Stress tests are an important topic for Long COVID patients. Some people worry about experiencing a crash after an overexertion and being set back in their recovery. Physicians are also unsure of how to proceed. Time to talk to Claudia Steurer-Stey to clear things up.
Stress tests are an important topic for Long COVID patients. Some people worry about experiencing a crash after an overexertion and being set back in their recovery. Physicians are also unsure of how to proceed. Time to talk to Claudia Steurer-Stey to clear things up.
Prof. Dr. med. Claudia Steurer-Stey is a FMH specialist in Internal Medicine and Pneumology. She works at the University of Zurich, where she is in charge of projects in the area of chronic care at the Epidemiology, Biostatistics and Prevention Institute ( EBPI). She has been involved in initiatives such as national guidelines on COPD (Chronic obstructive pulmonary disease), asthma management and patient coaching. She works as a pneumologist and family doctor at the mediX group practice in Zurich, where she has regular contact with both patients and other specialists. Claudia Steurer-Stey is a member of Altea’s Expert Board.
Claudia Steurer-Stey, which stress tests are used in connection with Long COVID?
In practice, the main test is the sit-to-stand test (STST). During the one-minute STST, the patient has one minute to stand up from a chair and sit back down again as often as possible and at a speed of their choice. The result of this test is the number of complete repetitions carried out within the minute under standardized conditions.
What other options are there?
There’s also the six-minute walking test. Following detailed and standardized instructions, the patient walks up and down a corridor of at least 30 meters in length, with two markers indicating when to turn. The patient themselves decides on the speed and therefore the load intensity.
And, lastly, there is cardiopulmonary exercise testing, which is only offered by specialist clinics. exercise testing, which is only offered by specialist clinics.
Saying “Things are looking up” can provide a huge amount of optimism.
Why exactly are these tests carried out? They’re not completely without risk.
The tests are used to work out the patient’s physical capacity. They allow for a reliable and valuable assessment of their physical functional capacity for day-to-day situations. They provide clinically relevant information for progress monitoring or for evaluating an intervention such as new medication or rehabilitation. Progress monitoring can also have a motivational impact: Saying “Things are looking up” can provide a huge amount of optimism.
Claudia Steurer-Stey is a family doctor, lung specialist and professor at the University of Zurich.
There are, however, reports of patients experiencing a crash after a test and therefore being set back in their recovery.
Fortunately, this isn’t something I’ve seen so far. Of course, it is important to take a few things into account. As always, the following principle applies: primum nihil nocere (first, do no harm).
What do you look out for?
Firstly, listening: what are the day-to-day complaints? In addition to the patient’s medical history regarding the physical complaints, it’s also important to take cognitive and social aspects into account. What is the patient’s everyday capacity? Which complaints develop after stress, when do they occur, how long do they last? How is the patient’s physical or mental tiredness, or their sleep?
“If I have any doubts, I don’t carry out the test”.
I then record the patient’s vital signs, such as blood pressure and pulse, and I measure the oxygen saturation at rest. If the patient has a resting saturation of below 97%, I don’t carry out the test. The same applies if it turns out during the consultation that even minor and short-term stresses in day-to-day life cause the symptoms to flare up (Post Excertional Malaise PEM) or if it’s not completely clear whether there could be an underlying heart problem.
And what about during the test?
I measure the oxygen saturation as the test is being performed. If the saturation falls by 3%, I terminate the test. This also applies if the heart rate increases too high too quickly or if the patient experiences chest pain or dizziness.
It’s also not just the acute reaction that needs to be observed. I also measure the saturation for 2 to 3 minutes after the end of the test. It’s then important to carefully observe the patient: do symptoms develop within 12 to 24 hours? How long do they last?
“Talk to your physician on an equal footing, as an informed and active patient”.
It takes a good deal of experience.
It’s important that the test is carried out in a standardized way. The COPD Pocket Guide from the Swiss Lung Association (page 12, available in German, French and Italian) provides useful information on STST and further literature. When carried out correctly, the STST is a less strenuous and valid test that I believe is helpful for Long COVID patients, provided that the specified precautionary measures are taken into account.
And if someone doesn’t feel well?
As a patient, you’re the expert when it comes to your own body. Talk to your physician on an equal footing, and let him or her know that you don’t think you’re feeling well enough to do a test. As a physician, don’t try and convince anyone. And listen to your gut feeling: if in doubt, you can always talk to colleagues or consult a specialist.
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