The Effects of Exercise Therapy Moderated by Sex in Rehabilitation of
                    COVID-19

Linda Rausch; Bernhard Puchner; Jürgen Fuchshuber; Barbara Seebacher; Judith Löffler-Ragg; Stephan Pramsohler; Nikolaus Netzer; Martin Faulhaber

doi:10.1055/a-1866-6092

International Journal of Sports Medicine, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Int J Sports Med 2022; 43(12): 1043-1051
DOI: 10.1055/a-1866-6092

Training & Testing

The Effects of Exercise Therapy Moderated by Sex in Rehabilitation of COVID-19

Linda Rausch

¹Department of Sport Science, University of Innsbruck, Innsbruck, Austria

,

Bernhard Puchner

²Department of Rehabilitation Research, Rehab Center Muenster, Muenster, Austria

,

Jürgen Fuchshuber

³Grüner Kreis Society, Center for Integrative Addiction Research (CIAR), Vienna, Austria

⁴University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria

,

Barbara Seebacher

²Department of Rehabilitation Research, Rehab Center Muenster, Muenster, Austria

,

Judith Löffler-Ragg

⁵Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria

,

Stephan Pramsohler

⁶associated to University of Innsbruck, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Lenggries, Germany

,

Nikolaus Netzer

⁶associated to University of Innsbruck, Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Lenggries, Germany

⁷Department Medicine, Division Sports Medicine, University Hospital Ulm, Ulm, Germany

⁸Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy

,

Martin Faulhaber

¹Department of Sport Science, University of Innsbruck, Innsbruck, Austria

› Institutsangaben

Abstract

Standardized exercise therapy programs in pulmonary rehabilitation have been shown to improve physical performance and lung function parameters in post-acute COVID-19 patients. However, it has not been investigated if these positive effects are equally beneficial for both sexes. The purpose of this study was to analyze outcomes of a pulmonary rehabilitation program with respect to sex differences, in order to identify sex-specific pulmonary rehabilitation requirements. Data of 233 post-acute COVID-19 patients (40.4% females) were analyzed before and after a three-week standardized pulmonary rehabilitation program. Lung function parameters were assessed using body-plethysmography and functional exercise capacity was measured by the Six-Minute Walk Test. At post-rehabilitation, females showed a significantly smaller improvement in maximal inspiration capacity and forced expiratory volume (F=5.86, ω²⁼.02; p<0.05) than males. Exercise capacity improvements between men and women did not differ statistically. Females made greater progress towards reference values of exercise capacity (T(231)=−3.04; p<0.01) and forced expiratory volume in the first second (T(231)=2.83; p<0.01) than males. Sex differences in the improvement of lung function parameters seem to exist and should be considered when personalizing standardized exercise therapies in pulmonary rehabilitation.

Key words

exercise therapy - rehabilitation - sex characteristics - COVID-19 - respiratory function tests - six-minute walk test

