Heart Rate Variability during Virtual Reality Activity in Individuals after Hospitalization for COVID-19: A Cross-Sectional Control Study

Abstract

(1) Background: COVID-19 can lead to many complications, including cardiorespiratory complications and dysautonomia. This can be assessed by heart rate variability (HRV), which reflects the autonomic nervous system. There are different possibilities for physical rehabilitation after COVID, one of which that has been growing fast is the use of Virtual reality (VR) for rehabilitation. VR may represent an innovative and effective tool to minimize deficits that could lead to permanent disabilities in patients of outpatient rehabilitation services. The aim of this protocol is to establish whether practicing a task using a VR game with body movements influences physiological variables, such as heart rate, HRV, oxygen saturation, blood pressure, and perceptual variables during exercise in individuals post-hospitalization for COVID. (2) Methods: This cross-sectional study evaluated individuals divided into two groups, a post-hospitalization for COVID-19 group and a healthy control group. Subjects underwent one session of a VR task, and physiological variables, including HRV, were measured during rest, VR activity, and recovery. In addition, considering the influence of age in HRV and the impact of COVID-19, we divided participants by age. (3) Results: In all HRV indices and in both groups, an increase in sympathetic and a decrease in parasympathetic activity were found during VR. Additionally, the older post-COVID-19 group performed worse in non-linear indices, peripheral oxygen saturation, and rating of perceived exertion (RPE). (4) Conclusions: The VR game positively affects physiological variables and can therefore be utilized as a secure physical activity in both healthy individuals and individuals after hospitalization for COVID-19. COVID-19 affects the autonomic nervous system of older patients’ post-hospitalization, which may be partly due to a higher BMI and the reduced exercise capacity in this population, affecting their ability to perform exercise activities. Other important observations were the higher RPE in COVID-19 patients during and after exercise, which may reflect altered physiological and autonomic responses. Taken together with the high reporting of fatigue after COVID-19, this is an important finding, and considering that RPE is usually lower during VR exercise compared to non-VR strengthens the potential for the use of VR in COVID-19 patients.

Keywords

• COVID-19
• heart rate
• virtual reality
• physiological adaptation
• physical exertion
• oxygen saturation