Post-Covid syndrome: women remain more affected than men after rehab

While the female sex has a protective effect during an acute infection with Covid-19, women run an increased risk of developing post-Covid syndrome (PCS) even after mild cases. It is already known that PCS symptoms such as shortness of breath and weakened respiratory muscles occur more frequently and more severely in women than in men. Yet it was not previously known whether the rehabilitation measures offered are equally effective for women and men. A recent study by MedUni Vienna, published in the journal "Biology of Sex Differences", now shows that women continue to be affected in their everyday lives to a greater extent than men, even after pulmonary rehabilitation.

The study included 263 PCS patients, 54.4 per cent of whom were female, who each underwent six weeks of outpatient pulmonary rehabilitation at Therme Wien Med between March 2020 and July 2022. A number of PCS parameters were measured both at the beginning and end of the rehabilitation programme, including lung function, shortness of breath, six-minute walking distance and the functional status of the patients according to the Post-Covid Functional Status Scale (PCFS). This instrument was developed to assess the persistent symptoms and impairments of people after a Covid-19 disease and to draw conclusions about their ability to perform work and daily activities as well as their need for medical care and support.

The analyses revealed a clear sex difference: indeed, the six-week outpatient pulmonary rehabilitation programme successfully improved the six-minute walking distance, lung function and the restrictions in daily life associated with Covid-19 in both women and men. " But at 19.4 percent, women were significantly less frequently able to achieve a complete reduction in functional limitations than men (38.5 percent) and accordingly remained more severely affected in their everyday lives even after rehabilitation," says lead author Alexander Kautzky (Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, MedUni Vienna), summarising the study results.

Intensify treatment for women

Up to a third of infections with the Sars-Cov-2 virus lead to post-Covid symptoms such as shortness of breath, respiratory muscle weakness, fatigue, cognitive and mental impairment, regardless of the severity of the course of the Covid-19 disease. While men suffer more from the acute infection, women are more frequently affected by PCS - a difference that is attributed to biological causes. The reasons for the observed sex differences in PCS are less well known. Among other aspects, hormonal and psychosocial backgrounds are being discussed. "Regardless of the causes, we recommend intensifying the treatment of symptoms in women with PCS," says gender medicine specialist and co-author Alexandra Kautzky-Willer (Department of Medicine III, MedUni Vienna), emphasising the relevance of the results. According to current Austrian guidelines, six weeks of outpatient pulmonary rehabilitation are provided for appropriate indications.

Publication: Biology of Sex Differences

Sex Differences of post-Covid Patients undergoing Outpatient Pulmonary Rehabilitation.
Alexander Kautzky, Stephan Nopp, Dietlinde Gattinger, Milos Petrovic, Martin Antlinger, Dustin Schomacker, Alexandra Kautzky-Willer, Ralf Harun Zwick.
DOI: https://doi.org/10.1186/s13293­’024 -00609-z