Identification of factors impairing exercise capacity after severe COVID-19 pulmonary infection: a 3-month follow-up of prospective COVulnerability cohort.

BACKGROUND: Patient hospitalized for coronavirus disease 2019 (COVID-19) pulmonary infection can have sequelae such as impaired exercise capacity. We aimed to determine the frequency of long-term exercise capacity limitation in survivors of severe COVID-19 pulmonary infection and the factors associated with this limitation. METHODS: Patients with severe COVID-19 pulmonary infection were enrolled 3 months after hospital discharge in COVulnerability, a prospective cohort. They underwent cardiopulmonary exercise testing, pulmonary function test, echocardiography, and skeletal muscle mass evaluation. RESULTS: Among 105 patients included, 35% had a reduced exercise capacity (VO2peak < 80% of predicted). Compared to patients with a normal exercise capacity, patients with reduced exercise capacity were more often men (89.2% vs. 67.6%, p = 0.015), with diabetes (45.9% vs. 17.6%, p = 0.002) and renal dysfunction (21.6% vs. 17.6%, p = 0.006), but did not differ in terms of initial acute disease severity. An altered exercise capacity was associated with an impaired respiratory function as assessed by a decrease in forced vital capacity (p < 0.0001), FEV1 (p < 0.0001), total lung capacity (p < 0.0001) and DLCO (p = 0.015). Moreover, we uncovered a decrease of muscular mass index and grip test in the reduced exercise capacity group (p = 0.001 and p = 0.047 respectively), whilst 38.9% of patients with low exercise capacity had a sarcopenia, compared to 10.9% in those with normal exercise capacity (p = 0.001). Myocardial function was normal with similar systolic and diastolic parameters between groups whilst reduced exercise capacity was associated with a slightly shorter pulmonary acceleration time, despite no pulmonary hypertension. CONCLUSION: Three months after a severe COVID-19 pulmonary infection, more than one third of patients had an impairment of exercise capacity which was associated with a reduced pulmonary function, a reduced skeletal muscle mass and function but without any significant impairment in cardiac function.

Measurement of Immunological Parameters to Assess Human Body Readiness for Physical Load.

We measured the level of natural antibodies (nAb) to glutamate and GABA reflecting the balance of excitation and inhibition systems and involved in the adaptation processes in athletes receiving normalized physical activity in the dynamics of training (figure skaters, football players, and people actively involved in sports). It was found that each subject has an individual immunological profile and its parameters change in accordance with the training load. The measured levels of nAbs to GABA and glutamate correlate the physical activity of a person. The surveyed football players were divided into 3 groups according to the results of the analysis. Subjects of the first group had reliably high immunological indices in comparison with the control and were at the peak of physical form; in the third group, low immunological indices relative to the control indicated exhaustion and fatigue. The indicators of the second group corresponded to normal and demonstrated the resource of adaptation to load. The developed method can be used for assessing person's readiness for physical activity.

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Cardiopulmonary exercise testing in systolic heart failure: from basic to advanced practice.

Cardiopulmonary exercise testing (CPET) is a specialized subtype of exercise testing that provides a more accurate and objective measure of cardiorespiratory fitness (CRF). CPET relies on measurement of ventilatory gases during exercise, i.e., a non-invasive procedure that involves the acquisition of expired ventilation and concentrations of oxygen (O2) and carbon dioxide (CO2) during progressive exercise. The non-invasive measurement of ventilation and expired gases permits the most accurate and reproducible quantification of CRF, a grading of the etiology and severity of impairment, and an objective assessment of the response to an intervention. Moreover, a particularly large volume of research has been directed toward the utility of CPET as a prognostic tool; CPET is a scientifically sound and therefore clinically valuable method for accurately estimating prognosis in various disease states. Although still underutilized, CPET has gained popularity not only due to the recognition of its clear value in the functional assessment of patients with cardiovascular, pulmonary and musculoskeletal disease/disorders, but also because technological advances (e.g., rapid response analyzers and computer-assisted data processing) have made this modality easier to use.

