Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

Abstract

After SARS-CoV-2 infection, strict recommendations for return-to-sport were published. However, data are insufficient about the long-term effects on athletic performance. After suffering SARS-CoV-2 infection, and returning to maximal-intensity trainings, control examinations were performed with vita-maxima cardiopulmonary exercise testing (CPET). From various sports, 165 asymptomatic elite athletes (male: 122, age: 20y (IQR: 17-24y), training:16 h/w (IQR: 12–20 h/w), follow-up:93.5 days (IQR: 66.8–130.0 days) were examined. During CPET examinations, athletes achieved 94.7 ± 4.3% of maximal heart rate, 50.9 ± 6.0 mL/kg/min maximal oxygen uptake (V̇O2max), and 143.7 ± 30.4L/min maximal ventilation. Exercise induced arrhythmias (n = 7), significant horizontal/descending ST-depression (n = 3), ischemic heart disease (n = 1), hypertension (n = 7), slightly elevated pulmonary pressure (n = 2), and training-related hs-Troponin-T increase (n = 1) were revealed. Self-controlled CPET comparisons were performed in 62 athletes: due to intensive re-building training, exercise time, V̇O2max and ventilation increased compared to pre-COVID-19 results. However, exercise capacity decreased in 6 athletes. Further 18 athletes with ongoing minor long post-COVID symptoms, pathological ECG (ischemic ST-T changes, and arrhythmias) or laboratory findings (hsTroponin-T elevation) were controlled. Previous SARS-CoV-2-related myocarditis (n = 1), ischaemic heart disease (n = 1), anomalous coronary artery origin (n = 1), significant ventricular (n = 2) or atrial (n = 1) arrhythmias were diagnosed. Three months after SARS-CoV-2 infection, most of the athletes had satisfactory fitness levels. Some cases with SARS-CoV-2 related or not related pathologies requiring further examinations, treatment, or follow-up were revealed.

The Influence of Different SARS-CoV-2 Strains on Changes in Maximal Oxygen Consumption, Ventilatory Efficiency and Oxygen Pulse of Elite Athletes

“…It is important to emphasize that most of the performed CPET tests were carried out during the competitive part of the season, when it is expected for players to be in peak-level condition. These results coincide with the results of most previous studies dealing with this topic, which showed that there is a decrease in VO 2 max values in athletes who have overcome SARS-CoV-2 infection [18,19,23]. Even though VO 2 max values were lower than expected for athletes in all three groups (Wuhan, Delta, and Omicron), there was an obvious increase in both aerobic capacity and aerobic economy as the pandemic progressed.…”

“…There is currently a lack of scientific research regarding the impact of a particular strain of coronavirus on the severity of infection, clinical symptoms, and the development of cardiorespiratory and other forms of diseases, both in the general population and in athletes. With regard to athletes, the latest studies indicate a decline in functional abilities after SARS-CoV-2 infection, with increased respiratory and metabolic demands [18][19][20]. Furthermore, different forms of inflammatory heart diseases (myocarditis and pericarditis), decreased lung capacity, and aerobic endurance have been reported as a result of SARS-CoV-2 infection [9,[21][22][23][24].…”

Retrospective study of COVID-19 experiences in elite multinational aquatic athletes

“…Female athletes reported slightly worse mood change scores compared to male athletes. Several studies found similar data regarding the post-COVID mental health of female athletes 20 , 38 , 54 , 55 . Notably, half of the athletes questioned did not need psychological support.…”

SARS-CoV-2 Infection Decreases Cardiorespiratory Fitness and Time-Trial Performance Even Two Months After Returning to Regular Training — Insights from A Longitudinal Case Series of Well-Trained Kayak Athletes

“… 7 The VE peak and VE/VCO 2 slope did not significantly change after infection in our case series ( Table 2 ), which is in accordance with previous studies. 32 , 35 Therefore, in the athletic population, pulmonary/ventilation function might not be the primary limitation of low VO 2peak and exercise intolerance in the long term, 5 , 6 or these factors could be gradually recovered over time. 32 , 36 …”