1
|
O'Sullivan O, Houston A, Ladlow P, Barker-Davies RM, Chamley R, Bennett AN, Nicol ED, Holdsworth DA. Factors influencing medium- and long-term occupational impact following COVID-19. Occup Med (Lond) 2024; 74:53-62. [PMID: 37101240 DOI: 10.1093/occmed/kqad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction ('fully deployable', FD) or with limitations ('medically downgraded', MDG). AIMS To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months. METHODS Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG. RESULTS Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading. CONCLUSIONS Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.
Collapse
Affiliation(s)
- O O'Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - A Houston
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - R M Barker-Davies
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - R Chamley
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK
- Royal Centre for Defence Medicine, Birmingham B15 2GW, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - E D Nicol
- Academic Department of Military Medicine, Birmingham B15 2GW, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - D A Holdsworth
- Royal Centre for Defence Medicine, Birmingham B15 2GW, UK
- Academic Department of Military Medicine, Birmingham B15 2GW, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| |
Collapse
|
2
|
Chamley RR, Holland JL, Collins J, Pierce K, Watson WD, Green PG, O'Brien D, O'Sullivan O, Barker-Davies R, Ladlow P, Neubauer S, Bennett A, Nicol ED, Holdsworth DA, Rider OJ. Exercise capacity following SARS-CoV-2 infection is related to changes in cardiovascular and lung function in military personnel. Int J Cardiol 2024; 395:131594. [PMID: 37979795 DOI: 10.1016/j.ijcard.2023.131594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Since the COVID-19 pandemic, post-COVID syndrome (persistent symptoms/complications lasting >12 weeks) continues to pose medical and economic challenges. In military personnel, where optimal fitness is crucial, prolonged limitations affecting their ability to perform duties has occupational and psychological implications, impacting deployability and retention. Research investigating post-COVID syndrome exercise capacity and cardiopulmonary effects in military personnel is limited. METHODS UK military personnel were recruited from the Defence Medical Services COVID-19 Recovery Service. Participants were separated into healthy controls without prior SARS-CoV-2 infection (group one), and participants with prolonged symptoms (>12 weeks) after mild-moderate (community-treated) and severe (hospitalised) COVID-19 illness (group 2 and 3, respectively). Participants underwent cardiac magnetic resonance imaging (CMR) and spectroscopy, echocardiography, pulmonary function testing and cardiopulmonary exercise testing (CPET). RESULTS 113 participants were recruited. When compared in ordered groups (one to three), CPET showed stepwise decreases in peak work, work at VT1 and VO2 max (all p < 0.01). There were stepwise decreases in FVC (p = 0.002), FEV1 (p = 0.005), TLC (p = 0.002), VA (p < 0.001), and DLCO (p < 0.002), and a stepwise increase in A-a gradient (p < 0.001). CMR showed stepwise decreases in LV/RV volumes, stroke volumes and LV mass (LVEDVi/RVEDVi p < 0.001; LVSV p = 0.003; RVSV p = 0.001; LV mass index p = 0.049). CONCLUSION In an active military population, post-COVID syndrome is linked to subclinical changes in maximal exercise capacity. Alongside disease specific changes, many of these findings share the phenotype of deconditioning following prolonged illness or bedrest. Partitioning of the relative contribution of pathological changes from COVID-19 and deconditioning is challenging in post-COVID syndrome recovery.
Collapse
Affiliation(s)
- Rebecca R Chamley
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Medicine, Birmingham, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Jennifer L Holland
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - Jonathan Collins
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Kayleigh Pierce
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - William D Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - Peregrine G Green
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - David O'Brien
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Oliver O'Sullivan
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Robert Barker-Davies
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK.; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Peter Ladlow
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - Alexander Bennett
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK; Departments of Cardiology and Radiology, Royal Brompton Hospital, Sydney Street, London, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Edward D Nicol
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Departments of Cardiology and Radiology, Royal Brompton Hospital, Sydney Street, London, UK; School of Biomedical Engineering and Imaging Sciences, Kings College, London, United Kingdom; Royal Centre for Defence Medicine (South), Oxford, UK
| | - David A Holdsworth
- Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Medicine, Birmingham, UK; Royal Centre for Defence Medicine (South), Oxford, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom.
| |
Collapse
|
3
|
Green PG, Monteiro C, Holdsworth DA, Betts TR, Herring N. Cardiac resynchronization using fusion pacing during exercise. J Cardiovasc Electrophysiol 2024; 35:146-154. [PMID: 37888415 DOI: 10.1111/jce.16120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/02/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Fusion pacing requires correct timing of left ventricular pacing to right ventricular activation, although it is unclear whether this is maintained when atrioventricular (AV) conduction changes during exercise. We used cardiopulmonary exercise testing (CPET) to compare cardiac resynchronization therapy (CRT) using fusion pacing or fixed AV delays (AVD). METHODS Patients 6 months post-CRT implant with PR intervals < 250 ms performed two CPET tests, using either the SyncAV™ algorithm or fixed AVD of 120 ms in a double-blinded, randomized, crossover study. All other programming was optimized to produce the narrowest QRS duration (QRSd) possible. RESULTS Twenty patients (11 male, age 71 [65-77] years) were recruited. Fixed AVD and fusion programming resulted in similar narrowing of QRSd from intrinsic rhythm at rest (p = .85). Overall, there was no difference in peak oxygen consumption (V̇O2 PEAK , p = .19), oxygen consumption at anaerobic threshold (VT1, p = .42), or in the time to reach either V̇O2 PEAK (p = .81) or VT1 (p = .39). The BORG rating of perceived exertion was similar between groups. CPET performance was also analyzed comparing whichever programming gave the narrowest QRSd at rest (119 [96-136] vs. 134 [119-142] ms, p < .01). QRSd during exercise (p = .03), peak O2 pulse (mL/beat, a surrogate of stroke volume, p = .03), and cardiac efficiency (watts/mL/kg/min, p = .04) were significantly improved. CONCLUSION Fusion pacing is maintained during exercise without impairing exercise capacity compared with fixed AVD. However, using whichever algorithm gives the narrowest QRSd at rest is associated with a narrower QRSd during exercise, higher peak stroke volume, and improved cardiac efficiency.
Collapse
Affiliation(s)
- Peregrine G Green
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre, University of Oxford, Oxford, UK
- Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford Heart Centre, John Radcliffe Hospital, University of Oxford NHS Foundation Trust, Oxford, UK
| | - Cristiana Monteiro
- Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - David A Holdsworth
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre, University of Oxford, Oxford, UK
- Oxford Heart Centre, John Radcliffe Hospital, University of Oxford NHS Foundation Trust, Oxford, UK
| | - Timothy R Betts
- Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford Heart Centre, John Radcliffe Hospital, University of Oxford NHS Foundation Trust, Oxford, UK
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre, University of Oxford, Oxford, UK
- Oxford Heart Centre, John Radcliffe Hospital, University of Oxford NHS Foundation Trust, Oxford, UK
| |
Collapse
|
4
|
Barker-Davies RM, O'Sullivan O, Holdsworth DA, Ladlow P, Houston A, Chamley R, Greenhalgh A, Nicol ED, Bennett AN. How long is Long-COVID? Symptomatic improvement between 12 and 18 months in a prospective cohort study. BMJ Mil Health 2023:e002500. [PMID: 37788921 DOI: 10.1136/military-2023-002500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION COVID-19 infection can precede, in a proportion of patients, a prolonged syndrome including fatigue, exercise intolerance, mood and cognitive problems. This study aimed to describe the profile of fatigue-related, exercise-related, mood-related and cognitive-related outcomes in a COVID-19-exposed group compared with controls. METHODS 113 serving UK Armed Forces participants were followed up at 5, 12 (n=88) and 18 months (n=70) following COVID-19. At 18 months, 56 were in the COVID-19-exposed group with 14 matched controls. Exposed participants included hospitalised (n=25) and community (n=31) managed participants. 43 described at least one of the six most frequent symptoms at 5 months: fatigue, shortness of breath, chest pain, joint pain, exercise intolerance and anosmia. Participants completed a symptom checklist, patient-reported outcome measures (PROMs), the National Institute for Health cognitive battery and a 6-minute walk test (6MWT). PROMs included the Fatigue Assessment Scale (FAS), Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Patient Checklist-5 (PCL-5) for post-traumatic stress. RESULTS At 5 and 12 months, exposed participants presented with higher PHQ-9, PCL-5 and FAS scores than controls (ES (effect size) ≥0.25, p≤0.04). By 12 months, GAD-7 was not significantly different to controls (ES <0.13, p=0.292). Remaining PROMs lost significant difference by 18 months (ES ≤0.11, p≥0.28). No significant differences in the cognitive scales were observed at any time point (F=1.96, p=0.167). At 5 and 12 months, exposed participants recorded significantly lower distances on the 6MWT (ηp 2≥0.126, p<0.01). 6MWT distance lost significant difference by 18 months (ηp 2<0.039, p>0.15). CONCLUSIONS This prospective cohort-controlled study observed adverse outcomes in depression, post-traumatic stress, fatigue and submaximal exercise performance up to 12 months but improved by 18-month follow-up, in participants exposed to COVID-19 compared with a matched control group.