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Referenzen

References
1 Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020; 91: 157-160
2 Richardson S, Hirsch JS, Narasimhan M. et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA 2020; 323: 2052-2059
3 Grasselli G, Zangrillo A, Zanella A. et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 2020; 323: 1574-1581
4 Guan W-J, Ni Z-Y, Hu Y. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-1720
5 Nasiri MJ, Haddadi S, Tahvildari A. et al. COVID-19 clinical characteristics, and sex-specific risk of mortality: systematic review and meta-analysis. Front Med (Lausanne) 2020; 7: 459
6 Mauvais-Jarvis F. Aging, male sex, obesity, and metabolic inflammation create the perfect storm for COVID-19. Diabetes 2020; 69: 1857-1863
7 Alberca RW, Oliveira LdM, Branco Anna Cláudia Calvielli Castelo. et al. Obesity as a risk factor for COVID-19: an overview. Crit Rev Food Sci Nutr 2021; 61: 2262-2276
8 Banfi P, Garuti G, Diaz de Teran T. et al. Differences between sexes concerning COVID-19-related pneumonia. Panminerva Med 2021;
9 Capuano A, Rossi F, Paolisso G. Covid-19 kills more men than women: an overview of possible reasons. Front Cardiovasc Med 2020; 7: 131
10 Channappanavar R, Fett C, Mack M. et al. Sex-based differences in susceptibility to severe acute respiratory syndrome coronavirus infection. J Immunol 2017; 198: 4046-4053
11 Elgendy IY, Pepine CJ. Why are women better protected from COVID-19: Clues for men? Sex and COVID-19. Int J Cardiol 2020; 315: 105-106
12 Huang C, Huang L, Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397: 220-232
13 Huang L, Yao Q, Gu X. et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet 2021; 398: 747-758
14 Simpson R, Robinson L. Rehabilitation after critical illness in people with COVID-19 infection. Am J Phys Med Rehabil 2020; 99: 470-474
15 Sonnweber T, Sahanic S, Pizzini A. et al. Cardiopulmonary recovery after COVID-19 – an observational prospective multi-center trial. Eur Respir J 2020; 57: 200-214
16 Puchner B, Sahanic S, Kirchmair R. et al. Beneficial effects of multi-disciplinary rehabilitation in post-acute COVID-19 – an observational cohort study. Eur J Phys Rehabil Med 2021; 57: 189-198
17 Spielmanns M, Pekacka-Egli A-M, Schoendorf S. et al. Effects of a comprehensive pulmonary rehabilitation in severe post-COVID-19 patients. Int J Environ Res Public Health 2021; 18: 26-35
18 Liu K, Zhang W, Yang Y. et al. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract 2020; 39: 101-166
19 Quaresima V, Scarpazza C, Sottini A. et al. Sex differences in a cohort of COVID-19 Italian patients hospitalized during the first and second pandemic waves. Biol Sex Differ 2021; 12: 45
20 Yoshida Y, Gillet SA, Brown MI. et al. Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans. Biol Sex Differ 2021; 12: 20
21 Unwin N, Shaw J, Zimmet P, Alberti KGMM. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 2002; 19: 708-723
22 Mancia G, Dominiczak A. The new international society of hypertension guidelines on hypertension. J Hypertens 2020; 38: 981
23 Mänttäri A, Suni J, Sievänen H. et al. Six-minute walk test: a tool for predicting maximal aerobic power (VO(2 ) max) in healthy adults. Clin Physiol Funct Imaging 2018;
24 ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111-117
25 Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158: 1384-1387
26 Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract 2017; 23: 377-381
27 Chan KS, Pfoh ER, Denehy L. et al. Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure. Chest 2015; 147: 1316-1326
28 McCormack MC, Bascom R, Brandt M. et al. Electronic health records and pulmonary function data: developing an interoperability roadmap. An official American Thoracic Society workshop Report. Ann Am Thorac Soc 2021; 18: 1-11
29 Graham BL, Steenbruggen I, Miller MR. et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2019; 200: 70-88
30 Quanjer PH, Stanojevic S, Cole TJ. et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 2012; 40: 1324-1343
31 Sha J, Qie G, Yao Q. et al. Sex differences on clinical characteristics, severity, and mortality in adult patients with COVID-19: a multicentre retrospective study. Front Med (Lausanne) 2021; 8: 60-70
32 Segizbaeva MO, Aleksandrova NP. Respiratory muscle strength and ventilatory function outcome: differences between trained athletes and healthy untrained persons. Adv Exp Med Biol 2021; 1289: 89-97
33 Myers J, Kokkinos P, Nyelin E. Physical activity, cardiorespiratory fitness, and the metabolic syndrome. Nutrients 2019; 11: 1652
34 Siopis G. Elite athletes maintain peak performance after testing positive for SARS-CoV-2. J Sci Med Sport 2022; 25: 195-196
35 Dominelli PB, Molgat-Seon Y, Sheel AW. Sex differences in the pulmonary system influence the integrative response to exercise. Exerc Sport Sci Rev 2019; 47: 142-150
36 Torres-Tamayo N, García-Martínez D, Lois Zlolniski S. et al. 3D analysis of sexual dimorphism in size, shape and breathing kinematics of human lungs. J Anat 2018; 232: 227-237
37 Molgat-Seon Y, Dominelli PB, Ramsook AH. et al. Effects of age and sex on inspiratory muscle activation patterns during exercise. Med Sci Sports Exerc 2018; 50: 1882-1891
38 Mitchell RA, Schaeffer MR, Ramsook AH. et al. Sex differences in respiratory muscle activation patterns during high-intensity exercise in healthy humans. Respir Physiol Neurobiol 2018; 247: 57-60
39 Wang B, Zhou Y, Xiao L. et al. Association of lung function with cardiovascular risk: a cohort study. Respir Res 2018; 19: 214
40 Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med 1997; 155: 1278-1282
41 Hayden MC, Limbach M, Schuler M. et al. Effectiveness of a three-week inpatient pulmonary rehabilitation program for patients after COVID-19: a prospective observational Study. Int J Environ Res Public Health 2021; 18: 9001
42 Maniscalco M, Fuschillo S, Ambrosino P. et al. Preexisting cardiorespiratory comorbidity does not preclude the success of multidisciplinary rehabilitation in post-COVID-19 patients. Respir Med 2021; 184: 106-470
43 Glöckl R, Buhr-Schinner H, Koczulla AR. et al. Recommendations from the German Respiratory Society for Pulmonary Rehabilitation in patients with COVID-19. DGP-Empfehlungen zur pneumologischen Rehabilitation bei COVID-19. Pneumologie 2020; 74: 496-504
44 Siopis G. The case for promoting physical activity amidst the COVID-19 pandemic. An update. J Sci Med Sport 2021; 24: 900-901
45 Barker-Davies RM, O'Sullivan O, Senaratne KPP. et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020; 54: 949-959
46 Wang TJ, Chau B, Lui M. et al. Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19. Am J Phys Med Rehabil 2020; 99: 769-774