Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation.

Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV.NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.

Combining Near-Infrared Spectroscopy and Heart Rate Variability Derived Thresholds to Estimate the Critical Intensity of Exercise.

ABSTRACT: Fleitas-Paniagua, PR, de Almeida Azevedo, R, Trpcic, M, Murias, JM, and Rogers, B. Combining near-infrared spectroscopy and heart rate variability derived thresholds to estimate the critical intensity of exercise. J Strength Cond Res 38(1): e16-e24, 2024-Critical intensity determination often requires costly tools and several testing sessions. Alternative approaches display relatively large individual variation. Therefore, simpler estimations with improved precision are needed. This study evaluated whether averaging the heart rate (HR) and oxygen uptake (V̇O 2 ) responses associated with the muscle deoxyhemoglobin concentration breakpoint ([HHb] BP ) and the heart rate variability (HRV) given by the detrended fluctuation analysis second threshold (HRVT2) during ramp incremental (RI) test improved the accuracy of identifying the HR and V̇O 2 at the respiratory compensation point (RCP). Ten female and 11 male recreationally trained subjects performed a 15 W·minute -1 RI test. Gas exchange, near-infrared spectroscopy (NIRS), and RR interval were recorded to assess the RCP, [HHb] BP , and HRVT2. Heart rate (mean ± SD : 158 ± 14, 156 ± 13, 160 ± 14 and, 158 ± 12 bpm) and V̇O 2 (3.08 ± 0.69, 2.98 ± 0.58, 3.06 ± 0.65, and 3.02 ± 0.60 L·minute -1 ) at the RCP, [HHb] BP , HRVT2, and HRVT2&[HHb] BP average (H&H Av ), respectively, were not significantly different ( p > 0.05). The linear relationship between H&H Av and RCP was higher compared with the relationship between [HHb] BP vs RCP and HRVT2 vs RCP for both HR ( r = 0.85; r = 0.73; r = 0.79, p > 0.05) and V̇O 2 ( r = 0.94; r = 0.93; r = 0.91, p > 0.05). Intraclass correlation between RCP, [HHb] BP , HRVT2, and H&H AV was 0.93 for V̇O 2 and 0.79 for HR. The [HHb] BP and the HRVT2 independently provided V̇O 2 and HR responses that strongly agreed with those at the RCP. Combining [HHb] BP and the HRVT2 resulted in estimations of the V̇O 2 and HR at the RCP that displayed smaller variability compared with each modality alone.

Effect of ramp slope on intensity thresholds based on correlation properties of heart rate variability during cycling.

An index of heart rate variability (HRV), detrended fluctuation analysis (DFA a1) has gathered interest as a surrogate marker of exercise intensity boundaries. The aim of this report was to examine heart rate variability threshold (HRVT) behavior across different ramp incremental (RI) slopes. Seventeen participants completed a series of three RI (15, 30, and 45 W · min-1 slopes) with monitoring of gas exchange parameters, heart rate (HR) and HRV. HRVT1 was defined as the V̇O2 or HR at which DFA a1 reached 0.75 and the HRVT2 at which these values reached 0.5. HRVTs were compared by Pearson's r, Bland-Altman analysis, ICC3,1 , ANOVA, and paired t-testing. An excellent degree of reliability was seen across all three ramps, with an ICC3,1 of 0.93 and 0.88 for the HRVT1 V̇O2 and HR, respectively, and 0.90 and 0.92 for the HRVT2 V̇O2 and HR, respectively. Correlations between HRVT1/2 of the individual ramps were high with r values 0.84-0.95 for both HR and V̇O2 . Bland-Altman differences ranged between -1.4 and 1.2 mL · kg-1 · min-1 and -2 and +2 bpm. Paired t-testing showed no mean differences between any HRVT1/2 ramp comparisons. Cycling ramp slope does not appear to affect either HRVT1 or HRVT2 in terms of HR or V̇O2 .

The effects of exercise intensity and duration on the relationship between the slow component of V̇O2 and peripheral fatigue.

AIM: If the development of the oxygen uptake slow component (V̇O2SC ) and muscle fatigue are related, these variables should remain coupled in a time- and intensity-dependent manner. METHODS: 16 participants (7 females) visited the laboratory on 7 separate occasions: (1) three 6-minutes moderate-intensity cycling exercise bouts proceeded by a ramp incremental test; (2-3) 30-minutes constant power output (PO) exercise bout to determine the maximal lactate steady state (MLSS); (4-7) constant-PO exercise bouts to task failure (TTF), pseudorandomized order, at (i) 15% below the PO at MLSS; (ii) 10 W below MLSS; (iii) MLSS; (iv) 10 W above MLSS (first intensity and randomized order thereafter). Neuromuscular fatigue was characterized by isometric maximal voluntary contractions and femoral nerve electrical stimulation of knee extensors to measure peripheral fatigue at baseline, at min 5, 10, 20, 30 and TTF. Pulmonary oxygen uptake (V̇O2 ) was continuously recorded during the constant-PO bouts and V̇O2SC was characterized based on each individual V̇O2 kinetics during moderate transitions. RESULTS: The development of V̇O2SC and peripheral fatigue were correlated across time (r2 adj range of 0.64-0.80) and amongst each exercise intensity (r2 adj range of 0.26-0.30) (all P < .001). Also, TTF was correlated with V̇O2SC and neuromuscular fatigue parameters (r2 adj range of 0.52-0.82, all P < .001). CONCLUSION: The V̇O2SC and peripheral fatigue development are correlated throughout the exercise in a time- and intensity-dependent manner, suggesting that the V̇O2SC may depend on muscle fatigue even if the mechanisms of reduced contractile function are different amongst intensities.