Evolución del patrón de actividad física en el embarazo y puerperio. análisis de una cohorte de 133 mujeres en Zaragoza (España) / Evolution of physical activity patterns in pregnancy and pospartum. A cohort study of 133 women in Zaragoza (Spain)

Introducción. El objetivo de este estudio ha sido describir las características y evolución de la actividad física a lo largo del embarazo y hasta tres meses después del parto. Metodología. Se realizó un estudio descriptivo longitudinal para evaluar la naturaleza, la frecuencia, la duración y la intensidad de la actividad física llevada a cabo por una cohorte de 133 mujeres en las semanas 11 a 13, 20 a 22 y 32 a 34 del embarazo y a las 12 semanas tras el parto. Resultados. La actividad física global disminuyó a lo largo del embarazo y también en la época del puerperio (p<0.05). La contribución de las actividades lúdicas al total de la actividad física realizada aumentó en cada uno de los momentos de medición. Por el contrario, la actividad física en el hogar, en el trabajo y para desplazarse disminuyó progresivamente a lo largo del embarazo y el puerperio (p < 0.05). El tiempo dedicado a actividades vigorosas fue prácticamente nulo, y el dedicado a actividades de intensidad moderada disminuyó a lo largo del seguimiento (p < 0.05). Conclusiones. Los profesionales de la salud deberían poner en marcha estrategias encaminadas al mantenimiento de los niveles previos de actividad física en las épocas del embarazo y el puerperio (AU)

Introduction. The aim of this study was to describe the characteristics and evolution of physical activity throughout pregnancy and puerperium. Method. We performed a descriptive longitudinal study to assess the nature, frequency, duration and intensity of physical activity undertaken by a cohort of 133 women at weeks 11-13, 20-22 and 32-34 of pregnancy and 12 weeks after birth. Results. Physical activity declined throughout pregnancy and in the postpartum period (p < 0.05). The contribution of leisure physical activity increased on each of the measures. By contrast, physical activity at home, at work and to be transported progressively decreased throughout pregnancy and postpartum (p < 0.05). Time spent in vigorous activity was near zero, and time spent in moderate-intensity activities decreased along the protocol (p<0.05). Conclusions. Health care professionals are encouraged to perform strategies in order to maintain previous levels of physical activity during pregnancy and the postpartum periods (AU)

Understanding graft-versus-host disease. Preliminary findings regarding the effects of exercise in affected patients.

Advances in this century regarding allogeneic hematopoietic stem cell transplantation (allo-HSCT) have led to an expanding population of long-term survivors, many of whom suffer severe side effects, particularly those related to graft-versushost disease (GVHD), a potentially multi-systemic disorder caused by immunoeffector donor lymphocytes that destroy host tissues. The GVHD, especially in its chronic form (cGVHD), generates considerable morbidity and compromises the physical capacity of patients. We have reviewed the main pathophysiological aspects of the disease as well as the data available on the effects of exercise in GVHD, based on animal and human patient research. Although exercise training as an adjunct therapy to improve health outcomes after allo-HSCT shows promise (particularly, this lifestyle intervention can improve physical fitness and possibly immune function while attenuating fatigue), there is a need for more randomized control trials that focus specifically on GVHD.

Recurrence of Anaphylaxis in a Spanish Series

Background: Anaphylaxis is a potentially fatal condition, and many patients experience recurrence. Objective: We report the incidence of first recurrence of anaphylaxis in our series and examine the risk factors associated with recurrence. Methods: A validated questionnaire was sent to 1512 patients and completed by 887. The chosen definition of anaphylaxis was that of the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network Symposium. We evaluated the incidence of first recurrence of anaphylaxis overall and by subtype (eg, drugs and foods) and attempted to determine associated risk factors. Results: The total incidence rate of the first recurrence of anaphylaxis (same subtype) was 3.2 episodes per 100 person-years (95%CI, 2.83-3.63). Incidence was lower in drug anaphylaxis (2.0 episodes per 100 person-years) than in latex and food anaphylaxis (8.6 and 5.6 episodes per 100 person-years, respectively). Cox and ordinal logistic regression models revealed that a first recurrence was less likely with drug anaphylaxis than with food anaphylaxis. The risk of experiencing 1 or more recurrences was higher for foods, exercise, and idiopathic causes than for the other subtypes. Conclusions: The incidence rate for a first recurrence of the same subtype of anaphylaxis was 2 to 6 times lower than that published by other authors. Recurrence of anaphylaxis is more common in subtypes with an increased prevalence of atopy (food, idiopathic, latex) than in other subtypes (drugs, Anisakis). Consequently, particular attention should be paid to prevention and care in this population (AU)

