Evaluation of exercise capacity and quality of life in patients recovered from COVID-19

Purpose: In this thesis study, long-term cardiopulmonary exercise endurance, autonomic nervous system, inflammatory status and quality of life were evaluated in individuals who had COVID-19, compared to individuals who did not have the infection, and whether there were long-term problems in cardiac and pulmonary system functions and inflammation states. Thus, it was aimed to reveal whether people's health status and quality of life were affected after the pandemic. Material and Methods: There were one hundred participants in all, either free of COVID-19 infection or infected and with a post-infectious time ranging from three to twenty-four months. Groups with similar age, gender, and BMI contents are created from n = 50 individuals who have had COVID-19 and n = 50 individuals who have had COVID-19. Measurements of copeptin levels, a stress marker that indicates the disease for chronic disease analysis, Spirometry, Heart Rate Variability (HRV) disease for the function of the autonomic nervous system, and Cardiopulmonary Exercise Test (CPET), the gold standard test in which cardiopulmonary capacity is functionally applied through exercise, were conducted. For the purpose of administering the Short Form-36 (SF-36) and Fatigue Severity Scale (FSS), an evaluation of general physical and mental health is conducted. General physical and emotional health assessment is performed for the Fatigue Severity Scale (FSS) and Short Form-36 (SF-36) surveys. Results: CPET threshold values, maximum CPET parameters and threshold value/maximum value percentages were compared between individuals with and without COVID-19. No significant differences were found between groups in all three analyses. On the other hand, when the reasons for terminating the CPET test were examined, it was determined that 56% of individuals who had COVID-19 terminated the test due to fatigue, while this rate was 34% in those who did not, and this difference was statistically significant (p = 0.027). Spirometry results showed that FEV1/FVC (%) (p=0.005), PEF (L/s) (p=0.044), PEF (%) (p= 0.025) values were statistically significantly lower in those xvi who had COVID-19 infection compared to those who did not. VD/VT (%) is higher in those who have had COVID-19 infection than in those who have not, and the difference is statistically significant (p = 0.013). Differences were observed in frequency domain parameters in HRV measurements. High frequency (HF) measurements are lower in those with COVID-19 infection than in those without, and the difference is statistically significant [HF(ms2, nu, log)] respectively (p=0.013, p=0.009, p=0.013). The LF/HF ratio is higher in those who had COVID-19 infection than in those who did not, and the difference is statistically significant (p = 0.016). In the Fatigue Severity Scale (FSS), the fatigue level of those who had COVID-19 was significantly higher (p = 0.026). According to the SF-36 survey, the subscales Physical role difficulty (p=0.040), emotional role difficulty (p=0.016), social functionality (p=0.048), pain p=0.004) were found to be significantly lower and the difference was statistically significant. Conclusion: While the COVID-19 infection did not have a long-term physical impact on the cardiopulmonary system or exercise capacity in the volunteers, there were detected exercise limitations as a result of condition loss in comparison to the non-infected subjects. Spirometry results suggest mild obstructive pattern lung disease and/or microvascular lung damage. Low-grade inflammation may be present if the sympathetic dominance seen in HRV and serum inflammation markers is taken into account. According to the survey results, people stated that they experienced problems due to physical deconditioning, were affected socially and emotionally, and that there was a significant increase in their pain levels. Key Words: COVID-19, CPET, Spirometry, HRV, SF-36, Fatigue, FSS, Chronic inflammation, Copeptin