포스트코로나 시대의 심폐운동검사 프로토콜 제언 = Recommendation of Cardiopulmonary Exercise Testing Protocol in Post-COVID era

다국어 초록 (Multilingual Abstract)

The purpose of this study was to explain the necessity of applying cardiopulmonary exercise testing(CPET) in the Post-COVID condition and compare several traditional protocols applied in Post-COVID sequelae. According to recent studies, Post-COVID condition show a decrease in CPET, and that is recommended to evaluate symptoms. However, there is no study on which protocol is appropriate to apply when testing when CPET is performed in Post-COVID condition. This systematic review examines the effectiveness of COVID-19, COVID-19 sequelae, Post-COVID condition, and CPET. Pubmed, EMBASE, Google Scholar, KISS, RISS, and JKMS databases were used to search for all studies, and assessments from December 2019 to 2022. As a result, most precedent studies have used modified Bruce and/or Ramp protocols for CPET in Post-COVID condition. High-intensity protocol is inappropriate to apply in Post-COVID condition on account of the large initial workload since it is developed to evaluate athletes’ cardiopulmonary fitness. This study suggests that a new protocol develops more suitable for Post-COVID condition.

국문 초록 (Abstract)

본 연구는 포스트코로나 시대의 심폐운동검사 적용의 필요성과 코로나 후유증 대상자에게 적용되는 여러 심폐운동검사 프로토콜의 비교에 대한 연구이다. 최근 연구에 따르면 코로나 후유증을 가진 대상자들은 심폐체력의 저하가 나타나며 증상에 대한 평가를 위해서 심폐운동검사가 권장된다. 그러나 코로나 후유증 대상자에게 심폐운동검사를 시행할 때 어떠한 프로토콜을 적용하는 것이 적합한가에 대한 연구는 이루어지고 있지 않다. PubMED, EMBASE, Google Scholar, KISS, RISS, JKMS를 사용하여 코로나19 발생 시기인 2019년 12월부터 2022년 12월까지의 기간으로 설정하여 COVID-19, COVID-19 sequelae, Post-COVID condition, Cardiopulmonary exercise testing(CPET) 검색어를 사용하여 문헌을 검색하였다. 그 결과, 심폐운동검사를 적용한 여러 선행연구는 기존의 Modified Bruce 프로토콜, Ramp 프로토콜 등의 검사 프로토콜을 적용하였다. 고강도 프로토콜들은 최초부하가 높고 단계별 강도 증가가 높아 코로나 후유증 대상자에게 적용하는 것은 부적합하다. 따라서 본 연구를 통해 기존 프로토콜을 토대로 코로나 후유증 대상자에게 더욱 적합한 새로운 프로토콜의 개발이 필요하다고 사료된다.

참고문헌 (Reference)

1 질병관리청, "코로나바이러스감염증-19(COVID-19) 정보"

2 대한비만학회, "코로나19 시대 국민 체중 관리현황 및 비만 인식 조사"

3 안정훈, "지속적 생활체육 참여 노인들의 코로나-19로 인한 운동제약이 삶의 만족도에 미치는 영향 - 우울의 매개효과" 한국스포츠학회 19 (19): 411-421, 2021

4 Mancini, Brunjes, Lala, "Use of cardiopulmonary stress testing for patients with unexplained dyspnea post–coronavirus disease" 9 (9): 927-937, 2021

5 Brooks, Webster Smith, "The psychological impact of quarantine and how to reduce it:Rapid review of the evidence" 395 (395): 912-920, 2020

6 Nieman Wentz, "The compelling link between physical activity and the body's defense system" 8 (8): 201-217, 2019

7 Kang Hyun Mi ; Jeong Dae Cheol ; Suh Byung-Kyu ; 안문배, "The Impact of the Coronavirus Disease-2019 Pandemic on Childhood Obesity and Vitamin D Status" 대한의학회 36 (36): 1-11, 2021

8 Cassar, Tunnicliffe, "Symptom persistence despite improvement in cardiopulmonary health–insights from longitudinal CMR, CPET and lung function testing post-COVID-19" 41 : 101159-, 2021

9 Kim Yoonjung ; 김신우 ; 장현하 ; Kwon Ki Tae ; Bae Sohyun ; Hwang Soyoon, "Significance and Associated Factors of Long-Term Sequelae in Patients after Acute COVID-19 Infection in Korea" 대한감염학회 53 (53): 463-476, 2021

10 Paolillo Agostoni, "Prognostic role of cardiopulmonary exercise testing in clinical practice" 14 (14): S53-S58, 2017

11 Kim, Kim, Chang, "Post-acute COVID-19 syndrome in patients after 12 months from COVID-19 infection in Korea" 22 (22): 1-12, 2022