Collapse
Affiliation(s)
- Robert M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - D A Holdsworth
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Department for Health, University of Bath, Bath, UK
| | - A Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R Chamley
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Greenhalgh
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - E D Nicol
- Department of Cardiology, Royal Brompton Hospital, Birmingham, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
5
|
Ladlow P, Holdsworth DA, O'Sullivan O, Barker-Davies RM, Houston A, Chamley R, Rogers-Smith K, Kinkaid V, Kedzierski A, Naylor J, Mulae J, Cranley M, Nicol ED, Bennett AN. Exercise tolerance, fatigue, mental health, and employment status at 5 and 12 months following COVID-19 illness in a physically trained population. J Appl Physiol (1985) 2023; 134:622-637. [PMID: 36759161 PMCID: PMC10010915 DOI: 10.1152/japplphysiol.00370.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Failure to recover following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may have a profound impact on individuals who participate in high-intensity/volume exercise as part of their occupation/recreation. The aim of this study was to describe the longitudinal cardiopulmonary exercise function, fatigue, and mental health status of military-trained individuals (up to 12-mo postinfection) who feel recovered, and those with persistent symptoms from two acute disease severity groups (hospitalized and community-managed), compared with an age-, sex-, and job role-matched control. Eighty-eight participants underwent cardiopulmonary functional tests at baseline (5 mo following acute illness) and 12 mo; 25 hospitalized with persistent symptoms (hospitalized-symptomatic), 6 hospitalized and recovered (hospitalized-recovered); 28 community-managed with persistent symptoms (community-symptomatic); 12 community-managed, now recovered (community-recovered), and 17 controls. Cardiopulmonary exercise function and mental health status were comparable between the 5 and 12-mo follow-up. At 12 mo, symptoms of fatigue (48% and 46%) and shortness of breath (SoB; 52% and 43%) remain high in hospitalized-symptomatic and community-symptomatic groups, respectively. At 12 mo, COVID-19-exposed participants had a reduced capacity for work at anaerobic threshold and at peak exercise levels of deconditioning persist, with many individuals struggling to return to strenuous activity. The prevalence considered "fully fit" at 12 mo was lowest in symptomatic groups (hospitalized-symptomatic, 4%; hospitalized-recovered, 50%; community-symptomatic, 18%; community-recovered, 82%; control, 82%) and 49% of COVID-19-exposed participants remained medically nondeployable within the British Armed Forces. For hospitalized and symptomatic individuals, cardiopulmonary exercise profiles are consistent with impaired metabolic efficiency and deconditioning at 12 mo postacute illness. The long-term deployability status of COVID-19-exposed military personnel is uncertain.NEW & NOTEWORTHY Subjective exercise limiting symptoms such as fatigue and shortness of breath reduce but remain prevalent in symptomatic groups. At 12 mo, COVID-19-exposed individuals still have a reduced capacity for work at the anaerobic threshold (which best predicts sustainable intensity), despite oxygen uptake comparable to controls. The prevalence of COVID-19-exposed individuals considered "medically non-deployable" remains high at 47%.
Collapse
Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,Department for Health, University of Bath, Bath, United Kingdom
| | - David A Holdsworth
- Academic Department of Military Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,Headquarters Army Medical Directorate (HQ AMD), Camberley, United Kingdom
| | - Robert M Barker-Davies
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Andrew Houston
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kasha Rogers-Smith
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Victoria Kinkaid
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Adam Kedzierski
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Jon Naylor
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Joseph Mulae
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Mark Cranley
- Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Edward D Nicol
- Academic Department of Military Medicine, Birmingham, United Kingdom.,Royal Brompton Hospital, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
6
|
Barker-Davies RM, Ladlow P, Chamley R, Nicol E, Holdsworth DA. Reduced athletic performance post-COVID-19 is associated with reduced anaerobic threshold. BMJ Case Rep 2023; 16:16/2/e250191. [PMID: 36805865 PMCID: PMC9943905 DOI: 10.1136/bcr-2022-250191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Detailed characterisation of cardiopulmonary limitations in patients post-COVID-19 is currently limited, particularly in elite athletes. A male elite distance runner in his late 30s experienced chest pain following confirmed COVID-19. He underwent cardiopulmonary exercise testing (CPET) at 5 months postacute illness. Subjective exercise tolerance was reduced compared with normal, he described inability to 'kick' (rapidly accelerate). His CPET was compared with an identical protocol 15 months prior to COVID-19. While supranormal maximal oxygen uptake was maintained (155% of peak predicted V̇O2) anaerobic threshold (AT), a better predictor of endurance performance, reduced from 84% to 71% predicted peak V̇O2 maximum. Likewise, fat oxidation at AT reduced by 21%, from 0.35 to 0.28 g/min. Focusing exclusively on V̇O2 maximum risks missing an impairment of oxidative metabolism. Reduced AT suggests a peripheral disorder of aerobic metabolism. This finding may result from virally mediated mitochondrial dysfunction beyond normal 'deconditioning', associated with impaired fat oxidation.
Collapse
Affiliation(s)
| | - Peter Ladlow
- Academic Department of Military Rehabilitation, Loughborough, UK
| | | | - Edward Nicol
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | | |
Collapse
|
7
|
O’Sullivan O, Holdsworth DA, Ladlow P, Barker-Davies RM, Chamley R, Houston A, May S, Dewson D, Mills D, Pierce K, Mitchell J, Xie C, Sellon E, Naylor J, Mulae J, Cranley M, Talbot NP, Rider OJ, Nicol ED, Bennett AN. Cardiopulmonary, Functional, Cognitive and Mental Health Outcomes Post-COVID-19, Across the Range of Severity of Acute Illness, in a Physically Active, Working-Age Population. Sports Med Open 2023; 9:7. [PMID: 36729302 PMCID: PMC9893959 DOI: 10.1186/s40798-023-00552-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to significant morbidity and mortality, with the former impacting and limiting individuals requiring high physical fitness, including sportspeople and emergency services. METHODS Observational cohort study of 4 groups: hospitalised, community illness with on-going symptoms (community-symptomatic), community illness now recovered (community-recovered) and comparison. A total of 113 participants (aged 39 ± 9, 86% male) were recruited: hospitalised (n = 35), community-symptomatic (n = 34), community-recovered (n = 18) and comparison (n = 26), approximately five months following acute illness. Participant outcome measures included cardiopulmonary imaging, submaximal and maximal exercise testing, pulmonary function, cognitive assessment, blood tests and questionnaires on mental health and function. RESULTS Hospitalised and community-symptomatic groups were older (43 ± 9 and 37 ± 10, P = 0.003), with a higher body mass index (31 ± 4 and 29 ± 4, P < 0.001), and had worse mental health (anxiety, depression and post-traumatic stress), fatigue and quality of life scores. Hospitalised and community-symptomatic participants performed less well on sub-maximal and maximal exercise testing. Hospitalised individuals had impaired ventilatory efficiency (higher VE/V̇CO2 slope, 29.6 ± 5.1, P < 0.001), achieved less work at anaerobic threshold (70 ± 15, P < 0.001) and peak (231 ± 35, P < 0.001), and had a reduced forced vital capacity (4.7 ± 0.9, P = 0.004). Clinically significant abnormal cardiopulmonary imaging findings were present in 6% of hospitalised participants. Community-recovered individuals had no significant differences in outcomes to the comparison group. CONCLUSION Symptomatically recovered individuals who suffered mild-moderate acute COVID-19 do not differ from an age-, sex- and job-role-matched comparison population five months post-illness. Individuals who were hospitalised or continue to suffer symptoms may require a specific comprehensive assessment prior to return to full physical activity.