Antecedentes: Aunque la anafilaxia es una enfermedad potencialmente fatal, muchos pacientes sufren recurrencias de la misma. Objetivo: Nuestro objetivo fue conocer la incidencia de la primera recurrencia de la anafilaxia en nuestra serie y examinar los factores de riesgo asociados a la misma. Métodos: Un cuestionario validado fue enviado a 1512 pacientes y completado por 887. La definición de anafilaxia elegida fue la del Simposio NIAID-FAAN (National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network). Se evaluó la incidencia de la primera recurrencia de la anafilaxia en general y por subtipo (por ejemplo, medicamentos y alimentos) y se trató de determinar factores de riesgo asociados a la recurrencia. Resultados: La tasa de incidencia total de la primera recurrencia de la anafilaxia (el mismo subtipo) fue de 3,2 episodios por 100 personas año (95% CI, 2,83 a 3,63). La incidencia fue menor en la anafilaxia por medicamentos (2,0 episodios por 100 personas-año) que en la anafilaxia por látex y alimentos (8,6 y 5,6 episodios por 100 personas-año respectivamente). Los modelos de regresión de Cox y logística ordinal revelaron que la primera recurrencia fue menos probable con anafilaxia por medicamentos que con la anafilaxia alimentaria. El riesgo de sufrir una o más recurrencias fue mayor para los alimentos, el ejercicio, y anafilaxia idiopática que para los otros subtipos. Conclusiones: La tasa de incidencia de una primera recurrencia del mismo subtipo de anafilaxia fue 2-6 veces inferior a la publicada por otros autores. La recurrencia de la anafilaxia es más común en los subtipos con una mayor prevalencia de atopia (alimentos, idiopática, látex) que en los otros subtipos (medicamentos, Anisakis). Por lo tanto, se debería prestar especial atención a la prevención y atención de estas poblaciones (AU)

Influence of repeated maximal exercise testing on biomarkers and fatigue in sarcoidosis.

Fatigue in the immune mediated inflammatory disease sarcoidosis is thought to be associated with impaired exercise tolerance. This prospective study assessed fatigue and recuperative capacity after repeated exercise, and examined whether changing concentrations in biomarkers upon exercise are associated with fatigue. Twenty sarcoidosis patients and 10 healthy volunteers performed maximal cardiopulmonary exercise tests on two successive days. Concentrations of cytokines, stress hormones, ACE and CK were assessed before and after the two exercise tests, and 3 days thereafter. All participants completed a sleep diary. Severely fatigued patients showed significant lower VO2 max (p=0.038, p=0.022) and maximal workload (p=0.034, p=0.028) on both exercise tests compared to healthy controls. No impairment of maximal exercise testing was demonstrated during the second cycling test in any group. Fatigue was not correlated with changes in concentrations of biomarkers upon exercise. Severely fatigued patients rated both tests as significantly more fatiguing, and reported significant lower mean subjective night sleeping time during the testing period. Fatigue in sarcoidosis patients cannot be objectified by reduction of exercise capacity after repeated maximal exercise testing, and is not correlated with significant changes in biomarkers. Severe fatigue is only and consistently featured by patient reported outcomes.

Relationship of self-reported exercise tolerance with inflammatory markers in women with stable ischemic heart disease.

