Functional Features of Adolescent Students Who Underwent COVID-19

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Abstract

The study was conducted based on the Moscow State Pedagogical University with the involvement of 126 students aged 17 to 21 years. Of these, 101 students suffered a coronavirus infection (experimental group). The control group consisted of 25 people who did not have COVID-19. The study included a questionnaire on the scale of asthenic condition, measurement of lung capacity, calculation of the Skibinsky index, determination of breath holding time, assessment of exercise tolerance, and cardiac rhythmography. Statistical data processing was carried out using the Microsoft Excel, STATISTICA 10 software package. Differences in the occurrence of deviations in the subjective and objective status of recovered and not ill students were noted. Most of the surveyed, who had asthenia, suffered from COVID-19 (85%). The recovered patients showed a significant decrease in the vital capacity of the lungs, and the presence of more pronounced shortness of breath in the six-minute walk test compared to the control group. According to the majority of the conducted tests, it was noted that the disease left fewer consequences for students who previously regularly went in for sports. To prevent the development and weakening of the manifestations of the post-COVID syndrome, all students should be strongly advised to increase the level of regular physical activity in any sport.

Keywords: Students, Adolescence, Post-COVID syndrome, Physical activity, Sports, Functional status

Symptoms that are usually identified with post-COVID syndrome, including shortness of breath and asthenia, occur in adolescents not only those who have had COVID-19 infection (Ladds et al., 2020). They can also occur in non-ill students. The situation is complicated by difficulties in finding a correlation between the manifestation of symptoms and the timing of the illness. It was noted that in the first month after COVID-19, there were no signs of asthenia in more than half of those observed (52%). There is reason to believe that the symptoms of asthenia are most pronounced during the first three months after the infection while maintaining increased fatigue for quite a long time. Of particular concern was the tendency found in the work to increase the manifestation of general asthenia in a significant part of students (46%) with the preservation of its signs for more than one year after the illness.

An assessment of the relationship between well-being after suffering COVID-19 and the level of physical activity showed that most often (in 27.5% of cases), a pronounced deterioration in well-being was observed in those who had been ill and did not regularly engage in physical culture (1-2 times a week). At the same time, the worsening of well-being (12%) was most rarely observed in professional athletes. This pattern confirmed our assumption that people who go in for sports regularly are less prone to asthenia as part of the post-COVID syndrome. Moreover, with an increase in the frequency of classes throughout the week, this symptom weakens or does not occur at all. Thus, regular muscle loads before the disease reduce the risk of developing asthenic syndrome during recovery from coronavirus infection.

The results of this study allow us to resolve the issue regarding the consideration of conceptual and methodological approaches in the field of physical culture and sports. For all students of the Moscow State Pedagogical University of 1-3 courses, the curriculum and study schedule provides practical classes in selected options for physical culture and sports, which are held once a week. This is not enough to affect the manifestations of the post-COVID syndrome, to have a pronounced general health-improving effect, and to increase the functionality of the students' respiratory system. Thanks to the study, it became clear that it is very difficult to restore the health of students who have had COVID-19 only in elective physical education and sports classes, even if students attend them regularly. Therefore, it seems important that these classes be held more often and not only provide physical training but also have an educational element on the issues of maintaining health and improving its level, forming a desire among students to engage in physical culture and sports for a long time.

Evaluation of the functional capabilities of the respiratory system of students by taking into account the value of the vital capacity of the lungs, the value of the Skibinskaya index, and the hypoxic test made it possible to establish a tendency for these indicators to worsen in the girls who had been ill (Zavalishina et al., 2022). This was consistent with the literature data on a decrease in the functionality of the respiratory system after a COVID infection (Polastri et al., 2018). Significant intergroup differences in girls revealed in terms of lung capacity were most pronounced in the period from 6 months to a year after the disease. In the same period, the girls also registered the lowest values ​​of the Skibinskaya index. The development of a deterioration in health and a decrease in the working capacity of female students who have had COVID-19 for six months after the disease isassociated primarily with a weakening of the respiratory system and, to a lesser extent, with changes in the cardiovascular system (Zavalishina et al., 2021a).

There were no significant intergroup differences in young men. However, attention is drawn to a tendency, similar to girls, to a decrease in the value of the vital capacity of the lungs in the period from 6 months to a year after the disease. Probably, the reduction in their lung volume indicators contributes to the activation of compensatory mechanisms that lead to an increase in the resistance of the respiratory center to hypoxia and provide an increase in the time of holding breath in young men 6-12 months after suffering COVID-19. Thus, the indicators of hypoxic tests in young men who had been ill in the period less than six months before our study are higher than in those who had been ill more than one year ago by 12.5%. The same feature was observed in girls (the difference was 11.3%).

Thus, a tendency to the development of an increase in the severity of the consequences of the disease six months after recovery was found. This fact can be explained by the different tolerance of SARS-CoV-2 strains that persist among students during different periods of the pandemic. It is known that the variant of the virus mutation that has dominated in recent months, omicron, is more easily tolerated and has fewer complications.

Comparison of the functional capabilities of the cardio-respiratory system in groups with different levels of physical activity showed that female athletes who underwent COVID-19 have higher resistance of the respiratory center to hypoxia and higher reserve capabilities compared to female students in the control group. According to all monitored indicators in the group of athletes, the results were better than those of people who do not regularly engage in physical culture and sports.