Collapse
Affiliation(s)
- Oliver O’Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK ,grid.4563.40000 0004 1936 8868Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - David A. Holdsworth
- Academic Department of Military Medicine, Birmingham, UK ,grid.410556.30000 0001 0440 1440Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK ,grid.7340.00000 0001 2162 1699Department for Health, University of Bath, Bath, UK
| | - Robert M. Barker-Davies
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK ,grid.6571.50000 0004 1936 8542School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, UK ,grid.410556.30000 0001 0440 1440Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Houston
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK
| | - Samantha May
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK
| | - Dominic Dewson
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK
| | - Daniel Mills
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK
| | - Kayleigh Pierce
- grid.410556.30000 0001 0440 1440Oxford University Hospitals NHS Foundation Trust, Oxford, UK ,grid.415490.d0000 0001 2177 007XRoyal Centre for Defence Medicine, Birmingham, UK
| | - James Mitchell
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK ,grid.6572.60000 0004 1936 7486Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Cheng Xie
- grid.410556.30000 0001 0440 1440Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Edward Sellon
- grid.410556.30000 0001 0440 1440Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jon Naylor
- grid.415490.d0000 0001 2177 007XRoyal Centre for Defence Medicine, Birmingham, UK
| | - Joseph Mulae
- grid.415490.d0000 0001 2177 007XRoyal Centre for Defence Medicine, Birmingham, UK
| | - Mark Cranley
- Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - Nick P. Talbot
- grid.410556.30000 0001 0440 1440Oxford University Hospitals NHS Foundation Trust, Oxford, UK ,grid.4991.50000 0004 1936 8948Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Oliver J. Rider
- grid.4991.50000 0004 1936 8948University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK ,grid.410556.30000 0001 0440 1440Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Edward D. Nicol
- Academic Department of Military Medicine, Birmingham, UK ,grid.439338.60000 0001 1114 4366Royal Brompton Hospital, London, UK
| | - Alexander N. Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5QW UK ,grid.7445.20000 0001 2113 8111National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
8
|
Holdsworth DA, Barker-Davies RM, Chamley RR, O'Sullivan O, Ladlow P, May S, Houston AD, Mulae J, Xie C, Cranley M, Sellon E, Naylor J, Halle M, Parati G, Davos C, Rider OJ, Bennett AB, Nicol ED. Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19. BMJ Mil Health 2022:military-2022-002193. [PMID: 36442889 DOI: 10.1136/military-2022-002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
Abstract
ObjectivePost-COVID-19 syndrome presents a health and economic challenge affecting ~10% of patients recovering from COVID-19. Accurate assessment of patients with post-COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings.Methods113 consecutive military patients were assessed in a comprehensive clinical pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CT pulmonary angiography and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease.Results7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V̇O226.7 (±5.1) vs 34.6 (±7.0) mL/kg/min; p=0.002) and functional capacity (peak power 200 (±36) vs 247 (±55) W; p=0.026) compared with those without significant disease. Simple CPET criteria (oxygen uptake (V̇O2) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V̇CO2) slope <30.0 or VE/V̇CO2slope <35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83%, respectively (area under the receiver operating characteristic curve (AUC) 0.89). The addition of capillary blood gases to estimate alveolar–arterial gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease.ConclusionsIn a population recovering from SARS-CoV-2, there is reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, permit the exclusion of clinically significant disease.
Collapse
Affiliation(s)
- D A Holdsworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Royal Centre for Defence Medicine, Birmingham, UK
| | - R M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R R Chamley
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Clincal Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - S May
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - A D Houston
- Academic Department of Military Rehabilitation, Defence Medical Services, Loughborough, UK
| | - J Mulae
- Royal Centre for Defence Medicine, Birmingham, UK
| | - C Xie
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Cranley
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - E Sellon
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Royal Centre for Defence Medicine, Birmingham, UK
| | - J Naylor
- Royal Centre for Defence Medicine, Birmingham, UK
| | - M Halle
- Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany
| | - G Parati
- Università degli Studi di Milano-Bicocca, Milano, Italy
| | - C Davos
- Academy of Athens Biomedical Research Foundation, Athens, Greece
| | - O J Rider
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Clincal Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - A B Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - E D Nicol
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| |
Collapse
|
9
|
Magor-Elliott SRM, Alamoudi A, Chamley RR, Xu H, Wellalagodage T, McDonald RP, O'Brien D, Collins J, Coombs B, Winchester J, Sellon E, Xie C, Sandhu D, Fullerton CJ, Couper JH, Smith NMJ, Richmond G, Cassar MP, Raman B, Talbot NP, Bennett AN, Nicol ED, Ritchie GAD, Petousi N, Holdsworth DA, Robbins PA. Altered lung physiology in two cohorts post COVID-19 infection as assessed using computed cardiopulmonography. J Appl Physiol (1985) 2022; 133:1175-1191. [PMID: 36173325 DOI: 10.1152/japplphysiol.00436.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The longer-term effects of COVID-19 on lung physiology remain poorly understood. Here, a new technique, computed cardiopulmonography (CCP), was used to study two COVID-19 cohorts (MCOVID and C-MORE-LP) at both ~6 and ~12 months post infection. CCP is comprised of two components. The first is to collect highly precise, highly time-resolved measurements of gas exchange using a purpose-built molecular flow sensor based around laser absorption spectroscopy. The second component is to estimate physiological parameters by fitting a cardiopulmonary model to the dataset. The measurement protocol involved 7 min breathing air followed by 5 min breathing pure O2. 178 participants were studied, with 97 returning for a repeat assessment. 126 arterial blood gas samples were drawn from MCOVID participants. For participants who had required intensive care and/or invasive mechanical ventilation, there was a significant increase in anatomical deadspace of ~ 30 ml and a significant increase in alveolar-to-arterial PO2 gradient of ~ 0.9 kPa relative to controls. Those who had been hospitalised had reductions in functional residual capacity of ~ 15%. Irrespectively of COVID-19 severity, participants who had had COVID-19 demonstrated a modest increase in ventilation inhomogeneity, broadly equivalent to that associated with 15 years of aging. This study illustrates the capability of CCP to study aspects of lung function not so easily addressed through standard clinical lung function tests. However, without measurements prior to infection, it is not possible to conclude whether the findings relate to the effects of COVID-19, or whether they constitute risk factors for more serious disease.