OBJECTIVE: Ischemic heart disease (IHD) is associated with decreased exercise tolerance and it is subjectively reported as angina pectoris or dyspnea. Inflammation and pro- inflammatory cytokines are related to progression of IHD, but their level is seldom analyzed in association with self reported exercise tolerance. METHODS: Women aged 35-75 years with stable IHD from Homocysteine Slovakia study (N=175) were analyzed for monocyte chemoatractant protein-1 (MCP-1), interleukin 6 (IL-6), transforming growth factor ß1 (TGF ß1), Mannan binding lectin (MBL), heat shock proteins 60 (HSP60), carbonyl protein (CP), high sensitivity C-reactive protein (hsCRP) and oxidized glutathione (GSSG) in relation to exercise induced dyspnea or angina pectoris (AP) (≤200 m). RESULTS: Patients with dyspnea had higher HSP60 (77.3±107.2 vs 43.7±48.9 ng/ml; p=0.014) and IL-6 (2.9±1.3 vs 1.9±0.6 pg/ml; p=0.04) levels. IL-6 and HSP60 demonstrated direct correlation with dyspnea (rho=0.39; p=0.02 resp. rho=0.22; p=0.01). AP≤200 m patients showed only decreased protein carbonyl a marker of protein oxidation and increased oxidative stress (CP 61.7±27.3 vs. 72.1±23.1 pg/ml; p=0.001). CP indirectly correlates with AP≤200 m (rho=-0.25; p=0.001). CONCLUSIONS: We have found associations of pro-inflammatory cytokines and inflammation markers with dyspnea or angina pectoris, but the relationship was not consistent in our patients with stable ischemic heart disease.

Bovine colostrum and immune function after exercise.

Strenuous and/or prolonged exercise causes transient perturbations in immune function. It is well accepted that this is one mechanism contributing to the higher occurrence of infection (e.g. upper respiratory tract infection (URTI)) in athletes, especially endurance athletes. URTI or upper respiratory tract (URT) symptoms can negatively affect training and competition performance but athletes must train intensively to be successful. Therefore, interventions that can legitimately enhance immune function and reduce URTI risk can be of benefit to athletes. Bovine colostrum supplementation has been investigated as a possible nutritional countermeasure to enhance (or maintain) immune function, and reduce URTI risk, following strenuous or prolonged exercise and during intensive training periods. There is convincing evidence that daily supplementation with bovine colostrum, for a number of weeks (and preliminary evidence for acute effects after a single dose), can maintain intestinal barrier integrity, immune function and reduce the chances of suffering URTI or URT symptoms in athletes or those undertaking heavy training. The mechanisms are not fully understood at present but there is preliminary evidence suggesting that the effects on immune function are attributable, at least in part, to small bioactive components that survive digestion and are biologically available after consumption, but further work is required. In summary, the balance of existing evidence does support the notion that bovine colostrum is beneficial for certain groups of athletes, such as those involved in strenuous training (e.g. endurance athletes), in terms of immunity and resistance to infection.

[Environmental influences on cellular and humoral immunity in athletes].

The study of seasonal changes in the state of cellular and humoral immunity in trained athletes with predominantly aerobic energy supply of muscle activity, but different different dynamics of the level of physical activity in the annual cycle has been performed. The immune status of athletes, the level of several hormones and interleukins have been established to undergo significant, regular fluctuations training--competitive load throughout the annual cycle that may affect the level of morbidity of athletes.

Effects of immunoadsorption and subsequent immunoglobulin G substitution on cardiopulmonary exercise capacity in patients with dilated cardiomyopathy.

