Functional capacity, exercise tolerance, muscle strength, hang grip, and quality of life in patients with COVID-19. A cross-sectional study
Keywords:
COVID-19,, Pandemic, , Hand Grip, , Muscle Strength, , Quality of life.Abstract
Background and aim: The COVID-19 pandemic has posed significant challenges to global health, affecting millions of individuals worldwide. This study aims to investigate the impacts of COVID-19 with moderate severity on functional capacity, exercise tolerance, isometric muscle strength, hand grip, and quality of life.
Methods: Ninety-six participants (48 with COVID-19, 48 without COVID-19) were recruited in this cross-sectional study. The effects on functional capacity, exercise-tolerance, isometric muscle power, hand grip, and quality of life were measured. The Mann-Whitney test was employed to compare the significant differences between the COVID-19 and matched groups. The Spearman correlation was used to determine the relationships among outcome measures.
Results: The mean values of functional capacity, isometric muscle power, hand grip, and quality of life were significantly reduced in patients with moderate COVID-19 compared to their matched counterparts (p<0.05), except for exercise tolerance (p>0.05). Positive relationships were detected between exercise tolerance, strength of the hand grip, and knee extensors; distance of the 6-minute walk test and exercise tolerance, strength of the hand grip, and knee extensors (p=<0.001).
Conclusions: Moderate-severity COVID-19 patients exhibit impairments in functional capacity, exercise tolerance, isometric muscle strength, hand grip strength, and quality of life. Exercise tolerance correlated positively with the 6-minute walk test, hand grip strength, and knee extensor strength.
References
1. Ochani R, Asad A, Yasmin F, et al. COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med. 2021;29(1):20-36.PMID: 33664170.
2. Nicola M, Alsafi Z, Sohrabi C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19): A review. Int J Surg. 2020;78:185-193 doi: 10.1016/j.ijsu.2020.04.018
3. McKibbin W, Fernando R. The global economic impacts of the COVID-19 pandemic. Econ Model. 2023;129. doi: 10.1016/j.econmod.2023.106551
4. Akhtar B, Ahsan M. Mental health, self-esteem, life satisfaction among Ethiopian population during covid-19 pandemic: a survey-based study. Eur J Mol Clin Med. 2020;7(9):2572-84. https://ejmcm.com/article_6885_8a784b33bd27320d705ac300bc7a8ebe.pdf
5. Ahsan M, Abualait T. Salud mental y actividad física durante y después de la pandemia de COVID-19: una revisión. Retos. 2024; 56:419-426. doi.org/10.47197/retos.v56.104572
6. Taboada M, Moreno E, Cariñena A, et al. Quality of life, functional status, and persistent symptoms after intensive care of COVID-19 patients. Br J Anaesth. 2021;126(3):e110-e113. doi: 10.1016/j.bja.2020.12.007
7. Paneroni M, Simonelli C, Saleri M, et al. Muscle Strength and Physical Performance in Patients without Previous Disabilities Recovering from COVID-19 Pneumonia. Am J Phys Med Rehabil. 2021;100(2):105-109. doi:10.1097/PHM.0000000000001641
8. Latronico N, Peli E, Calza S, et al. Physical, cognitive and mental health outcomes in 1-year survivors of COVID-19-associated ARDS. Thorax. 2022;77(3):300-303. doi:10.1136/thoraxjnl-2021-218064
9. Ramírez-Vélez R, Legarra-Gorgoñon G, Oscoz-Ochandorena S, et al. Reduced muscle strength in patients with long-COVID-19 syndrome is mediated by limb muscle mass. J Appl Physiol. 2023;134(1):50-58. doi:10.1152/japplphysiol.00599.2022
10. Belli S, Balbi B, Prince I, et al. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation. Eur Respir J. 2020;56(4):2002096. doi:10.1183/13993003.02096-2020
11. Zhang S, Bai W, Yue J, et al. Eight months follow-up study on pulmonary function, lung radiographic, and related physiological characteristics in COVID-19 survivors. Sci Rep. 2021;11(1):13854. doi:10.1038/s41598-021-93191-y
12. Lorent N, Weygaerde Y Vande, Claeys E, et al. Prospective longitudinal evaluation of hospitalised COVID-19 survivors 3 and 12 months after discharge. ERJ Open Res. 2022;8(2):00004-2022. doi:10.1183/23120541.00004-2022
13. Tanriverdi A, Savci S, Kahraman BO, Ozpelit E. Extrapulmonary features of post-COVID-19 patients: muscle function, physical activity, mood, and sleep quality. Ir J Med Sci. 2022;191(3):969-975. doi:10.1007/s11845-021-02667-3
