Role of Body Mass and Physical Activity in Autonomic Function Modulation on Post-COVID-19 Condition: An Observational Subanalysis of Fit-COVID Study

  1. Ana Paula Coelho Figueira Freire
  2. Fabio Santos Lira
  3. Ana Elisa von Ah Morano
  4. Telmo Pereira
  5. Manuel-João Coelho-E-Silva
  6. Armando Caseiro
  7. Diego Giulliano Destro Christofaro
  8. Osmar Marchioto Júnior
  9. Gilson Pires Dorneles
  10. Luciele Guerra Minuzzi
  11. Ricardo Aurino Pinho
  12. Bruna Spolador de Alencar Silva

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Abstract

The harmful effects of coronavirus disease 2019 (COVID-19) can reach the autonomic nervous system (ANS) and endothelial function. Therefore, the detrimental multiorgan effects of COVID-19 could be induced by deregulations in ANS that may persist after the acute SARS-CoV-2 infection. Additionally, investigating the differences in ANS response in overweight/obese, and physically inactive participants who had COVID-19 compared to those who did not have the disease is necessary. The aim of the study was to analyze the autonomic function of young adults after mild-to-moderate infection with SARS-CoV-2 and to assess whether body mass index (BMI) and levels of physical activity modulates autonomic function in participants with and without COVID-19. Patients previously infected with SARS-CoV-2 and healthy controls were recruited for this cross-sectional observational study. A general anamnesis was taken, and BMI and physical activity levels were assessed. The ANS was evaluated through heart rate variability. A total of 57 subjects were evaluated. Sympathetic nervous system activity in the post-COVID-19 group was increased (stress index; p = 0.0273). They also presented lower values of parasympathetic activity (p < 0.05). Overweight/obese subjects in the post-COVID-19 group presented significantly lower parasympathetic activity and reduced global variability compared to non-obese in control group (p < 0.05). Physically inactive subjects in the post-COVID-19 group presented significantly higher sympathetic activity than active subjects in the control group. Parasympathetic activity was significantly increased in physically active subjects in the control group compared to the physically inactive post-COVID-19 group (p < 0.05). COVID-19 promotes changes in the ANS of young adults, and these changes are modulated by overweight/obesity and physical activity levels.

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  1. Version published to 10.3390/ijerph19042457
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    SciScore for 10.1101/2021.11.17.21266473: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Additionally, all participants were informed of the study purpose and protocols and gave written informed consent to the protocols.
    IRB: The Ethical Institutional Review Board approved the study (approval number: 38701820.0.0000.5402).
    Sex as a biological variableMale and female patients aged 20-40 years after mild or moderate clinical COVID-19 infection (slight clinical symptoms, fever, or respiratory symptoms who were not admitted to the intensive care unit) were recruited after <180 days of diagnosis.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    To detect confirmed or probable previous SARS-CoV-2 infection, a lateral flow test for IgM and IgG antibodies was conducted using internal anti-SARS-CoV-2 Immunoglobulin G (IgG) and Immunoglobulin M (IgM) ELISA kits.
    IgG
    suggested: None
    anti-SARS-CoV-2 Immunoglobulin G ( IgG
    suggested: None
    Immunoglobulin M ( IgM
    suggested: None
    Software and Algorithms
    SentencesResources
    Additionally, the following indexes were calculated: For the frequency domain, spectral analysis was computed using the fast Fourier transform, and the following indexes were included in the study: The following indexes computed in Kubios HRV software were also included: Statistical analysis: Statistical procedures were performed using GraphPad Prism (version 5.00; GraphPad Software, San Diego, CA, USA) for Windows.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The main limitations to our investigation were (1) the cross-sectional nature of the study and the small sample size. This is of particular concern because our primary outcome measure (HRV) is characterized by high interindividual variability. (2) Despite matching for age and BMI, groups were not similar regarding physical activity. The post-COVID-19 group was less active, probably due to the symptoms and indisposition related to the infection, which can generate a confounding bias. Therefore, longitudinal designs monitoring healthy young subjects recovering from SARS-CoV-2 infection are undoubtedly warranted to better understand the impact of the virus on ANS activity. This study also presents several strengths. First, young subjects with post mild and moderate COVID-19 infection were investigated, a commonly overlooked population in recent studies. Second, to our knowledge, this is the first study to investigate the influence of the BMI and physical activity level on the ANS after COVID-19. Third, our results are of great clinical relevance since it shows the importance of screening and monitoring in young adults, especially those who are overweight/obesity or physically inactive. Finally, in our study, the practice of physical activity was measured using accelerometry, which provides more reliable information about the intensity of physical activity since self-reports may be susceptible to memory bias. As practical applications of the present study, the importance of maint...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

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    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.11.17.21266473v1 on medRxiv