BACKGROUND: Recent data indicate that cardiac antibodies play an active role in the pathogenesis of dilated cardiomyopathy (DCM) and may contribute to cardiac dysfunction in patients with DCM. The present study investigated the influence of immunoadsorption with subsequent immunoglobulin G substitution (IA/IgG) on cardiopulmonary exercise capacity in patients with DCM. METHODS: Sixty patients with DCM (New York Heart Association II-IV, left ventricular ejection fraction < or =45%) were included in this single-center university hospital-based case-control study. Patients either were treated with IA/IgG (n = 30) or were followed without IA/IgG (n = 30). At baseline and after 3 months, we compared echocardiographic assessment of left ventricular function and spiroergometric exercise parameters. RESULTS: In contrast to controls, left ventricular ejection fraction improved significantly in the IA/IgG group from 33.0% +/- 1.2% to 40.1% +/- 1.5% (P < .001). In the control group, spiroergometric exercise parameters did not change during follow-up. After 3 months, maximum achieved power increased in the treatment group from 114.2 +/- 7.4 to 141.9 +/- 7.9 W (P = .02). Total exercise time increased in the treatment group from 812 +/- 29 to 919 +/- 30 seconds (P < .05). Peak oxygen uptake (Vo(2)) increased from 17.3 +/- 0.9 to 21.8 +/- 1.0 mL min(-1) kg(-1) after IA/IgG (P < .01). Oxygen pulse (peak Vo(2)/maximum heart rate) increased in the treatment group (10.7 +/- 0.7 vs 13.6 +/- 0.7 mL beat(-1) min(-1), P < .01). The Vo(2) at the gas exchange anaerobic threshold increased after 3 months in the treatment group from 10.3 +/- 0.5 to 13.2 +/- 0.5 mL min(-1) kg(-1) (P < .001). The ventilatory response to exercise (V(E)/Vco(2) slope) decreased after IA/IgG therapy from 32.3 +/- 1.5 to 28.7 +/- 0.9 (P = .02). CONCLUSIONS: In patients with DCM, IA/IgG therapy may induce improvement in echocardiographic and cardiopulmonary exercise parameters.

Biochemical markers of possible immunodepression in military training in harsh environments.

Prolonged, exhaustive exercise frequently leads to an increased incidence of upper respiratory tract illness (URTI) which is linked to transient immunodepression. We investigated potential biochemical markers of stress and fatigue, and URTI symptoms as a surrogate of immunodepression, in US Marines undergoing intensive winter training at altitude. Selected plasma amino acids and leptin (p[Lep]) were measured as possible markers of fatigue and immunodepression, together with nonesterified fatty acids (p[NEFA]) and total antioxidant capacity (p[TAC]). Changes were observed in plasma free tryptophan (p[FT]), p[Gln], p[Lep], p[NEFA], p[TAC] but not branched chain amino acids (p[BCAA]). p[FT] decreased markedly. Resting p[Gln] decreased overall after one month at altitude. p[Gln] routinely decreases 1-2 hrs after prolonged exercise. Importantly, we observed early morning decreases in p[Gln], suggesting a cumulative effect of prolonged activity, stress, and fatigue. Concomitantly, individuals with highest illness scores had the greatest p[Gln] decrease: low p[Gln] may therefore be associated with a diminished stress tolerance.

Blood parameters in adults with intellectual disability at rest and after endurance exercise.

Clinically, adults with intellectual disability (ID) appear less physically fit than people without ID, yet formal endurance evaluation has not previously been reported. We hypothesized that the immune system in adults with ID can be positively influenced from 4 weeks of endurance training. Healthy subjects with ID ages from 43 to 55 years were included in the study. The subjects (n = 22) exercised on a treadmill for 30-40 min/d for 4 day/wk/4 wks. Blood samples were drawn at rest and immediately after the last exercise training. Plasma concentration of creatine kinase (CK), myoglobin (Mb), glutamine, and uric acid (UA) as biomarkers of muscle stress were measured. The results indicate that following the exercise program the plasma glutamine and UA increased significantly (p < 0.05) from pre- to post-training levels, whereas CK isoenzyme and Mb levels showed no changes. In conclusion, 4 weeks of endurance training increased concentration of plasma glutamine and UA, which might be useful in the monitoring of training responses in adults with ID.

Acute inflammatory and anabolic systemic responses to peak and constant-work-rate exercise bout in hospitalized patients with COPD.