In young men, the benefits of regular physical culture and sports were revealed only by the Skibinskaya index when compared with those who did not have COVID-19 and did not go in for physical culture.

Likely, the differences in the functional capabilities of the cardiorespiratory system in boys and girls who have had a coronavirus infection are associated with gender morphological features, which were manifested in the value of lung capacity. In addition, the consequences of the disease on the respiratory system in young men were less noticeable, while for girls, the presence of systematic physical activity played a large role in the presence of post-COVID syndrome and the severity of its manifestations (Zavalishina et al., 2021b).

When conducting a test with a six-minute walk, there were no functional disorders in the cardiovascular system in all the subjects. However, the subjective sensations of exercise tolerance significantly differed between those who recovered from the disease and those who did not go in for sports and in the control group. There was also a difference in the distance traveled. It turned out to be minimal in the group of those who had been ill and those who did not go in for physical culture. When comparing the distance traveled among the observed students, the greatest result was shown by those who had the disease less than 6 months ago, and the smallest was observed in those who had the disease from 6 months to a year ago.

All students who recovered from COVID-19 felt shortness of breath when walking, although the distance they walked without it was slightly longer than in the control group. The strongest feeling of shortness of breath was in the group of students who had the disease more than 1 year ago. Athletes who recovered from illness subjectively endured the load easier than those who did not go in for sports. The found significant intergroup differences in subjective feelings of shortness of breath between recovering athletes and non-athletes testified to the powerful health-improving possibilities of regular physical activity. Undoubtedly, they ensure the development of pronounced adaptive changes in the bodyand reduce the subjective threshold of physical and psychological stress. Because shortness of breath is a purely subjective phenomenon, it cannot be defined in terms used in assessing the physical performance or aerobic capacity of the body (Mikhaylova et al., 2021). The standard six-minute walk test cannot be considered a completely reliable test for assessing exercise tolerance in adolescents, including those who have had a new coronavirus infection.

Evaluation of heart rate variability in the study groups allowed us to determine the severity of the adaptive response of the body based on the parameters of autonomic balance and neurohumoral regulation under the action of an infectious factor on the body. The most informative indicators reflecting nonspecific reactions of the body to the action of various factors were the index of tension of regulatory systems and the indicator of the activity of regulatory systems. We considered an increase in the stress index as evidence of a decrease in the body's functional reserves with an increase in the tension of regulatory systems. A low degree of tension betweenregulatory systems and normal indicators of the functioning of the body wasconsidered by us as a manifestation of the physiological norm (Karpov et al., 2021a).

The results of the cardiorhythmogram of the observed students confirmed the higher adaptive capabilities of the body in athletes. So the index of tension of the regulatory systems was the lowest (less than 100 c.u.) in the groups of boys and girls who regularly performed physical exercises. This indicated that they had a satisfactory adaptation to changing environmental conditions and sufficiently high functional capabilities of their organism. According to the degree of tension in the regulatory systems of students who had a coronavirus infection, there were gender differences. The maximum tension of regulatory systems occurred in young men (121.6±49.2 c.u.) who had diseases more than a year ago and in girls (126.97±63.52 c.u.) in the period from 6 months to 1- year after an illness. At the same time, the girls showed a clear relationship with the functional capabilities of the body. They revealed the lowest values ​​of the Skibinskaya index and lung capacity. There was no clear intersystem dependence of indicators in young men. Their vital capacity was maximally reduced in the period from 6 to 12 months after the disease, and breath holding was impaired for more than a year after the disease.

The indicator of the activity of regulatory systems in the studied groups of students did not differ significantly and was in the range of 3-4 c.u. This corresponded to a state of moderate tension of regulatory systems when the body needs activation of existing functional reserves for successful adaptation to environmental conditions. This was due to the loads observed by students associated with their participation in the educational process. At the same time, the athletes had a combination of physical and mental stress, however, the indicator of the activity of regulatory systems in people who regularly exercise was lower than in the group of non-athletes. In this regard, it can be argued that regular physical education and sports do not interfere with the educational process and contribute to a significant increase in the body's adaptive capabilities in relation to any adverse environmental factors (Shalabodina & Stradze, 2020).

This fragment of the study showed less severity of the consequences of COVID-19 in students who regularly go in for sports, which indicated the need to revise the mode of physical activity in all students in the direction of its increase, regardless of the duration of the coronavirus infection.

Conclusion

Post-covid syndrome in students is manifested in 52.8% of cases by increased fatigue, ranging from mild to moderate severity; in 46.5% of cases there is shortness of breath of mild and moderate severity; insomnia is present in 37.8% of cases; in 32.5% of cases - some cognitive impairment. For students who underwent COVID-19, it turned out to be characterized by a decrease in the functionality of the respiratory system and tolerance to a standard load. The relationship between the development of asthenic syndrome in students who had the disease more than six months ago and who did not regularly experience physical activity was traced. It is becoming clear that traditional exercise tolerance tests need to be improved for use in screening studies of young COVID-19 survivors with varying attitudes towards exercise and sports. In addition, existing student physical education programs need to be reviewed for people who have had a new coronavirus infection.

Acknowledgments: The team of authors thanks the administration of the Institute of Natural Science and Sports Technologies of the Moscow City Pedagogical University for the opportunity to research its basis.

Conflict of interest: None

Financial support: None

Ethics statement: The study was approved by the local ethics committee of the Institute of Natural Science and Sports Technologies of the Moscow City Pedagogical University on September 15, 2018 (protocol №11).

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