14. Fumagalli A, Misuraca C, Bianchi A, et al. Pulmonary function in patients surviving to COVID-19 pneumonia. Infection. 2021;49(1):153-157. doi:10.1007/s15010-020-01474-9
15. Delbressine JM, Machado FVC, Goërtz YMJ, et al. The impact of post-covid-19 syndrome on self-reported physical activity. Int J Environ Res Public Health. 2021;18(11):6017. doi:10.3390/ijerph18116017
16. Dorri M, Mozafari Bazargany MH, Khodaparast Z, et al. Psychological problems and reduced health-related quality of life in the COVID-19 survivors. J Affect Disord Reports. 2021;6:100248. doi: 10.1016/j.jadr.2021.100248
17. Alshammari M, Shanb A, Alsubaiei M, Youssef E. Long-term effect of non-severe COVID-19 on pulmonary function, exercise capacities and physical activities: a cross-section study in Sakaka Aljouf. F1000Research. 2024;12:809. doi:10.12688/f1000research.133516.5
18. Bandyopadhyay D, Akhtar T, Hajra A, et al. COVID-19 Pandemic: Cardiovascular Complications and Future Implications. Am J Cardiovasc Drugs. 2020;20(4):311-324. doi:10.1007/s40256-020-00420-2
19. Rooney S, Webster A, Paul L. Systematic review of changes and recovery in physical function and fitness after severe acute respiratory syndrome-related coronavirus infection: Implications for COVID-19 rehabilitation. Phys Ther. 2020;100(10):1717-1729. doi:10.1093/ptj/pzaa129
20. Ngai JC, Ko FW, Ng SS, To KW, Tong M, Hui DS. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15(3):543-50. doi:10.1111/j.1440-1843.2010.01720.x
21. Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (April 2020). Clin Infect Dis. 2024;78(7):e250-e349. doi:10.1093/cid/ciaa478
22. Graham BL, Steenbruggen I, Barjaktarevic IZ, 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(8):e70-e88. doi:10.1164/rccm.201908-1590ST
23. Giannitsi S, Bougiakli M, Bechlioulis A, Kotsia A, Michalis LK, Naka KK. 6-minute walking test: A useful tool in the management of heart failure patients. Ther Adv Cardiovasc Dis. 2019;13:1753944719870084. doi:10.1177/1753944719870084
24. Buekers J, Theunis J, De Boever P, et al. Wearable finger pulse oximetry for continuous oxygen saturation measurements during daily home routines of patients with chronic obstructive pulmonary disease (COPD) over one week: Observational study. JMIR mHealth uHealth. 2019;7(6):e12866.. doi:10.2196/12866
25. Sverzellati N, Lynch DA, Hansell DM, Johkoh T, King TE, Travis WD. American thoracic society–European respiratory society classification of the idiopathic interstitial pneumonias: Advances in knowledge since 2002. Radiographics. 2015;35(7):1849-71. doi:10.1148/rg.2015140334
26. Gochicoa-Rangel L, Mora-Romero U, Guerrero-Zúñiga S, et al. Six-minute walk test: Recommendations and procedure. Neumol y Cir Torax(Mexico). 2019;78(S2):164-172. doi:10.35366/NTS192J
27. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158(5 PART I):1384-7. doi:10.1164/ajrccm.158.5.9710086
28. Rikli RE, Jones CJ. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. J Aging Phys Act. 1998;6(4):363–375. doi:10.1123/japa.6.4.363
29. Huang Y, Tan C, Wu J, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res. 2020;21(1):163. doi:10.1186/s12931-020-01429-6
30. Bohannon RW, Crouch R. 1-Minute Sit-To-Stand Test: SYSTEMATIC REVIEW of PROCEDURES, PERFORMANCE, and CLINIMETRIC PROPERTIES. J Cardiopulm Rehabil Prev. 2019;39(1):2-8. doi:10.1097/HCR.0000000000000336
31. Ohaeri JU, Awadalla AW. The reliability and validity of the short version of the WHO Quality of Life Instrument in an Arab general population. Ann Saudi Med. 2009;29(2):98-104. doi:10.4103/0256-4947.51790
32. Ekiz T, Kara M, Özçakar L. Measuring grip strength in COVID-19: A simple way to predict overall frailty/impairment. Hear Lung. 2020;49(6):853-854. doi: 10.1016/j.hrtlng.2020.05.011
33. Binda F, Rossi V, Gambazza S, et al. Muscle strength and functional outcome after prone positioning in COVID-19 ICU survivors. Intensive Crit Care Nurs. 2022;69:103160. doi: 10.1016/j.iccn.2021.103160
34. Huang L, Liu Y, Lin T, et al. Reliability and validity of two hand dynamometers when used by community-dwelling adults aged over 50 years. BMC Geriatr. 2022;22(1):580. doi:10.1186/s12877-022-03270-6
35. Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age Ageing. 2011;40(4):423-9. doi:10.1093/ageing/afr051
