Physical functional recovery in the early period after hospitalization for COVID-19: impact of hypertension and outcome prediction model

Main Article Content

O. V. Honchar


The aim – to study the influence of hypertension (HT) on the dynamics of natural recovery of physical functional status in the early period after hospitalization for COVID-19 and to develop a model for predicting recovery results at 1 month after discharge.
Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % women) were included in the study, 176 of whom underwent the 6-minute walk test (6MWT) using an extended protocol within 1-2 days before discharge. A repeat visit to assess the dynamics of natural recovery was performed at 1 month after discharge.
Results and discussion. Pre-discharge 6-minute walk distance was 378±57 m in patients with HT and 418±75 m without it, p=0.001, during the second visit – 440±52 versus 478±68, p=0.002; the achieved percentage of the individually predicted distance was 67.4±10.5 vs. 69.5±13.6 % and 81.6±9.9 vs. 81.9±15.7 %, respectively, p>0.05 for both visits. The increase in heart rate during the test at visit 1 was 18.5±8.3 versus 30.1±19.3 bpm, p<0.001, the percentage of chronotropic reserve utilizatoin was 21.3±9.6 % versus 29.2±11.4 %, p<0.001. During the second visit, residual manifestations of this trend were observed, with an increase in HR by 24.0±9.5 vs. 30.8±12.1, p=0.003 and the use of chronotropic reserve of 28.1±10.1 % vs. 33.4±12.4 %, respectively, p=0.029. The developed multivariate linear regression model explained 59 % of the variability in the achieved percentage of the individually predicted 6-minute walk distance at 1 month after discharge. The use of machine learning allowed to create an artificial neural network based regression model that used age, height, use of remdesivir in treatment, and SBP and DBP values at the time of discharge as predictors, and explained 90 % of observed variability.
Conclusions. Hospitalized patients with COVID-19 were characterized by a decrease in the general physical functional status as assessed by 6MWT at the time of discharge and incomplete recovery after 1 month. Presence of hypertension was associated with more pronounced disturbances of the autonomic regulation of heart rate, but did not affect the reached percentage of the distance walked. The proposed artificial neural network based regression model allows for a high accuracy prediction of the 6MWT results at 1 month after discharge, which can be used in the selection of candidates for cardiopulmonary rehabilitation programs.

Article Details


COVID-19, hospitalization, post-COVID-19 syndrome, physical performance, recovery of function, 6-minute walk test, prognosis, machine learning


Covid-19 Excess Mortality Collaborators. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet. 2022;399:1513-36.

Astin R, Banerjee A, Baker MR, Dani M, Ford E, Hull JH, Lim PB, McNarry M, Morten K, O’Sullivan O, Pretorius E, Raman B, Soteropoulos DS, Taquet M, Hall CN. Long COVID: mechanisms, risk factors and recovery. Exp Physiol. 2023;108:12-27.

Delardas O, Kechagias KS, Pontikos PN, Giannos P. Socio-Economic Impacts and Challenges of the Coronavirus Pandemic (COVID-19): An Updated Review. Sustainability. 2022;14.

Gyöngyösi M, Alcaide P, Asselbergs FW, Brundel BJJM, Camici GG, Martins PDC, Ferdinandy P, Fontana M, Girao H, Gnecchi M, Gollmann-Tepeköylü C, Kleinbongard P, Krieg T, Madonna R, Paillard M, Pantazis A, Perrino C, Pesce M, Schiattarella GG, Sluijter JPG, Steffens S, Tschöpe C, Van Linthout S, Davidson SM. Long COVID and the cardiovascular system – elucidating causes and cellular mechanisms in order to develop targeted diagnostic and therapeutic strategies: A joint Scientific Statement of the ESC Working Groups on Cellular Biology of the Heart and Myocardial & Pericardial Diseases. Cardiovasc Res. 2022.

Carfi A, Bernabei R, Landi F, Gemelli Against C-P-ACSG. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324:603-5.

