Michel Lamotte

Our aim was to evaluate the benefits of cardio-pulmonary rehabilitation on severe to moderate COVID-19 patients. 25 discharged COVID-19 patients underwent a cardio-pulmonary test (CPET), a spirometry test and a measure of carbon monoxide lung diffusion capacity (DLCO) at the beginning of their rehabilitation program and after 23 ± 5 rehabilitation sessions. This rehabilitation program combined interval training exercises on a bike and resistance exercises for major muscle groups. We then compared their progress in rehabilitation to that obtained with cardiac patients. At the beginning of their rehabilitation program, COVID-19 patients presented a reduced physical capacity with a maximal aerobic capacity (VO₂ max) at 71% of predicted value, a maximal workload at 70% of predicted value and an exercise hyperventilation measured by a higher VE/VCO₂ slope. Exercise was mainly limited by muscle deconditioning. After rehabilitation, the VO₂ max and maximal workload increased in COVID 19 patients by 18% and 26%, respectively. In patients with ischemic heart disease the post-rehabilitation gains in VO2 max and maximal workload were 22% and 25%, respectively. Moreover, exercise hyperventilation decreased by 10% in both groups. On the other hand, the intrinsic pulmonary function of COVID 19 patients improved following natural recovery. In conclusion, even if cardio-pulmonary rehabilitation is probably not the only parameter which explains the partial recovery of moderate to severe COVID-19 patients, it certainly helps to improve their physical capacity and reduce exercise hyperventilation.

Background: With more than 15,000 implanted patients worldwide and a survival rate of 80% at 1-year and 59% at 5-years, left ventricular assist device (LVAD) implantation has become an interesting strategy in the management of heart failure patients who are resistant to other kinds of treatment. There are limited data in the literature on the change over time of exercise capacity in LVAD patients, as well as limited knowledge about the beneficial effects that rehabilitation might have on these patients. Therefore, the aim of our study was to evaluate the evolution of exercise capacity on a cohort of patients implanted with the same device (HeartWare©) and to analyse the potential impact of rehabilitation. Methods: Sixty-two patients implanted with a LVAD between June 2011 and June 2015 were screened. Exercise capacity was evaluated by cardiopulmonary exercise testing at 6 weeks, 6 and 12 months after implantation. Results: We have observed significant differences in the exercise capacity and evolution between the trained and non-trained patients. Some of the trained patients nearly normalised their exercise capacity at the end of the rehabilitation programme. Conclusions: Exercise capacity of patient implanted with a HeartWare© LVAD increased in the early period after implantation. Rehabilitation allowed implanted patients to have a significantly better evolution compared to non-rehabilitated patients.

La mesure continue et non invasive des principaux paramètres hémodynamiques (pression artérielle, fréquence cardiaque, volume d’éjection systolique) permet d’objectiver les modifications hémodynamiques survenant, soit au cours d’une séance d’exercices pour rechercher une variation hémodynamique bénéfique ou délétère, soit à la suite de plusieurs séances (approche longitudinale) pour évaluer l’effet d’un entraînement ou d’un traitement spécifique. Ces systèmes de mesure n’apportent pas plus de renseignements que les systèmes invasifs mais sont plus simples à mettre en oeuvre et peuvent s’adresser à des patients « intermédiaires », moins lourdement monitorés. Ils contribuent ainsi à renforcer les connaissances dans le domaine de la physiologie en quantifiant les réponses qui accompagnent les exercices de kinésithérapie, mais également à comparer les différentes stratégies de traitement et donc à améliorer la prise en charge du patient. The continuous and non-invasive measurement of the main hemodynamic parameters including heart rate, blood pressure, and stroke volume allows evaluating the hemodynamic changes occurring either during one workout in order to look for beneficial or deleterious hemodynamic effects, or after several sessions (longitudinal approach) to measure the effects of one specific training or treatment. These non-invasive devices do not provide more information than the invasive ones; however, they are easier to implement and may be used in “intermediate” and less monitored patients. They contribute not only to enhance knowledge in the field of physiology by quantifying the responses that accompany physiotherapy exercises but also to compare different management strategies, thus improving patient’s care.