Collapse
Affiliation(s)
- Snapper R M Magor-Elliott
- Department of Physiology, Anatomy and Genetics, https://ror.org/052gg0110University of Oxford, Oxford, United Kingdom
| | - Asma Alamoudi
- Department of Physiology, Anatomy and Genetics, https://ror.org/052gg0110University of Oxford, Oxford, United Kingdom
| | - Rebecca R Chamley
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom.,Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Haopeng Xu
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tishan Wellalagodage
- Department of Physiology, Anatomy and Genetics, https://ror.org/052gg0110University of Oxford, Oxford, United Kingdom
| | - Rory P McDonald
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - David O'Brien
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jonathan Collins
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ben Coombs
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - James Winchester
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ed Sellon
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Cheng Xie
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Dominic Sandhu
- Department of Chemistry, University of Oxford, Oxford, United Kingdom
| | - Christopher J Fullerton
- Department of Physiology, Anatomy and Genetics, https://ror.org/052gg0110University of Oxford, Oxford, United Kingdom
| | - John H Couper
- Department of Chemistry, University of Oxford, Oxford, United Kingdom
| | | | - Graham Richmond
- Department of Chemistry, University of Oxford, Oxford, United Kingdom
| | - Mark P Cassar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nick P Talbot
- Department of Physiology, Anatomy and Genetics, https://ror.org/052gg0110University of Oxford, Oxford, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Alexander N Bennett
- Academic Department of Medical Rehabilitation, Stanford Hall, Loughborough,, United Kingdom
| | - Edward D Nicol
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Grant A D Ritchie
- Department of Chemistry, University of Oxford, Oxford, United Kingdom
| | - Nayia Petousi
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David A Holdsworth
- Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, https://ror.org/052gg0110University of Oxford, Oxford, United Kingdom
| |
Collapse
|
10
|
Frise MC, Holdsworth DA, Sandhu MS, Mellor AJ, Kasim AS, Hancock HC, Maier RH, Dorrington KL, Robbins PA, Akowuah EF. Non-anemic iron deficiency predicts prolonged hospitalisation following surgical aortic valve replacement: a single-centre retrospective study. J Cardiothorac Surg 2022; 17:157. [PMID: 35710500 PMCID: PMC9204877 DOI: 10.1186/s13019-022-01897-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 05/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Iron deficiency has deleterious effects in patients with cardiopulmonary disease, independent of anemia. Low ferritin has been associated with increased mortality in patients undergoing cardiac surgery, but modern indices of iron deficiency need to be explored in this population. Methods We conducted a retrospective single-centre observational study of 250 adults in a UK academic tertiary hospital undergoing median sternotomy for non-emergent isolated aortic valve replacement. We characterised preoperative iron status using measurement of both plasma ferritin and soluble transferrin receptor (sTfR), and examined associations with clinical outcomes. Results Measurement of plasma sTfR gave a prevalence of iron deficiency of 22%. Patients with non-anemic iron deficiency had clinically significant prolongation of total hospital stay (mean increase 2.2 days; 95% CI: 0.5–3.9; P = 0.011) and stay within the cardiac intensive care unit (mean increase 1.3 days; 95% CI: 0.1–2.5; P = 0.039). There were no deaths. Defining iron deficiency as a plasma ferritin < 100 µg/L identified 60% of patients as iron deficient and did not predict length of stay. No significant associations with transfusion requirements were evident using either definition of iron deficiency. Conclusions These findings indicate that when defined using sTfR rather than ferritin, non-anemic iron deficiency predicts prolonged hospitalisation following surgical aortic valve replacement. Further studies are required to clarify the role of contemporary laboratory indices in the identification of preoperative iron deficiency in patients undergoing cardiac surgery. An interventional study of intravenous iron targeted at preoperative non-anemic iron deficiency is warranted.
Collapse
Affiliation(s)
- Matthew C Frise
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK. .,Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK.
| | - David A Holdsworth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Manraj S Sandhu
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Terrell Street, Bristol, BS2 8ED, UK
| | - Adrian J Mellor
- South Tees NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - Adetayo S Kasim
- Durham Research Methods Centre, NEDTC Hub, 1st Floor Arthur Holmes Building, Lower Mountjoy, South Road, Durham, DH1 3LE, UK
| | - Helen C Hancock
- Faculty of Medical Sciences, Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle Upon Tyne, NE2 4AE, UK
| | - Rebecca H Maier
- Faculty of Medical Sciences, Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle Upon Tyne, NE2 4AE, UK
| | - Keith L Dorrington
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Enoch F Akowuah
- Academic Cardiovascular Unit, South Tees NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK.,Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| |
Collapse
|
11
|
Holdsworth DA, Chamley R, Barker-Davies R, O’Sullivan O, Ladlow P, Mitchell JL, Dewson D, Mills D, May SLJ, Cranley M, Xie C, Sellon E, Mulae J, Naylor J, Raman B, Talbot NP, Rider OJ, Bennett AN, Nicol ED. Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID. PLoS One 2022; 17:e0267392. [PMID: 35687603 PMCID: PMC9187094 DOI: 10.1371/journal.pone.0267392] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/07/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There have been more than 425 million COVID-19 infections worldwide. Post-COVID illness has become a common, disabling complication of this infection. Therefore, it presents a significant challenge to global public health and economic activity. METHODS Comprehensive clinical assessment (symptoms, WHO performance status, cognitive testing, CPET, lung function, high-resolution CT chest, CT pulmonary angiogram and cardiac MRI) of previously well, working-age adults in full-time employment was conducted to identify physical and neurocognitive deficits in those with severe or prolonged COVID-19 illness. RESULTS 205 consecutive patients, age 39 (IQR30.0-46.7) years, 84% male, were assessed 24 (IQR17.1-34.0) weeks after acute illness. 69% reported ≥3 ongoing symptoms. Shortness of breath (61%), fatigue (54%) and cognitive problems (47%) were the most frequent symptoms, 17% met criteria for anxiety and 24% depression. 67% remained below pre-COVID performance status at 24 weeks. One third of lung function tests were abnormal, (reduced lung volume and transfer factor, and obstructive spirometry). HRCT lung was clinically indicated in <50% of patients, with COVID-associated pathology found in 25% of these. In all but three HRCTs, changes were graded 'mild'. There was an extremely low incidence of pulmonary thromboembolic disease or significant cardiac pathology. A specific, focal cognitive deficit was identified in those with ongoing symptoms of fatigue, poor concentration, poor memory, low mood, and anxiety. This was notably more common in patients managed in the community during their acute illness. CONCLUSION Despite low rates of residual cardiopulmonary pathology, in this cohort, with low rates of premorbid illness, there is a high burden of symptoms and failure to regain pre-COVID performance 6-months after acute illness. Cognitive assessment identified a specific deficit of the same magnitude as intoxication at the UK drink driving limit or the deterioration expected with 10 years ageing, which appears to contribute significantly to the symptomatology of long-COVID.
Collapse
Affiliation(s)
- David A. Holdsworth
- Royal Centre for Defence Medicine Birmingham, Birmingham, United Kingdom
- Academic Department of Military Medicine, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, United Kingdom
- University of Oxford, OCMR, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - Rob Barker-Davies
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
- Loughborough University, School of Sport, Exercise and Health Sciences, Loughborough, United Kingdom
| | - Oliver O’Sullivan
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
| | - Peter Ladlow
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - James L. Mitchell
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
- University of Birmingham, Metabolic Neurology, Institute of Metabolism and Systems Research, Birmingham, United Kingdom
| | - Dominic Dewson
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
| | - Daniel Mills
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
| | - Samantha L. J. May
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
| | - Mark Cranley
- Defence Medical Rehabilitation Centre, Stanford Hall, United Kingdom
| | - Cheng Xie
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Edward Sellon
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Defence Medical Rehabilitation Centre, Stanford Hall, United Kingdom
| | - Joseph Mulae
- Royal Centre for Defence Medicine Birmingham, Birmingham, United Kingdom
| | - Jon Naylor
- Royal Centre for Defence Medicine Birmingham, Birmingham, United Kingdom
| | - Betty Raman
- University of Oxford, OCMR, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - Nick P. Talbot
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Department of Physiology, University of Oxford, Anatomy and Genetics, Oxford, United Kingdom
| | - Oliver J. Rider
- University of Oxford, OCMR, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - Alexander N. Bennett
- Defence Medical Rehabilitation Centre, Academic Department of Military Rehabilitation, Stanford Hall, United Kingdom
- Imperial College London National Heart and Lung Institute, London, United Kingdom
| | - Edward D. Nicol
- Royal Centre for Defence Medicine Birmingham, Birmingham, United Kingdom
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Kings College, London, United Kingdom
| |
Collapse
|
12
|
Ladlow P, O'Sullivan O, Bennett AN, Barker-Davies R, Houston A, Chamley R, May S, Mills D, Dewson D, Rogers-Smith K, Ward C, Taylor J, Mulae J, Naylor J, Nicol ED, Holdsworth DA. The effect of medium-term recovery status after COVID-19 illness on cardiopulmonary exercise capacity in a physically active adult population. J Appl Physiol (1985) 2022; 132:1525-1535. [PMID: 35608204 PMCID: PMC9190734 DOI: 10.1152/japplphysiol.00138.2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high-functioning populations ranging from frontline emergency services to professional or amateur/recreational athletes. The aim of the study is to describe the medium-term cardiopulmonary exercise profiles of individuals with “persistent symptoms” and individuals who feel “recovered” after hospitalization or mild-moderate community infection following COVID-19 to an age, sex, and job-role matched control group. A total of 113 participants underwent cardiopulmonary functional tests at a mean of 159 ± 7 days (∼5 mo) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered); and 26 controls. Hospitalized groups had the least favorable body composition (body mass, body mass index, and waist circumference) compared with controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇o2) at peak exercise (hospitalized-symptomatic, 29.9 ± 5.0 mL/kg/min; community-symptomatic, 34.4 ± 7.2 mL/kg/min; vs. control 43.9 ± 3.1 mL/kg/min, both P < 0.001). Hospitalized-symptomatic individuals had a steeper V̇e/V̇co2 slope (lower ventilatory efficiency) (30.5 ± 5.3 vs. 25.5 ± 2.6, P = 0.003) versus. controls. Hospitalized-recovered had a significantly lower oxygen uptake at peak (32.6 ± 6.6 mL/kg/min vs. 43.9 ± 13.1 mL/kg/min, P = 0.015) compared with controls. No significant differences were reported between community-recovered individuals and controls in any cardiopulmonary parameter. In conclusion, medium-term findings suggest that community-recovered individuals did not differ in cardiopulmonary fitness from physically active healthy controls. This suggests their readiness to return to higher levels of physical activity. However, the hospitalized-recovered group and both groups with persistent symptoms had enduring functional limitations, warranting further monitoring, rehabilitation, and recovery. NEW & NOTEWORTHY At 5 mo postinfection, community-treated individuals who feel recovered have comparable cardiopulmonary exercise profiles to the physically trained and active controls, suggesting a readiness to return to higher intensity/volumes of exercise. However, both symptomatic groups and the hospital-recovered group have persistent functional limitations when compared with active controls, supporting the requirement for ongoing monitoring, rehabilitation, and recovery.