Zheng B, Daines L, Han Q, Hurst JR, Pfeffer P, Shankar-Hari M, et al. Prevalence, risk factors and treatments for post-COVID-19 breathlessness: a systematic review and meta-analysis. Eur Respir Rev. 2022;31.

Ferioli M, Prediletto I, Bensai S, Betti S, Daniele F, Di Scioscio V, Modolon C, Rimondi MR, De Molo C, Serra C, Nava S, Fasano L. Spontaneous Evolution of COVID-19 Lung Sequelae: Results from a Double-Step Follow-Up. Respiration. 2022;101:381-93.

Bretas DC, Leite AS, Mancuzo EV, Prata TA, Andrade BH, Oliveira JDGF, Batista AP, Machado-Coelho GLL, Augusto VM, Marinho CC. Lung function six months after severe COVID-19: Does time, in fact, heal all wounds? Braz J Infect Dis. 2022;26:102352.

Raman B, Bluemke DA, Luscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J. 2022;43:1157-72.

Dotan Y, Weiner E, Zucker-Toledano M, Solomonov A, Fuchs E, Dawood H, Mor E, Hanna M, Naser-Aldeen R, Bentur L, Bar-Yoseph R. Functional Capacity in Patients Who Recovered from Mild COVID-19 with Exertional Dyspnea. J Pers Med. 2022;12.

Cordani C, Lazzarini SG, Zampogna E, Del Furia MJ, Arienti C, Negrini S, Kiekens C. Dyspnea: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med. 2022;58:864-9.

Fugazzaro S, Contri A, Esseroukh O, Kaleci S, Croci S, Massari M, Facciolongo NC, Besutti G, Iori M, Salvarani C, Costi S; Reggio Emilia COVID-19 Working Group. Rehabilitation Interventions for Post-Acute COVID-19 Syndrome: A Systematic Review. Int J Environ Res Public Health. 2022;19.

Reinert G, Müller D, Wagner P, Martínez-Pozas O, Cuenca-Záldivar JN, Fernández-Carnero J, Sánchez Romero EA, Corbellini C. Pulmonary Rehabilitation in SARS-CoV-2: A Systematic Review and Meta-Analysis of Post-Acute Patients. Diagnostics (Basel). 2022;12.

Chen H, Shi H, Liu X, Sun T, Wu J, Liu Z. Effect of Pulmonary Rehabilitation for Patients With Post-COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022;9:837420.

Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, Lee AL, Camillo CA, Troosters T, Spruit MA, Carlin BW, Wanger J, Pepin V, Saey D, Pitta F, Kaminsky DA, McCormack MC, MacIntyre N, Culver BH, Sciurba FC, Revill SM, Delafosse V, Holland AE. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014;44:1447-78.

Carvalho EE, Costa DC, Crescêncio JC, Santi GL, Papa V, Marques F, Schmidt A, Marin-Neto JA, Simões MV, Gallo Junior L. Heart failure: comparison between six-minute walk test and cardiopulmonary test. Arq Bras Cardiol. 2011;97:59-64.

Simonelli C, Paneroni M, Vitacca M, Ambrosino N. Measures of physical performance in COVID-19 patients: a mapping review. Pulmonology. 2021;27:518-28.

Azevedo RB, Botelho BG, Hollanda JVG, Ferreira LVL, Junqueira de Andrade LZ, Oei SSML, Mello TS, Muxfeldt ES. Covid-19 and the cardiovascular system: a comprehensive review. J Hum Hypertens. 2021;35:4-11.

Hu Y, Sun J, Dai Z, Deng H, Li X, Huang Q, Wu Y, Sun L, Xu Y. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Virol. 2020;127:104371.

Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, Como-Sabetti K, Lynfield R, Sosin D, Torres S, Muse A, Bennett NM, Billing L, Sutton M, West N, Schaffner W, Talbot HK, Aquino C, George A, Budd A, Brammer L, Langley G, Hall AJ, Fry A. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:458-64.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW; the Northwell COVID-19 Research Consortium; Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323:2052-9.

World Health Organization (WHO). COVID-19 Clinical management: living guidance, 25.01.2021.

