Exercise performance in vaccinated and unvaccinated individuals previously infected with SARS-CoV-2

A cross-sectional report from Israel demonstrated the protective effect of BNT162b2 mRNA vaccine (Pfizer–BioNTech) even after mild to moderate coronavirus disease 2019 (COVID-19). The paper is currently available on medRxiv* preprint server while it undergoes peer review.

Study: Protective effect of BNT162b2 vaccination on aerobic capacity following mild to moderate SARS-CoV-2 infection: a cross sectional study, Israel, March-December 2021. Image Credit: etonastenka/ShutterstockStudy: Protective effect of BNT162b2 vaccination on aerobic capacity following mild to moderate SARS-CoV-2 infection: a cross sectional study, Israel, March-December 2021. Image Credit: etonastenka/Shutterstock

Background

Following the infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a causative agent of the unrelenting COVID-19 pandemic, some individuals may present with a myriad of post-acute adverse health outcomes – a phenomenon known as long-COVID.

And even though in some people long-COVID symptoms are rather mild and uneventful, for others they may well be debilitating and life-changing. Still, the case definition is very broad and includes symptoms such as fatigue, headache, and problems with breathing.

Studies thus far show that vaccination could reduce the possibility of these scenarios, although the evidence is still not robust. Generating data on rates of long-COVID (and especially some specific facets of the syndrome) among vaccinated and unvaccinated is one of the pivotal next steps in elucidating the correlates of protection.

In this study, a research group led by Dr. Yair Blumberg and Dr. Michael Edelstein from Rivka Ziv Medical Center and Bar-Ilan University in Zefat (Israel) aimed to determine whether vaccination was linked to improved exercise capacity among individuals previously infected with SARS-CoV-2, i.e., following the acute phase of COVID-19.

The study

A total of forty-three individuals between the ages of 18 and 65 with documented mild or moderate COVID-19 were eligible to participate in this prospective study that was conducted in 2021 at the cardiac rehabilitation department of the Ziv Medical Centre in Israel.

Each study participant (either vaccinated with a Pfizer–BioNTech mRNA vaccine or unvaccinated) underwent a spirometry test (i.e., the most common type of pulmonary function testing), followed by a cardio-pulmonary exercise test on an individually calibrated bicycle ergometer.

Subjects were requested to maintain a continuous pedaling frequency of approximately sixty revolutions per minute, while their cardiac electrical activity was monitored with the use of electrocardiography. Moreover, blood pressure and perceived exertion have been measured every two minutes. Peak oxygen consumption and the minute ventilation/carbon dioxide production were also assessed.

The researchers have found significant differences in aerobic capacity when comparing vaccinated to unvaccinated study subjects previously infected with SARS-CoV-2. More specifically, a high proportion of unvaccinated individuals performed poorly on indicators such as peak oxygen consumption and heart rate.

If we look at the numbers, the mean peak oxygen consumption per kilogram of body weight in the unvaccinated group was 83%, while it was 95% in the vaccinated group. Furthermore, in the unvaccinated group, 50% of them had peak oxygen consumption lower than 80% of predicted vs 14% among those vaccinated.

Chronotropic incompetence in the unvaccinated group, presenting with a reduction in the peak-exercise heart rate and ventilation, contributed in turn to limited exercise capacity. Even the sub-analysis which excluded patients that had co-morbidities did not change these findings.

In a nutshell, this paper implies that patients suffering from COVID-19 can develop objective and significant limitations to exercise capacity in the months following their acute disease episode. Possible mechanisms of damage include immune-mediated pathology in the autonomic nervous system and a possible oxygen diffusion defect.

Our study is the first to show a protective effect of vaccination against decreased aerobic capacity”, say study authors in this medRxiv paper. “As a more objectively quantifiable definition of long-COVID is needed, studies able to demonstrate measurable changes post-acute infection with SARS-CoV-2 are essential”, they add.

In any case, the undoubtedly protective effect of vaccines gives additional impetus to continue and intensify the vaccine drive around the world, while studies akin to this one should be replicated on a larger scale to confirm the reported findings.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Tomislav Meštrović

Written by

Dr. Tomislav Meštrović

Dr. Tomislav Meštrović is a medical doctor (MD) with a Ph.D. in biomedical and health sciences, specialist in the field of clinical microbiology, and an Assistant Professor at Croatia's youngest university - University North. In addition to his interest in clinical, research and lecturing activities, his immense passion for medical writing and scientific communication goes back to his student days. He enjoys contributing back to the community. In his spare time, Tomislav is a movie buff and an avid traveler.

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Comments

  1. Siddhartha Krishna Deka Siddhartha Krishna Deka India says:

    I am unvaccinated and I regularly walk 6 kms atop the hill to my office and then again below the hill to catch the vehicle for my home after work hours are over.

    • Jerry Drawhorn Jerry Drawhorn Malaysia says:

      Note that unless you have already been infected with Covid  the study likely didn't deal with your cohort. Even then your experience would be anecdotal and not statistical.

  2. Ronald Kornfeld Ronald Kornfeld United States says:

    Controls needed to rule out exercise behavior and pre-existing aerobic capacity. Even as a pilot study these could be fatal flaws. 28 and 15 -- are they all equal in terms of exercise behaviors.

    • Jerry Drawhorn Jerry Drawhorn Malaysia says:

      That might be quite difficult to standardize. You would need to have their histories of prior capabilities on the treadmill test before vaccination/infection. That data simply is unlikely to exist and the numbers of individuals that even have that data (probably highly trained athleted or people needing stress tests) would be both limited and unusual cases. But on the surface why would people sort themselves into fitter/less fit groups by vaccination status? Do people more prone to avoid vaccination tend to avoid exercise? Presumably the sample excluded those who were seriously ill...if not then that should have been done. And presumably gender and age cohorts were standardized.

      Mind you that if the above wasn't done you might end up by chance with the previously infected unvaccinated group showing better fitness


      I'd view this as a highly suggestive study that requires larger sample sizes or bootstrap analysis.

      There is a statistically significant tendency, though.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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