12 Nalbandian, Desai, Wan, "Post-COVID-19 Condition" 74-, 2022

13 Carfì, Bernabei, Landi, "Persistent symptoms in patients after acute COVID-19" 324 (324): 603-605, 2020

14 Goërtz, Van Herck, "Persistent symptoms 3months after a SARS-CoV-2 infection: The post-COVID-19 syndrome?" 6 (6): 2020

15 Singh, Joseph, "Persistent exertional intolerance after COVID-19: insights from invasive cardiopulmonary exercise testing" 161 (161): 54-63, 2022

16 Jung Young Hee ; Ha Eun-Hye ; Choe Kang Won ; Lee Seungbok ; Jo Dong Ho ; Lee Wang Jun, "Persistent Symptoms After Acute COVID-19 Infection in Omicron Era" 대한의학회 37 (37): 1-11, 2022

17 Riou Althaus, "Pattern of early humanto-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020" 25 (25): 2000058-, 2020

18 Brown, Saigal Karia, "Ongoing exercise intolerance following COVID‐19: A magnetic resonance–augmented cardiopulmonary exercise test study" 11 (11): e024207-, 2022

19 Lopez-Leon, Wegman-Ostrosky, "More than 50 long-term effects of COVID-19: A systematic review and meta-analysis" 11 (11): 16144-, 2021

20 CDC, "Long COVID or Post-COVID conditions"

21 Dorelli, Braggio, "Importance of cardiopulmonary exercise testing amongst subjects recovering from COVID-19" 11 (11): 507-, 2021

22 Baratto, Caravita, "Impact of COVID-19 on exercise pathophysiology: A combined cardiopulmonary and echocardiographic exercise study" 130 (130): 1470-1478, 2021

23 Motiejunaite, Balagny, "Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors" 58 (58): 2021

24 World Health Organization, "Global status report on noncommunicable diseases 2010" World Health Organization 2011

25 Aparisi, Ybarra-Falcón, "Exercise ventilatory inefficiency in post-COVID-19 syndrome: insights from a prospective evaluation" 10 (10): 2591-, 2021

26 Ágnes Krisztina, "Effects of COVID-19infection on physical performance" 6 (6): 45-46, 2022

27 Li, Guan, "Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia" 2020

28 Guazzi, Adams, "EACPR/AHA Scientific Statement Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations" 126 (126): 2261-2274, 2012

29 Rinaldo, Mondoni, "Deconditioning as main mechanism of impaired exercise response in COVID-19 survivors" 58 (58): 2021

30 WHO, "Coronavirus disease (COVID-19): Post COVID-19 condition"

31 Komici, Bianco, "Clinical characteristics, exercise capacity and pulmonary function in post-COVID-19 competitive athletes" 10 (10): 3053-, 2021

32 Guazzi, Bandera, "Cardiopulmonary exercise testing: What is its value?" 70 (70): 1618-1636, 2017

33 Gao, Chen, "Cardiopulmonary exercise testing might be helpful for interpretation of impaired pulmonary function in recovered COVID-19patients" 57 (57): 2021

34 Faghy, Sylvester, "Cardiopulmonary exercise testing in the COVID-19endemic phase" 125 (125): 447-449, 2020

35 Barbagelata, Masson, "Cardiopulmonary exercise testing in patients with post-COVID-19syndrome" 159 (159): 6-11, 2022

36 Clavario, De Marzo, "Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up" 340 : 113-118, 2021

37 Mihalick, Canada, Arena, "Cardiopulmonary exercise testing during the COVID-19 pandemic" 67 : 35-39, 2021

38 Skjørten, Ankerstjerne, "Cardiopulmonary exercise capacity and limitations 3months after COVID-19 hospitalisation" 58 (58): 2021

39 김윤정, "COVID-19와 장기 후유증" 대한내과학회 97 (97): 23-27, 2022

40 박용천 ; 박기호 ; 김나은 ; 이주희 ; 조수린 ; 장지희 ; 정다운 ; 장은진 ; 최기홍, "COVID-19, 한국에서의 심리적 영향: 예비 연구" 한국임상심리학회 39 (39): 355-367, 2020

41 Clavario, De Marzo, "Assessment of functional capacity with cardiopulmonary exercise testing in non-severe COVID-19 patients at three months follow-up"

42 Yu, Jee, "Analysis of online classes in physical education during the COVID-19pandemic" 11 (11): 3-, 2020

43 Odor, Neun, "Anaesthesia and COVID-19 : Infection control" 125 (125): 16-24, 2020

44 Tran, Cimon, "Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review" 7 (7): e35797-, 2012

45 American College of Sports Medicine, "ACSM’s guidelines for exercise testing and prescription" Lippincott Williams & Wikins 2021

46 보건복지부, "15일간 강력한 사회적 거리 두기, 정부부터 앞장서 실천한다!"