defence Medicine (South), Oxford, UK.
⁵ Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK.; Royal Centre for Defence Medicine (South), Oxford, UK.
⁶ Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; Departments of Cardiology and Radiology, Royal Brompton Hospital, Sydney Street, London, UK; Royal Centre for Defence Medicine (South), Oxford, UK.
⁷ Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Departments of Cardiology and Radiology, Royal Brompton Hospital, Sydney Street, London, UK; School of Biomedical Engineering and Imaging Sciences, Kings College, London, United Kingdom; Royal Centre for Defence Medicine (South), Oxford, UK.
⁸ Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Medicine, Birmingham, UK; Royal Centre for Defence Medicine (South), Oxford, UK.
⁹ University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom. Electronic address: oliver.rider@cardiov.ox.ac.uk.

PMID: 37979795
DOI: 10.1016/j.ijcard.2023.131594

Abstract

Background: Since the COVID-19 pandemic, post-COVID syndrome (persistent symptoms/complications lasting >12 weeks) continues to pose medical and economic challenges. In military personnel, where optimal fitness is crucial, prolonged limitations affecting their ability to perform duties has occupational and psychological implications, impacting deployability and retention. Research investigating post-COVID syndrome exercise capacity and cardiopulmonary effects in military personnel is limited.

Methods: UK military personnel were recruited from the Defence Medical Services COVID-19 Recovery Service. Participants were separated into healthy controls without prior SARS-CoV-2 infection (group one), and participants with prolonged symptoms (>12 weeks) after mild-moderate (community-treated) and severe (hospitalised) COVID-19 illness (group 2 and 3, respectively). Participants underwent cardiac magnetic resonance imaging (CMR) and spectroscopy, echocardiography, pulmonary function testing and cardiopulmonary exercise testing (CPET).

Results: 113 participants were recruited. When compared in ordered groups (one to three), CPET showed stepwise decreases in peak work, work at VT1 and VO₂ max (all p < 0.01). There were stepwise decreases in FVC (p = 0.002), FEV₁ (p = 0.005), TLC (p = 0.002), V_A (p < 0.001), and DLCO (p < 0.002), and a stepwise increase in A-a gradient (p < 0.001). CMR showed stepwise decreases in LV/RV volumes, stroke volumes and LV mass (LVEDVi/RVEDVi p < 0.001; LVSV p = 0.003; RVSV p = 0.001; LV mass index p = 0.049).

Conclusion: In an active military population, post-COVID syndrome is linked to subclinical changes in maximal exercise capacity. Alongside disease specific changes, many of these findings share the phenotype of deconditioning following prolonged illness or bedrest. Partitioning of the relative contribution of pathological changes from COVID-19 and deconditioning is challenging in post-COVID syndrome recovery.

Keywords: Exercise capacity; Military; Post-COVID syndrome; SARS-CoV-2 infection.

MeSH terms

COVID-19*
Exercise Test
Exercise Tolerance
Humans
Lung
Military Personnel*
Pandemics
SARS-CoV-2