Collapse
Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- Headquarters Army Medical Directorate, Robertson House, Camberley, United Kingdom
| | - Alexander N. Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Robert Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Andrew Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Samantha May
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Daniel Mills
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Dominic Dewson
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Kasha Rogers-Smith
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Christopher Ward
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - John Taylor
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Joseph Mulae
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Jon Naylor
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Edward D. Nicol
- Royal Brompton Hospital, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - David A. Holdsworth
- Academic Department of Military Medicine, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| |
Collapse
|
13
|
Guettler NJ, Cox A, Holdsworth DA, Rajappan K, Nicol ED. Possible safety hazards with cardiac implantable electronic devices in those working in the aviation industry. Eur J Prev Cardiol 2022; 30:zwac045. [PMID: 35234879 DOI: 10.1093/eurjpc/zwac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Norbert J Guettler
- Internal Medicine and Cardiology Section, Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Germany
- Departments of Cardiology and Electrophysiology, Bundeswehr Central Hospital, Koblenz, Germany
| | - Andrew Cox
- Departments of Cardiology and Electrophysiology, Joint Hospital Group (South East), Frimley Park Hospital, Camberley, UK
| | - David A Holdsworth
- Aviation Medicine Clinical Service, Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
- Department of Cardiology, Oxford Unviversity Hospital, Headley Way, Oxford, UK
| | - Kim Rajappan
- Department of Cardiology, Oxford Unviversity Hospital, Headley Way, Oxford, UK
- Department of Electrophysiology, Oxford Unviversity Hospital, Headley Way, Oxford, UK
| | - Edward D Nicol
- Aviation Medicine Clinical Service, Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
- School of Biomedical Engineering and Information Sciences, Kings College, London, UK
| |
Collapse
|
14
|
Frise MC, Holdsworth DA, Johnson AW, Chung YJ, Curtis MK, Cox PJ, Clarke K, Tyler DJ, Roberts DJ, Ratcliffe PJ, Dorrington KL, Robbins PA. Publisher Correction: Abnormal whole-body energy metabolism in iron-deficient humans despite preserved skeletal muscle oxidative phosphorylation. Sci Rep 2022; 12:3685. [PMID: 35232980 PMCID: PMC8888599 DOI: 10.1038/s41598-022-06694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew C Frise
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - David A Holdsworth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Andrew W Johnson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Yu Jin Chung
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - M Kate Curtis
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Pete J Cox
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - David J Roberts
- Nuffield Department of Clinical Laboratory Sciences, National Blood Service Oxford Centre, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9BQ, UK
| | - Peter J Ratcliffe
- Nuffield Department of Medicine, University of Oxford, NDM Research Building, Old Road Campus, Headington, OX3 7FZ, Oxford, UK
- Francis Crick Institute, London, NW1 1AT, UK
| | - Keith L Dorrington
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK.
| |
Collapse
|
15
|
Frise MC, Holdsworth DA, Johnson AW, Chung YJ, Curtis MK, Cox PJ, Clarke K, Tyler DJ, Roberts DJ, Ratcliffe PJ, Dorrington KL, Robbins PA. Abnormal whole-body energy metabolism in iron-deficient humans despite preserved skeletal muscle oxidative phosphorylation. Sci Rep 2022; 12:998. [PMID: 35046429 PMCID: PMC8770476 DOI: 10.1038/s41598-021-03968-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/10/2021] [Indexed: 01/01/2023] Open
Abstract
Iron deficiency impairs skeletal muscle metabolism. The underlying mechanisms are incompletely characterised, but animal and human experiments suggest the involvement of signalling pathways co-dependent upon oxygen and iron availability, including the pathway associated with hypoxia-inducible factor (HIF). We performed a prospective, case-control, clinical physiology study to explore the effects of iron deficiency on human metabolism, using exercise as a stressor. Thirteen iron-deficient (ID) individuals and thirteen iron-replete (IR) control participants each underwent 31P-magnetic resonance spectroscopy of exercising calf muscle to investigate differences in oxidative phosphorylation, followed by whole-body cardiopulmonary exercise testing. Thereafter, individuals were given an intravenous (IV) infusion, randomised to either iron or saline, and the assessments repeated ~ 1 week later. Neither baseline iron status nor IV iron significantly influenced high-energy phosphate metabolism. During submaximal cardiopulmonary exercise, the rate of decline in blood lactate concentration was diminished in the ID group (P = 0.005). Intravenous iron corrected this abnormality. Furthermore, IV iron increased lactate threshold during maximal cardiopulmonary exercise by ~ 10%, regardless of baseline iron status. These findings demonstrate abnormal whole-body energy metabolism in iron-deficient but otherwise healthy humans. Iron deficiency promotes a more glycolytic phenotype without having a detectable effect on mitochondrial bioenergetics.
Collapse
Affiliation(s)
- Matthew C Frise
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - David A Holdsworth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Andrew W Johnson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Yu Jin Chung
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - M Kate Curtis
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Pete J Cox
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - David J Roberts
- Nuffield Department of Clinical Laboratory Sciences, National Blood Service Oxford Centre, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9BQ, UK
| | - Peter J Ratcliffe
- Nuffield Department of Medicine, University of Oxford, NDM Research Building, Old Road Campus, Headington, Oxford, OX3 7FZ, UK
- Francis Crick Institute, London, NW1 1AT, UK
| | - Keith L Dorrington
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK
| | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK.
| |
Collapse
|
16
|
Ladlow P, O'Sullivan O, Houston A, Barker-Davies R, May S, Mills D, Dewson D, Chamley R, Naylor J, Mulae J, Bennett AN, Nicol ED, Holdsworth DA. Dysautonomia following COVID-19 is not associated with subjective limitations or symptoms but is associated with objective functional limitations. Heart Rhythm 2021; 19:613-620. [PMID: 34896622 PMCID: PMC8656177 DOI: 10.1016/j.hrthm.2021.12.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 12/05/2021] [Indexed: 02/06/2023]
Abstract
Background Individuals who contract coronavirus disease 2019 (COVID-19) can suffer with persistent and debilitating symptoms long after the initial acute illness. Heart rate (HR) profiles determined during cardiopulmonary exercise testing (CPET) and delivered as part of a post-COVID recovery service may provide insight into the presence and impact of dysautonomia on functional ability. Objective Using an active, working-age, post–COVID-19 population, the purpose of this study was to (1) determine and characterize any association between subjective symptoms and dysautonomia; and (2) identify objective exercise capacity differences between patients classified “with” and those “without” dysautonomia. Methods Patients referred to a post–COVID-19 service underwent comprehensive clinical assessment, including self-reported symptoms, CPET, and secondary care investigations when indicated. Resting HR >75 bpm, HR increase with exercise <89 bpm, and HR recovery <25 bpm 1 minute after exercise were used to define dysautonomia. Anonymized data were analyzed and associations with symptoms, and CPET outcomes were determined. Results Fifty-one of the 205 patients (25%) reviewed as part of this service evaluation had dysautonomia. There were no associations between symptoms or perceived functional limitation and dysautonomia (P >.05). Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate (219 ± 37 W vs 253 ± 52 W; P <.001) and peak oxygen consumption (V̇o2: 30.6 ± 5.5 mL/kg/min vs 35.8 ± 7.6 mL/kg/min; P <.001); and a steeper (less efficient) V̇e/V̇co2 slope (29.9 ± 4.9 vs 27.7 ± 4.7; P = .005). Conclusion Dysautonomia is associated with objective functional limitations but is not associated with subjective symptoms or limitation.