36. Bohannon RW. Hand-Held Dynamometry: A Practical Guide to Clinical Measurement. OXford; Churchill Livingstone; 2018.
37. Marshall JC, Murthy S, Diaz J, et al. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020;20(8):e192-e197. doi:10.1016/S1473-3099(20)30483-7
38. Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J Emerg Nurs. 2000;26(3):216-22. doi:10.1067/men.2000.107012
39. Terese Scollard. Handgrip Strength Assessment: A skill to enhance diagnosis of disease-related malnutrition. Eat right STORE. 2022. https://www.eatrightstore.org/dpg-and-mig-products/dns/handgrip-strength-assessment-a-skill-to-enhance-the-diagnosis-of-disease-related-malnutrition
40. Magdy D, Metwally A, Tawab D, Hassan S, Makboul M, Farghaly S. Long-Term COVID-19 effects on pulmonary function, exercise capacity, and health status. Ann Thorac Med. 2022;17(1):28-36. doi:10.4103/atm.atm_82_21
41. Lau HMC, Lee EWC, Wong CNC, Ng GYF, Jones AYM, Hui DSC. The impact of severe acute respiratory syndrome on the physical profile and quality of life. Arch Phys Med Rehabil. 2005;86(6):1134-40. doi:10.1016/j.apmr.2004.09.025
42. Ong KC, Ng AWK, Lee LSU, et al. Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome. Eur Respir J. 2004;24(3):436-42. doi:10.1183/09031936.04.00007104
43. Raman B, Cassar MP, Tunnicliffe EM, et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021;31:100683. doi:10.1016/j.eclinm.2020.100683
44. Herridge MS, Tansey CM, Matté A, et al. Functional Disability 5 Years after Acute Respiratory Distress Syndrome. N Engl J Med. 2011;364(14):1293-304. doi:10.1056/nejmoa1011802
45. Haddad F, Zaldivar F, Cooper DM, Adams GR. IL-6-induced skeletal muscle atrophy. J Appl Physiol. 2005;98(3):911-7. doi:10.1152/japplphysiol.01026.2004
46. Abdallah SJ, Voduc N, Corrales-Medina VF, et al. Symptoms, pulmonary function, and functional capacity four months after COVID-19. Ann Am Thorac Soc. 2021;18(11):1912-1917. doi:10.1513/AnnalsATS.202012-1489RL
47. Lerum TV, Aaløkken TM, Brønstad E, et al. Dyspnoea, lung function and CT findings 3 months after hospital admission for COVID-19. Eur Respir J. 2021;57(4):2003448. doi:10.1183/13993003.03448-2020
48. Eksombatchai D, Wongsinin T, Phongnarudech T, Thammavaranucupt K, Amornputtisathaporn N, Sungkanuparph S. Pulmonary function and six-minute-walk test in patients after recovery from COVID-19: A prospective cohort study. PLoS One. 2021;16(9):e0257040. doi:10.1371/journal.pone.0257040
49. van der Sar - van der Brugge S, Talman S, Boonman - de Winter LJM, et al. Pulmonary function and health-related quality of life after COVID-19 pneumonia. Respir Med. 2021;176:106272. doi:10.1016/j.rmed.2020.106272
50. Cheng SKW, Tsang JSK, Ku KH, Wong CW, Ng YK. Psychiatric complications in patients with severe acute respiratory syndrome (SARS) during the acute treatment phase: A series of 10 cases. Br J Psychiatry. 2004;184(APR.):359-60. doi:10.1192/bjp.184.4.359
51. Chua SE, Cheung V, McAlonan GM, et al. Stress and psychological impact on SARS patients during the outbreak. Can J Psychiatry. 2004;49(6):385-90. doi:10.1177/070674370404900607
52. Pradon D, Roche N, Enette L, Zory R. Relationship between lower limb muscle strength and 6-minute walk test performance in stroke patients. J Rehabil Med. 2013;45(1):105-8. doi:10.2340/16501977-1059
53. Hamdani R, Florencia Leona D. Relationship Between Handgrip Strength with the 6-Minute Walking Test Distance in Heart Failure Patients. INSOLOGI J Sains dan Teknol. 2023;2(4):834-841. doi:10.55123/insologi.v2i4.2323
54. Nunes MF, Hervé BB, Lukrafka JL, Monteiro MB. Handgrip strength and its relation to isokinetic dynamometry in COPD. Fisioter Mov. 2020;33:e003356. doi:10.1590/1980-5918.033.AO56
55. Yee XS, Ng YS, Allen JC, et al. Performance on sit-to-stand tests in relation to measures of functional fitness and sarcopenia diagnosis in community-dwelling older adults. Eur Rev Aging Phys Act. 2021;18(1):1. doi:10.1186/s11556-020-00255-5
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