Key result
Long COVID links to elevated standing heart rate, reduced HRV, and ~13% orthostatic hypotension.
Why the study?
Individuals with long COVID frequently report orthostatic intolerance symptoms that may be linked to autonomic and cardiovascular dysfunction, but the utility of active standing orthostatic stress tests in evaluating these physiological responses needed evaluation.
Does the active standing orthostatic stress test identify cardiovascular and autonomic impairments in adults with long COVID compared to healthy controls?
Systematic Review (n=402)
Does the active standing orthostatic stress test identify cardiovascular and autonomic impairments in adults with long COVID compared to healthy controls?
The active standing test reveals elevated heart rate and impaired autonomic function in individuals with long COVID, suggesting its utility in early clinical assessment.
Answers are grounded in this paper and cite their sources.
LC patients show elevated heart rate and reduced HRV on active standing; supports targeted autonomic assessment but leaves open clinical utility pending prospective trials.
Background/Objectives: Individuals experiencing long COVID (LC) frequently report orthostatic intolerance symptoms, which may be linked to autonomic and cardiovascular dysfunction. The active standing test provides a simple, clinically relevant means to assess these impairments. This systematic review aims to determine the use of the active standing orthostatic stress test in evaluating cardiovascular, autonomic, and respiratory responses in people experiencing LC. Methods: A systematic search, according to PRISMA guidelines, was conducted in PubMed, MEDLINE, EMBASE, CINAHL, and Scopus for articles published between 2020 and 2025. This study was registered in PROSPERO CRD-42024615872. Studies were included if they used the active standing test, enrolled adults (≥18 years), included both long COVID and healthy control groups, used continuous beat-to-beat measurements, and reported physiological outcomes. Risk of bias was assessed using the nine-point Newcastle–Ottawa Scale. Results: Three studies (216 participants experiencing LC and 186 controls) met the inclusion criteria. Across studies, LC individuals consistently exhibited elevated heart rate in both supine and standing positions. However, blood pressure findings were more variable: only one study reported 13% of participants met orthostatic hypotension criteria, while another found significant increases in diastolic blood pressure during standing. Long COVID groups also showed reduced heart rate variability compared to controls. Conclusions: Individuals experiencing LC show elevated heart rate and impaired autonomic function during active standing, with subgroup-specific blood pressure changes. These alterations may contribute to dizziness, fatigue, and reduced activity tolerance. Incorporating active standing into clinical assessment could aid early identification of autonomic dysfunction and inform rehabilitation strategies, though more research is urgently needed.
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Olarinde et al. (2025) conducted a systematic review in Long COVID (n=402). Long COVID vs. Healthy controls was evaluated on Physiological responses (heart rate, blood pressure, heart rate variability) during active standing. Individuals with long COVID exhibited elevated heart rate and reduced heart rate variability during active standing compared to controls, with 13% meeting orthostatic hypotension criteria in one study.
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