Collapse
Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom; Department for Health, University of Bath, Bath, United Kingdom
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom
| | - Andrew Houston
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom
| | - Robert Barker-Davies
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Samantha May
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom
| | - Daniel Mills
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom
| | - Dominic Dewson
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, United Kingdom; Oxford Centre for Cardiovascular MRI, University of Oxford, Oxford, United Kingdom
| | - Jon Naylor
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Joseph Mulae
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Edward D Nicol
- Royal Centre for Defence Medicine, Birmingham, United Kingdom; Royal Brompton Hospital, London, United Kingdom; Faculty of Medicine, Imperial College London, London, United Kingdom
| | - David A Holdsworth
- Academic Department of Military Medicine, Birmingham, United Kingdom; Royal Centre for Defence Medicine, Birmingham, United Kingdom; Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
| |
Collapse
|
17
|
Nicol ED, Holdsworth DA, Halle M, Davos CH. The European Association of Preventive Cardiology Aviation and Occupational Cardiology Task Force. Eur Heart J 2021; 42:2030-2033. [PMID: 33855347 DOI: 10.1093/eurheartj/ehab205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.,National Heart and Lung Institute, Imperial College, Guy Scadding Building, Cale Street, London SW3 6LY, UK
| | - David A Holdsworth
- Oxford University Hospital Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 56, D-80992 Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece
| |
Collapse
|
18
|
O'Sullivan O, Barker-Davies R, Chamley R, Sellon E, Jenkins D, Burley R, Holden L, Nicol AM, Phillip R, Bennett AN, Nicol E, Holdsworth DA. Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service. BMJ Mil Health 2021; 169:271-276. [PMID: 33547188 DOI: 10.1136/bmjmilitary-2020-001681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/04/2022]
Abstract
Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.
Collapse
Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,Headquarters Army Medical Services (HQ AMS), Camberley, Surrey, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - R Chamley
- Academic Department of Military Medicine, Birmingham, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - E Sellon
- Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Royal Centre for Defence Medicine, Birmingham, UK
| | - D Jenkins
- Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Royal Centre for Defence Medicine, Birmingham, UK
| | - R Burley
- Headquarters Defence Primary Healthcare, Lichfield, Staffordshire, UK
| | - L Holden
- Royal Centre for Defence Medicine, Birmingham, UK
| | - A M Nicol
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK
| | - R Phillip
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - E Nicol
- Royal Centre for Defence Medicine, Birmingham, UK.,Royal Brompton Hospital, London, UK
| | - D A Holdsworth
- Academic Department of Military Medicine, Birmingham, UK .,Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| |
Collapse
|
19
|
Parsons IT, Snape D, O'Hara J, Holdsworth DA, Stacey MJ, Gall N, Chowienczyk P, Wainwright B, Woods DR. Echocardiographic changes following active heat acclimation. J Therm Biol 2020; 93:102705. [PMID: 33077126 PMCID: PMC7467033 DOI: 10.1016/j.jtherbio.2020.102705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
Heat adaption through acclimatisation or acclimation improves cardiovascular stability by maintaining cardiac output due to compensatory increases in stroke volume. The main aim of this study was to assess whether 2D transthoracic echocardiography (TTE) could be used to confirm differences in resting echocardiographic parameters, before and after active heat acclimation (HA). Thirteen male endurance trained cyclists underwent a resting blinded TTE before and after randomisation to either 5 consecutive daily exertional heat exposures of controlled hyperthermia at 32°C with 70% relative humidity (RH) (HOT) or 5-days of exercise in temperate (21°C with 36% RH) environmental conditions (TEMP). Measures of HA included heart rate, gastrointestinal temperature, skin temperature, sweat loss, total non-urinary fluid loss (TNUFL), plasma volume and participant's ratings of perceived exertion (RPE). Following HA, the HOT group demonstrated increased sweat loss (p = 0.01) and TNUFL (p = 0.01) in comparison to the TEMP group with a significantly decreased RPE (p = 0.01). On TTE, post exposure, there was a significant comparative increase in the HOT group in left ventricular end diastolic volume (p = 0.029), SV (p = 0.009), left atrial volume (p = 0.005), inferior vena cava diameter (p = 0.041), and a significant difference in mean peak diastolic mitral annular velocity (e’) (p = 0.044). Cardiovascular adaptations to HA appear to be predominantly mediated by improvements in increased preload and ventricular compliance. TTE is a useful tool to demonstrate and quantify cardiac HA. There are echocardiographic differences in comparing an isothermic heat acclimation regime to equivalent temperate exercise. Heat acclimation results in an increased LA volume, LVEDV, stroke volume, IVC diameter and LV diastolic function (e’). The increase in LA volume and IVC diameter would suggest an increase in preload secondary to increased plasma volume. The rise in the speed of early LV relaxation (e’) during diastole reflects increased LV compliance or reduced LV stiffness. This gives further insight into the cardiovascular adaptations to heat acclimation.
Collapse
Affiliation(s)
- Iain T Parsons
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK; School of Cardiovascular Medicine and Sciences, King's College London, UK.
| | - Daniel Snape
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK.
| | - John O'Hara
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK.
| | - David A Holdsworth
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Michael J Stacey
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Nick Gall
- School of Cardiovascular Medicine and Sciences, King's College London, UK.
| | - Phil Chowienczyk
- School of Cardiovascular Medicine and Sciences, King's College London, UK.
| | - Barney Wainwright
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK.
| | - David R Woods
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK; Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK.