Wong HYF, Lam HYS, Fong AH, Leung ST, Chin TW, Lo CSY, Lui MM, Lee JCY, Chiu KW, Chung TW, Lee EYP, Wan EYF, Hung IFN, Lam TPW, Kuo MD, Ng MY. Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology. 2020;296:E72-E78.

Laboratories ATSCoPSfCPF. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-117.

Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384-7.

Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37:153-6.

Baeza-Delgado C, Cerdá Alberich L, Carot-Sierra JM, Veiga-Canuto D, Martínez de Las Heras B, Raza B, Martí-Bonmatí L. A practical solution to estimate the sample size required for clinical prediction models generated from observational research on data. Eur Radiol Exp. 2022;6:22.

Long Q, Li J, Hu X, Bai Y, Zheng Y, Gao Z. Follow-Ups on Persistent Symptoms and Pulmonary Function Among Post-Acute COVID-19 Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021;8:702635.

Sonnweber T, Tymoszuk P, Sahanic S, Boehm A, Pizzini A, Luger A, Schwabl C, Nairz M, Grubwieser P, Kurz K, Koppelstätter S, Aichner M, Puchner B, Egger A, Hoermann G, Wöll E, Weiss G, Widmann G, Tancevski I, Löffler-Ragg J. Investigating phenotypes of pulmonary COVID-19 recovery: A longitudinal observational prospective multicenter trial. Elife. 2022;11.

Guo T, Jiang F, Liu Y, Zhao Y, Li Y, Wang Y. Respiratory Outcomes in Patients Following COVID-19-Related Hospitalization: A Meta-Analysis. Front Mol Biosci. 2021;8:750558.

Ingul CB, Grimsmo J, Mecinaj A, Trebinjac D, Berger Nossen M, Andrup S, Grenne B, Dalen H, Einvik G, Stavem K, Follestad T, Josefsen T, Omland T, Jensen T. Cardiac Dysfunction and Arrhythmias 3 Months After Hospitalization for COVID-19. J Am Heart Assoc. 2022;11:e023473.

Sonnweber T, Sahanic S, Pizzini A, Luger A, Schwabl C, Sonnweber B, Kurz K, Koppelstätter S, Haschka D, Petzer V, Boehm A, Aichner M, Tymoszuk P, Lener D, Theurl M, Lorsbach-Köhler A, Tancevski A, Schapfl A, Schaber M, Hilbe R, Nairz M, Puchner B, Hüttenberger D, Tschurtschenthaler C, Aßhoff M, Peer A, Hartig F, Bellmann R, Joannidis M, Gollmann-Tepeköylü C, Holfeld J, Feuchtner G, Egger A, Hoermann G, Schroll A, Fritsche G, Wildner S, Bellmann-Weiler R, Kirchmair R, Helbok R, Prosch H, Rieder D, Trajanoski Z, Kronenberg F, Wöll E, Weiss G, Widmann G, Löffler-Ragg J, Tancevski I. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. Eur Respir J. 2021;57.

de Graaf MA, Antoni ML, Ter Kuile MM, Arbous MS, Duinisveld AJF, Feltkamp MCW, Groeneveld GH, Hinnen SCH, Janssen VR, Lijfering WM, Omara S, Postmus PE, Ramai SRS, Rius-Ottenheim N, Schalij MJ, Schiemanck SK, Smid L, Stöger JL, Visser LG, de Vries JJC, Wijngaarden MA, Geelhoed JJM, Roukens AHE. Short-term outpatient follow-up of COVID-19 patients: A multidisciplinary approach. E Clin Med. 2021;32:100731.

Szekely Y, Lichter Y, Sadon S, Lupu L, Taieb P, Banai A, Sapir O, Granot Y, Hochstadt A, Friedman S, Laufer-Perl M, Banai S, Topilsky Y. Cardiorespiratory Abnormalities in Patients Recovering from Coronavirus Disease 2019. J Am Soc Echocardiogr. 2021;34:1273-84 e1279.

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. 2022;19:613-20.

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