STUDY OBJECTIVES: To explore the acute systemic inflammatory and anabolic effects of cycling in hospital admitted patients with chronic obstructive pulmonary disease (COPD) and in patients with clinically stable disease. DESIGN: Cross-sectional comparative study. SETTING: University Hospital Gasthuisberg, a tertiary care setting. PATIENTS: 16 patients with clinically stable COPD (no acute exacerbation in the past 12 weeks; median age: 73 years (IQR: 60 to 75); median forced expiratory volume in the first second (FEV1): 45% predicted (IQR: 33 to 58)) and 14 patients who were admitted to a hospital due to an acute exacerbation of COPD (median age: 65 years (IQR: 59 to 74); median FEV1 on day 8 of hospital stay: 41% predicted (IQR: 33 to 54)). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Circulating levels of C reactive protein, interleukin 6, interleukin 8 and insulin-like growth factor I were determined before, at the end and 2 and 30 minutes after a symptom-limited peak cycling test and before, at the end and 2 and 30 minutes after a symptom-limited constant-work-rate cycling test at 70% of the peak load. Non-significant changes in the circulating markers of inflammation and anabolism were found during or up to 30 minutes after ceasing the peak or constant-work-rate cycling exercise tests. The systemic responses of the hospitalized patients with COPD did not differ from those with clinically stable disease. CONCLUSIONS: High-intensity cycling exercises did not increase the circulating levels of inflammatory markers in patients with chronic obstructive pulmonary disease, irrespective of their clinical stability.

Intense training: mucosal immunity and incidence of respiratory infections.

This investigation examined the impact of a multistressor situation on salivary immunoglobulin A (sIgA) levels, and incidence of upper respiratory tract infection (URTI) during the French commando training (3 weeks of training followed by a 5-day combat course). For the URTI, the types of symptoms were classified according to the anatomical location of the infection. Saliva samples were collected (8 a.m.) from 21 males [21 (2) years] before entry into the commando training, the morning following the 3 weeks of training, after the 5-day combat course, and after 1 week of recovery. sIgA, protein and cortisol concentrations were measured. Symptoms of URTI were recorded during the study from health logs and medical examinations. After the 3 weeks of training, the sIgA concentration was not changed, although it was reduced after the 5-day course [from 120 (14) mg l(-1) to 71 (9) mg l(-1), P<0.01]. It returned to pre-training levels within a week of recovery. The incidence of URTI increased during the trial (chi(2)=53.48; P<0.01), but was not related to sIgA. Among the 30 episodes of URTI reported, there were 12 rhino-pharyngitis, 6 bronchitis, 5 tonsillitis, 4 sinusitis and 3 otitis. Cortisol levels were raised after the 3-week training (P<0.01), dropping below baseline after the combat course (P<0.01). Stressful situations have an adverse effect on mucosal immunity and incidence of URTI. However, the relationship between sIgA and illness remained unclear. The large proportion of rhino-pharyngitis indicated that the nasopharyngeal cavity is at a higher risk of infection.

Performance enhancement with maintenance of resting immune status after intensified cycle training.

BACKGROUND: Unaccustomed intense endurance exercise is associated with short-term suppression of natural immunity. However, it is not established whether intensified endurance training alters resting immune status or increases the risk of upper respiratory infection (URI). PURPOSE: This study examined the effect of intensified endurance training for performance enhancement on resting immune status in nine healthy, male competitive cyclists. DESIGN: Data were collected during 4 weeks of usual training (baseline), followed by prescribed cycle training that consisted of volume-building at customary training intensity (V phase, 6 weeks), unaccustomed very high intensity interval training at 100% maximal heart rate (I phase, 18 days), and an unloading taper (U phase, 10 days). METHODS: The main performance criterion was a simulated 20 km time-trial. Aerobic capacity measures included power output at ventilatory threshold (POT(vent)) and maximal oxygen uptake (VO(2max)). Markers of immune status (lymphocyte subset counts, serum cytokine levels, and new URI cases) and physiological indicators of training stress (cycling economy, 24-hour urinary cortisol excretion, and serum testosterone concentration) were evaluated in the rested state, 36 to 44 hours postexercise, during baseline, and after each training phase. RESULTS: Time-trial performance, POT9(vent), VO(2max), and cycling economy improved significantly (p < 0.001) after the V phase, and remained higher than baseline (p < 0.001) after the I and U phases. As compared with the V phase, performance time was faster after the U phase (p < 0.01). In contrast, lymphocyte counts, cytokine levels, incidence of URI, cortisol excretion, and serum testosterone concentration were not significantly different from baseline in any phase. CONCLUSIONS: Cycling efficiency and performance improved while resting immune status was maintained throughout the 10-week training program. This study provides encouraging data in support of immunological robustness during intensified endurance training.