| |
Collapse
|
20
|
Holdsworth DA, Frise MC, Bakker-Dyos J, Boos C, Dorrington KL, Woods D, Mellor A, Robbins PA. Iron bioavailability and cardiopulmonary function during ascent to very high altitude. Eur Respir J 2020; 56:13993003.02285-2019. [PMID: 32430412 PMCID: PMC7494841 DOI: 10.1183/13993003.02285-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/17/2020] [Indexed: 11/22/2022]
Abstract
More than one hundred million people reside worldwide at altitudes in excess of 2500 m above sea level. In the millions more who sojourn at high altitude for recreational, occupational or military pursuits, hypobaric hypoxia drives physiological changes affecting the pulmonary circulation, haematocrit and right ventricle (RV) [1]. Coincident with these, maximal left ventricular (LV) stroke volume (SV) falls [2], with a reduction of 20% reported after a 2-week stay at 4300 m [3]. A rise in heart rate (HR) compensates at rest and during submaximal exercise but is insufficient during maximal intensity exercise, constraining maximal cardiac output (CO). Previously, it was considered that a reduction in plasma volume or a direct effect of hypoxia on LV myocardial contractility were probably responsible [4]. More recently it has been suggested that increased RV afterload may be of greater importance [5]. Intravenous iron supplementation at sea level is associated with enhanced stroke volume and higher SpO2 on ascent to very high altitude (5100 m). These effects appear to result from reduced pulmonary vascular resistance and improved right heart function.https://bit.ly/2VQX5fR
Collapse
Affiliation(s)
- David A Holdsworth
- Dept of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK .,Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Matthew C Frise
- Dept of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Josh Bakker-Dyos
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Christopher Boos
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,Dept of Postgraduate Medical Education, Bournemouth University, Bournemouth, UK
| | - Keith L Dorrington
- Dept of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - David Woods
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK.,Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Adrian Mellor
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK.,Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Peter A Robbins
- Dept of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| |
Collapse
|
21
|
Affiliation(s)
| | - Joanna L D’Arcy
- Consultant Cardiologist Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Maj Thomas Syburra
- Senior consultant cardiac surgeon Luzern Kantonsspital - Herzzentrum Spitalstrasse, 6000 Luzern 16, Switzerland. Military Deputy Head Aviation Medicine Swiss Air Force Aeromedical Centre, Dübendorf, Switzerland
| | - David A Holdsworth
- Consultant Cardiologist Oxford Heart Centre John Radcliffe Hospital Oxford, UK
| |
Collapse
|
22
|
Holdsworth DA, Chamley RR, Rider OJ, Nicol ED. The importance of exercise testing in occupational cardiovascular assessment for high-hazard professions. Eur Heart J 2019; 40:3078-3080. [DOI: 10.1093/eurheartj/ehz664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Rebecca R Chamley
- Cardiology Trainee, Oxford Heart Centre, Oxford University Hospital NHS Foundation Trust, UK
| | - Oliver J Rider
- Associate Professor of Cardiovascular Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Edward D Nicol
- Consultant Cardiologist, Aviation Medicine Clinical Service, Centre of Aviation Medicine, RAF Henlow, Beds., UK
| |
Collapse
|
23
|
Affiliation(s)
- Norbert Guettler
- Colonel, Internal Medicine and Cardiology, Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Germany
| | - Kim Rajappan
- Consultant Cardiologist & Electrophysiologist, Cardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David A Holdsworth
- Consultant Cardiologist, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - Edward D Nicol
- Consultant Cardiologist, Aviation Medicine Clinical Service, Centre of Aviation Medicine, RAF Henlow, Beds., UK
| |
Collapse
|
24
|
Affiliation(s)
- Rebecca R Chamley
- Cardiology Trainee Oxford Heart Centre Oxford University Hospital NHS Foundation Trust UK
| | - David A Holdsworth
- Consultant Cardiologist Oxford Heart Centre John Radcliffe Hospital Oxford, UK
| | - Kim Rajappan
- Consultant Cardiologist & Electrophysiologist Cardiac Department John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust Oxford, OX3 9DU, UK
| | - Edward D Nicol
- Consultant Cardiologist Aviation Medicine Clinical Service Centre of Aviation Medicine RAF Henlow Beds., SG16 6DN, UK
| |
Collapse
|
25
|
Affiliation(s)
- David A Holdsworth
- Consultant Cardiologist Oxford Heart Centre John Radcliffe Hospital Oxford, UK
| | - Leanne J Eveson
- Cantab Core Medical Trainee Royal Brompton Hospital, London, UK
| | - Olivier Manen
- Aeromedical Center - Medicine Department HIA Percy - DEA/CPEMPN 101 Avenue Henri Barbusse Clamart, FRANCE
| | - Edward D Nicol
- FACC DAvMed Consultant Cardiologist Aviation Medicine Clinical Service Centre of Aviation Medicine RAF Henlow Beds., UK
| |
Collapse
|
26
|
Affiliation(s)
- Rebecca R Chamley
- Cardiology Trainee Oxford Heart Centre Oxford University Hospital NHS Foundation Trust, UK
| | - David A Holdsworth
- Consultant Cardiologist Oxford Heart Centre John Radcliffe Hospital Oxford, UK
| | - Joanna L D’arcy
- Consultant Cardiologist Dept. of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Edward D Nicol
- Consultant Cardiologist Aviation Medicine Clinical Service Centre of Aviation Medicine RAF Henlow Beds., SG16 6DN, UK
| |
Collapse
|
27
|
Holdsworth DA, Parsons IT, Chamley R, Britton J, Pavitt C, Baksi AJ, Neubauer S, d’Arcy J, Nicol ED. Cardiac MRI improves cardiovascular risk stratification in hazardous occupations. J Cardiovasc Magn Reson 2019; 21:48. [PMID: 31352898 PMCID: PMC6661777 DOI: 10.1186/s12968-019-0544-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/21/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The benefit of cardiovascular magnetic resonance Imaging (CMR) in assessing occupational risk is unknown. Pilots undergo frequent medical assessment for occult disease, which threatens incapacitation or distraction during flight. ECG and examination anomalies often lead to lengthy restriction, pending full investigation. CMR provides a sensitive, specific assessment of cardiac anatomy, tissue characterisation, perfusion defects and myocardial viability. We sought to determine if CMR, when added to standard care, would alter occupational outcome. METHODS A retrospective review was conducted of all personnel attending the RAF Aviation Medicine Consultation Service (AMCS) for assessment of a cardiac anomaly, over a 2-year period. Those undergoing standard of care (history, examination, exercise ECG, 24 h-Holter and transthoracic echocardiography), and those undergoing a CMR in addition, were identified. The influence of CMR upon the final decision regarding flying restriction was determined by comparing the diagnosis reached with standard of care plus CMR vs. standard of care alone. RESULTS Of the ~ 8000 UK military aircrew, 558 personnel were seen for cardiovascular assessment. Fifty-two underwent CMR. A normal TTE did not reliably exclude abnormalities subsequently detected by CMR. Addition of CMR resulted in an upgraded occupational status in 62% of those investigated, with 37% returning to unrestricted duties. Only 8% of referrals were undiagnosed following CMR. All these were cases of borderline chamber dilatation and reduction in systolic function in whom diagnostic uncertainty remained between physiological exercise adaptation and early cardiomyopathy. CONCLUSIONS CMR increases the likelihood of a definitive diagnosis and of return to flying. This study supports early use of CMR in occupational assessment for high-hazard occupations.
Collapse
Affiliation(s)
- David A. Holdsworth
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, England
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Iain T. Parsons
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, England
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW36NP England
| | - Rebecca Chamley
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, England
- Royal Berkshire NHS Foundation Trust, Reading, England
| | - Joseph Britton
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, England
| | - Christopher Pavitt
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW36NP England
| | - A. John Baksi
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW36NP England
| | - Stefan Neubauer
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Division of Cardiovascular Medicine, University of Oxford, Oxford NIHR Biomedical Research Centre, Oxford, England
| | - Joanna d’Arcy
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, England
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Edward D. Nicol
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, England
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW36NP England
| |
Collapse
|
28
|
Abstract
Introduction Physical endurance can be limited by muscle glycogen stores, in that glycogen depletion markedly reduces external work. During carbohydrate restriction, the liver synthesizes the ketone bodies, d-β-hydroxybutyrate, and acetoacetate from fatty acids. In animals and in the presence of glucose, d-β-hydroxybutyrate promotes insulin secretion and increases glycogen synthesis. Here we determined whether a dietary ketone ester, combined with plentiful glucose, can increase postexercise glycogen synthesis in human skeletal muscle. Methods After an interval-based glycogen depletion exercise protocol, 12 well-trained male athletes completed a randomized, three-arm, blinded crossover recovery study that consisted of consumption of either a taste-matched, zero-calorie control or a ketone monoester drink, followed by a 10-mM glucose clamp or saline infusion for 2 h. The three postexercise conditions were control drink then saline infusion, control drink then hyperglycemic clamp, or ketone ester drink then hyperglycemic clamp. Skeletal muscle glycogen content was determined in muscle biopsies of vastus lateralis taken before and after the 2-h clamps. Results The ketone ester drink increased blood d-β-hydroxybutyrate concentrations to a maximum of 5.3 versus 0.7 mM for the control drink (P < 0.0001). During the 2-h glucose clamps, insulin levels were twofold higher (31 vs 16 mU·L−1, P < 0.01) and glucose uptake 32% faster (1.66 vs 1.26 g·kg−1, P < 0.001). The ketone drink increased by 61 g, the total glucose infused for 2 h, from 197 to 258 g, and muscle glycogen was 50% higher (246 vs 164 mmol glycosyl units per kilogram dry weight, P < 0.05) than after the control drink. Conclusion In the presence of constant high glucose concentrations, a ketone ester drink increased endogenous insulin levels, glucose uptake, and muscle glycogen synthesis.
