Fatigue and Fatigability in Veterans Following SARS-CoV-2 Infection

项目摘要/摘要 疲劳中长期存在的海拔高度表明，患有新冠肺炎后疲劳的个体可能 在从事体力活动时面临疲劳感增加的风险。一个人的水平 疲劳性是由性能(性能)的客观下降之间的相互作用决定的 疲劳性)和调节活动表现的知觉变化(即感知疲劳性)。骨骼 肌肉的改变包括力量能力降低，纤维萎缩和代谢功能障碍 在SARS-CoV-2感染后的患者中观察。此外，抑郁症和焦虑症也已被发现 作为PCF患者常见的既往疾病。因此，心理和生理上的 SARS-CoV-2的后果可能为深入了解由SARS-CoV-2引起的 疲劳性在SARS-CoV-2感染后发生并持续存在。虽然有广泛的呼声要求 对SARS-CoV-2感染康复者实施康复，相对较少 了解体育锻炼在这一人群中的潜在好处。基于家庭的锻炼计划 可能特别有利，因为它能够提供一种锻炼选项来对抗久坐不动的行为 新冠肺炎造成的封锁、隔离和限制社区活动 大流行。到目前为止，家庭锻炼的安全性和可行性尚未得到彻底的调查。 以前感染过SARS-CoV-2的人。这个项目的总体目标是增进我们对 影响PCF和PCF退伍军人运动疲劳性和感知疲劳性的潜在机制 探讨以家庭为基础的“小剂量”阻力训练计划的安全性和可行性。 人口。中心假设是力量能力、骨骼肌氧摄取量和 对体力活动的情感反应提供了潜在的机制，通过这种机制可以增加人体的疲劳性 患有PCF的退伍军人。此外，基于家庭的远程抗击演习可以提供一种安全和 对于这一人群，可行的治疗方案。为了解决这一假设，提出了以下目标：目标 1：比较退伍军人和退伍军人的疲劳性以及潜在的神经肌肉和神经生物学因素。 新冠肺炎疲劳症使退伍军人既往感染SARS-CoV-2无疲劳。假设1a。退伍军人 与新冠肺炎后疲劳相比，后新冠肺炎疲劳将表现出更好的性能疲劳性和感知疲劳性 以前感染了SARS-CoV-2的退伍军人没有报告新冠肺炎后的疲劳。假设1b。退伍军人 新冠肺炎后疲劳将表现为膝关节伸肌力量、肌肉吸氧能力、 与新冠肺炎后未报告的先前感染SARS-CoV-2的退伍军人的情感效度比较 疲惫。目标2：确定为期8周的家庭“最小剂量”抵抗力的安全性和可行性 为新冠肺炎后疲劳退伍军人制定的锻炼计划。假设2a。为期8周的家庭生活最低限度- 剂量抵抗运动对于新冠肺炎后疲劳的退伍军人是安全可行的。为了测试目标2，我们将 使用随机对照可行性试验。骨骼肌力将在等长和 动态膝关节伸肌收缩的测功法和股外侧肌吸氧试验 将使用近红外光谱分析进行估算。情感反应将使用感觉来衡量 比例。次要测量包括运动单位属性、功能结果和与健康相关的质量 生活。

Project Summary/Abstract The chronic presence of elevations in fatigue suggests that individuals with post-COVID-19 fatigue (PCF) may be at risk for experiencing increased fatigability when engaging in physical activity. An individual’s level of fatigability is determined by the interactions between objective declines in performance (performance fatigability) and perceptual changes regulating activity performance (i.e., perceived fatigability). Skeletal muscle alterations including reduced force capacity, fiber atrophy, and metabolic dysfunction have been observed in patients following SARS-CoV-2 infection. In addition, depression and anxiety have been identified as common pre-existing conditions in patients with PCF. Thus, psychological as well as physiological consequences of SARS-CoV-2 may provide insight into co-occurring mechanisms by which increased fatigability occurs and persists following SARS-CoV-2 infection. While there have been widespread calls for the implementation of rehabilitation for individuals recovering from SARS-CoV-2 infection, relatively little is known about the potential benefits of physical exercise in this population. Home-based exercise programs maybe particularly advantageous due to its ability to provide an exercise option to combat sedentary behavior imposed by lockdowns, quarantines, and restrictions on community activity caused by the COVID-19 pandemic. To date, the safety and feasibility of home-based exercise has yet to be thoroughly investigated in people previously infected by SARS-CoV-2. The overall goal of this project is to advance our understanding of underlying mechanisms impacting performance fatigability and perceived fatigability in Veterans with PCF and explore the safety and feasibility of a home-based “minimal-dose” resistance exercise program in this population. The central hypothesis is that declines in force capacity, skeletal muscle oxygen extraction, and affective responses to physical activity offer potential mechanisms through which fatigability is increased in Veterans with PCF. Moreover, home-based resistance exercise delivered remotely may provide a safe and feasible treatment option for this population. To address this hypothesis, the following aims are proposed: Aim 1: Compare fatigability, and the underlying neuromuscular and neurobiological factors, in Veterans with post- COVID-19 fatigue to Veterans previously infected by SARS-CoV-2 without fatigue. Hypothesis 1a. Veterans with post-COVID-19 fatigue will exhibit greater performance fatigability and perceived fatigability compared to Veterans previously infected with SARS-CoV-2 not reporting post-COVID-19 fatigue. Hypothesis 1b. Veterans with post-COVID-19 fatigue will exhibit reductions in knee extensor force capacity, muscle oxygen extraction, and affective valence compared to Veterans previously infected with SARS-CoV-2 not reporting post-COVID-19 fatigue. Aim 2: Determine the safety and feasibility of an 8-week home-based “minimal-dose” resistance exercise program for Veterans with post-COVID-19 fatigue. Hypothesis 2a. 8 weeks of home-based minimal- dose resistance exercise will be safe and feasible in Veterans with post-COVID-19 fatigue. To test aim 2, we will use a randomized controlled feasibility trial. Skeletal muscle force will be assessed during isometric and dynamic knee extensor contractions using dynamometry and muscle oxygen extraction of the vastus lateralis will be estimated using near-infrared spectroscopy. Affective responses will be measured using the Feeling Scale. Secondary measures include motor unit properties, functional outcomes, and health-related quality of life.