Maximal aerobic capacity exercise testing protocols for elderly individuals in the era of COVID-19

Monitoring the clinical evolving stages and cardiopulmonary
sequelae, in terms of organ injury and functional
response, of elderly individuals infected with SARS-CoV-2
is of utmost importance for our times, placing gas exchange
and functional capacity evaluation in the forefront of the
clinical decision-making process, i.e., for staging, prognostication
and for establishing the most appropriate therapeutic
strategies tailored for the elderly population that is the
most impacted by this pandemic. From a geriatric point of
view, the assessment of clinical and functional outcomes,
such as mobility of the elderly individuals, their daily energy
expenditure and other indices of physical function and quality
of life coupled with the determination of the maximal
aerobic capacity, one of the most important predictors of
independence, offers a multidimensional evaluation-tool
useful for monitoring the COVID-19 effects in the elderly
population. Historically, cardiopulmonary exercise test
(CPET) evaluation has multifold goals, such as providing a
thorough and objective definition of physical limitation and
garnering information on how interventions may impact the
limiting steps in the symptoms cascade and along the natural
course of disease.
This information and the step-by-step analyses on differential
diagnosis of organ-driven origin of symptoms are
generally accomplished by performing preliminary static
pulmonary function tests (spirometry) and alveolar gas diffusion
for carbon monoxide (DLco) evaluation.
Most of the evidence so far accumulating on COVID-
19 patients suggests that: (a) the lung organ injury is sustained,
persistent, expectedly irreversible in many patients
[1] and is predicted to become the main clinical issue on
the long term; (b) cardiovascular comorbidities are highly
represented, and a very frequent background for associated
complications; (c) myocarditis or acute coronary syndrome
may complicate the acute phase. Irrespective of documented
myocarditis, the values of the convectional biomarkers of
myocardial injury, especially cardiac troponins, may considerably
increase. These COVID-19 complications may
occur in previously asymptomatic or symptomatic subjects,
without or with lung and/or cardiac pre-existing diseases.