Collapse
Affiliation(s)
- David A Holdsworth
- 1Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UNITED KINGDOM; and 2Research Institute for Sport and Exercise Sciences, Liverpool John Moore's University, Liverpool, UNITED KINGDOM
| | | | | | | | | | | |
Collapse
|
29
|
O'Hara JP, Woods DR, Mellor A, Boos C, Gallagher L, Tsakirides C, Arjomandkhah NC, Holdsworth DA, Cooke CB, Morrison DJ, Preston T, King RF. A comparison of substrate oxidation during prolonged exercise in men at terrestrial altitude and normobaric normoxia following the coingestion of 13C glucose and 13C fructose. Physiol Rep 2017; 5:5/1/e13101. [PMID: 28082428 PMCID: PMC5256160 DOI: 10.14814/phy2.13101] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 11/30/2016] [Accepted: 11/29/2016] [Indexed: 01/14/2023] Open
Abstract
This study compared the effects of coingesting glucose and fructose on exogenous and endogenous substrate oxidation during prolonged exercise at altitude and sea level, in men. Seven male British military personnel completed two bouts of cycling at the same relative workload (55% Wmax) for 120 min on acute exposure to altitude (3375 m) and at sea level (~113 m). In each trial, participants ingested 1.2 g·min−1 of glucose (enriched with 13C glucose) and 0.6 g·min−1 of fructose (enriched with 13C fructose) directly before and every 15 min during exercise. Indirect calorimetry and isotope ratio mass spectrometry were used to calculate fat oxidation, total and exogenous carbohydrate oxidation, plasma glucose oxidation, and endogenous glucose oxidation derived from liver and muscle glycogen. Total carbohydrate oxidation during the exercise period was lower at altitude (157.7 ± 56.3 g) than sea level (286.5 ± 56.2 g, P = 0.006, ES = 2.28), whereas fat oxidation was higher at altitude (75.5 ± 26.8 g) than sea level (42.5 ± 21.3 g, P = 0.024, ES = 1.23). Peak exogenous carbohydrate oxidation was lower at altitude (1.13 ± 0.2 g·min−1) than sea level (1.42 ± 0.16 g·min−1, P = 0.034, ES = 1.33). There were no differences in rates, or absolute and relative contributions of plasma or liver glucose oxidation between conditions during the second hour of exercise. However, absolute and relative contributions of muscle glycogen during the second hour were lower at altitude (29.3 ± 28.9 g, 16.6 ± 15.2%) than sea level (78.7 ± 5.2 g (P = 0.008, ES = 1.71), 37.7 ± 13.0% (P = 0.016, ES = 1.45). Acute exposure to altitude reduces the reliance on muscle glycogen and increases fat oxidation during prolonged cycling in men compared with sea level.
Collapse
Affiliation(s)
- John P O'Hara
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - David R Woods
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom.,Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Northumbria NHS Trust and Newcastle Trust, Newcastle, United Kingdom
| | - Adrian Mellor
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom.,Royal Centre for Defence Medicine, Birmingham, United Kingdom.,James Cook University Hospital, Middlesborough, United Kingdom
| | - Christopher Boos
- Department of Cardiology, Poole Hospital, Poole, Dorset, United Kingdom
| | - Liam Gallagher
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - Costas Tsakirides
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - Nicola C Arjomandkhah
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | | | - Carlton B Cooke
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Douglas J Morrison
- Scottish Universities Environmental Research Centre, Glasgow, United Kingdom
| | - Thomas Preston
- Scottish Universities Environmental Research Centre, Glasgow, United Kingdom
| | - Roderick Fgj King
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| |
Collapse
|
30
|
Rider O, Bull SC, Nethononda RM, Ntusi NA, Ferreira VM, Holloway C, Holdsworth DA, Mahmod M, Rayner JJ, Banerjee R, Myerson SG, Neubauer S, Watkins H. Using CMR to improve the diagnostic accuracy of the ECG for the detection of left ventricular hypertrophy; production of a simple adjustment for body mass index. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032553 DOI: 10.1186/1532-429x-18-s1-q35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Holdsworth DA, Cox PJ, Clarke K. The Effects Of Oral Ketones On Human Muscle Recovery Following Exercise. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485493.99417.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
32
|
Hunter A, Holdsworth DA, D'Arcy J, Bailey K, Casadei B. Hypertension in the military patient. J ROY ARMY MED CORPS 2015; 161:200-5. [PMID: 26253125 DOI: 10.1136/jramc-2015-000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
Hypertension and hypertension-related diseases are a leading cause of morbidity and mortality worldwide. A diagnosis of hypertension can have serious occupational implications for military personnel. This article examines the diagnosis and management of hypertension in military personnel, in the context of current international standards. We consider the consequences of hypertension in the military environment and potential military-specific issues relating to hypertension.
Collapse
Affiliation(s)
- Alys Hunter
- MDHU Portsmouth, Queen Alexandra Hospital, Portsmouth, UK
| | - D A Holdsworth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - J D'Arcy
- RCDM (Oxford), John Radcliffe Hospital, Oxford, UK
| | - K Bailey
- AMD, Marlborough Lines, Andover, UK
| | - B Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
33
|
Evans T, Holdsworth DA, Jackson S, Nicol E. Managing palpitations in the military patient. J ROY ARMY MED CORPS 2015; 161:192-9. [PMID: 26243805 DOI: 10.1136/jramc-2015-000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
'Palpitations' include a broad range of symptoms relating to the perception of abnormal activity of the heart. They may reflect an underlying arrhythmia or a hyperawareness of normal cardiac activity caused by stress or anxiety. The challenge to a clinician assessing patients with palpitations is to assess the likely cause of symptoms, to stratify the individual patient risk and to choose the correct management strategy delivered with appropriate urgency. The young military population, subject to increased exposure to environmental stress, is at an increased risk of palpitations. Due to the distracting nature of this symptom and the frequently sudden and unheralded onset, a common consequence is medical downgrading. This article will provide a guide to assessing the heterogeneous group presenting with palpitations and how to both establish the cause and identify the correct treatment for each patient in a timely manner.
Collapse
Affiliation(s)
- Thomas Evans
- Medical Centre, British Army, Forres, Morayshire, UK Royal Centre for Defence Medicine, Defence Medical Services, Lichfield, UK
| | - D A Holdsworth
- Department of Physiology Anatomy and Genetics, Oxford University, Oxford, UK
| | | | - E Nicol
- Department of Cardiovascular CT, Royal Brompton Hospital, London, UK Royal Centre for Defence Medicine, Defence Medical Services, Lichfield, UK
| |
Collapse
|
34
|
Holdsworth DA, Mulae J, Williams A, Jackson S, Chambers J. Valvular heart disease and the military patient. J ROY ARMY MED CORPS 2015; 161:223-9. [PMID: 26240189 DOI: 10.1136/jramc-2015-000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/03/2022]
Abstract
Valvular heart disease refers to all inherited and acquired abnormalities impairing the function of one or more of the four cardiac valves. Pathology may be of the valve leaflets themselves, of the subvalvular apparatus or of the annulus or other surrounding structures that influences valve function. This paper examines the most common valve lesions, with specific reference to a military population; it focuses on detection and initial management of valve disease in a young adult population and specifically describes how the diagnosis and treatment of valve disease impacts military medical grading.
Collapse
Affiliation(s)
- D A Holdsworth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - J Mulae
- Horton General Hospital, Banbury, Oxfordshire, UK
| | - A Williams
- Cardiology Department, Royal Gwent Hospital, Newport, South Wales, UK
| | - S Jackson
- Department of Occupational Medicine, Army Medical Directorate, Andover, UK
| | - J Chambers
- Guy's and St Thomas' Hospital, London, UK
| |
Collapse
|
35
|
Holdsworth DA, Cox AT, Boos C, Hardman R, Sharma S. Cardiomyopathies and the Armed Forces. J ROY ARMY MED CORPS 2015; 161:259-67. [DOI: 10.1136/jramc-2015-000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 11/04/2022]
|
36
|
Reid IM, Holdsworth DA, Morris RJ, Murphy DJ, Vincent RA. Meteor observations using the Davis mesosphere-stratosphere-troposphere radar. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2005ja011443] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|