Evaluating the suitability of supra-POpeak verification trials after ramp-incremental exercise to confirm the attainment of maximum O2 uptake.

During exhaustive ramp-incremental cycling tests, the incidence of O2 uptake (V̇o2) plateaus is low. To verify the attainment of maximum V̇o2 (V̇o2max), it is recommended that a trial at a power output (PO) corresponding to 110% of the ramp-derived peak (POpeak) is performed. It remains unclear whether verification trials set at this PO can be tolerated for long enough to allow attainment of V̇o2max. Eleven recreationally trained individuals performed five ramp tests of varying slope (5, 10, 15, 25, and 30 W/min), each followed, in series, by two verification trials: the first at 110% POpeak of the 25 W/min ramp and the second at 110% POpeak attained in the preceding ramp test. Exercise duration of the first verification trial was on average 81 ± 15 s (CV = 9 ± 3%) versus 162 ± 32, 121 ± 24, 103 ± 15, and 73 ± 10 s for the second verification trials at 110% of POpeak of the 5, 10, 15, and 30 W/min ramp tests, respectively (P < 0.05). Compared with the highest V̇o2 recorded during ramp tests, V̇o2 from the subsequent verification trials was not different for the 5, 10, and 15 W/min ramp tests (P > 0.05) but was lower for the 25 and 30 W/min ramp tests (P < 0.05). Verification trials at 110% POpeak of rapidly incrementing ramp tests (i.e., 25 W/min) were not sustained for long enough to allow the attainment of V̇o2max. With commonly used rapidly incrementing ramp tests engendering exhaustion within 8-12 min, verification trials less than POpeak should be preferred as they can be sustained sufficiently long to allow the attainment of V̇o2max.

Establishing the V̇o2 versus constant-work-rate relationship from ramp-incremental exercise: simple strategies for an unsolved problem.

The dissociation between constant work rate of O2 uptake (V̇o2) and ramp V̇o2 at a given work rate might be mitigated during slowly increasing ramp protocols. This study characterized the V̇o2 dynamics in response to five different ramp protocols and constant-work-rate trials at the maximal metabolic steady state (MMSS) to characterize 1) the V̇o2 gain (G) in the moderate, heavy, and severe domains, 2) the mean response time of V̇o2 (MRT), and 3) the work rates at lactate threshold (LT) and respiratory compensation point (RCP). Eleven young individuals performed five ramp tests (5, 10, 15, 25, and 30 W/min), four to five time-to-exhaustions for critical power estimation, and two to three constant-work-rate trials for confirmation of the work rate at MMSS. G was greatest during the slowest ramp and progressively decreased with increasing ramp slopes (from ~12 to ~8 ml·min-1·W-1, P < 0.05). The MRT was smallest during the slowest ramp slopes and progressively increased with faster ramp slopes (1 ± 1, 2 ± 1, 5 ± 3, and 10 ± 4, 15 ± 6 W, P < 0.05). After "left shifting" the ramp V̇o2 by the MRT, the work rate at LT was constant regardless of the ramp slope (~150 W, P > 0.05). The work rate at MMSS was 215 ± 55 W and was similar and highly correlated with the work rate at RCP during the 5 W/min ramp (P > 0.05, r = 0.99; Lin's concordance coefficient = 0.99; bias = -3 W; root mean square error = 6 W). Findings showed that the dynamics of V̇o2 (i.e., G) during ramp exercise explain the apparent dichotomy existing with constant-work-rate exercise. When these dynamics are appropriately "resolved", LT is constant regardless of the ramp slope of choice, and RCP and MMSS display minimal variations between each other.NEW & NOTEWORTHY This study demonstrates that the dynamics of V̇o2 during ramp-incremental exercise are dependent on the characteristics of the increments in work rate, such that during slow-incrementing ramp protocols the magnitude of the dissociation between ramp V̇o2 and constant V̇o2 at a given work rate is reduced. Accurately accounting for these dynamics ensures correct characterizations of the V̇o2 kinetics at ramp onset and allows appropriate comparisons between ramp and constant-work-rate exercise-derived indexes of exercise intensity.