Recovery of performance and persistent symptoms in athletes after COVID-19

Abstract

Introduction After the acute Sars-CoV-2-infection, some athletes suffer from persistent, performance-impairing symptoms, although the course of the disease is often mild to moderate. The relation between cardiopulmonary performance and persistent symptoms after the acute period is still unclear. In addition, information about the development of this relationship is lacking. Objective To assess the prevalence of persistent symptoms over time and their association with the performance capability of athletes. Methods We conducted two cardiopulmonary exercise tests (CPET) in a three months interval with 60 athletes (age: 35.2±12.1 years, 56.7% male) after infection with Sars-CoV-2 (t0: study inclusion; t1: three months post t0). At each examination, athletes were asked about their persistent symptoms. To evaluate the change of Peak VO2/BM (Body Mass) between the time before infection and the first examination, the VO2/BM (predVO2) before infection was predicted based on anthropometric data and exercise history of the athletes. For data analysis, athletes were grouped according to their symptom status (symptom-free, SF; persistent symptoms, PS) and its progression from the first to the second examination 1) SF-SF, 2) PS-SF and 3) PS-PS. Results Comparing the SF and PS groups at t0, significant differences for Max Power/BM, Max Power/lbm (lean body mass), Peak VO2, Peak VO2/BM, Peak VO2/lbm, Peak VO2/HR, Peak VE, Peak Vt and VE/VCO2-Slope were observed. Regarding the progression over three months, an increase in Max Power/BM was shown in SF-SF and PS-SF (tendency). Max Power/lbm increased in SF-SF and PS-PS (tendency). A decrease of VE/VCO2-Slope in PS-PS was found. Conclusion COVID-19 led to a decline in performance that was greater in PS than in SF. Additionally, PS had decreased ventilatory parameters compared to SF. Furthermore, an improvement over time was observed in some CPET parameters and a partial recovery was observed judging by the decrease in various symptoms.

Decreased physical performance despite objective and subjective maximal exhaustion in post-COVID-19 individuals with fatigue

“…In contrast to our study, they did not report differences in peak power. In a previous study (partly overlapping with this study population), we found that the existence of persistent symptoms in athletes was associated with a decreased maximal power and V̇O 2 peak compared to those who were symptom-free [ 9 ]. All these study results indicate that the disease itself, the existence of persistent symptoms as well as the symptom fatigue reduce the physical performance of individuals.…”

“…An individualized ramp protocol was used during CPET on the bicycle ergometer. Detailed information of this specific study execution is described in another research article [ 9 ]. The following variables which were used to determine objective exhaustion according to Wasserman [ 11 ] were determined: Peak V̇O 2 /BM (volume oxygen/body mass) (ml/min/kg BM), Max Power/BM (maximal power/BM) (Watt/kg BM), Peak HR (heart rate) (beats/min), peak breathing frequency (BF) (1/min), Peak V̇E/V̇O 2 (peak ventilation/V̇O 2 ) (l/min/l/min), Peak respiratory exchange ratio (RER) (V̇CO 2 /V̇O 2 ) (l/min/l/min).…”

“…Comorbidities increase the risk to suffer from persistent symptoms [ 7 , 8 ]. Regardless of the fitness level, one of the most often reported symptoms is fatigue, which is associated with a drop in performance capacity [ 4 , 5 , 7 , 9 ]. Individuals who reported having fatigue were also more likely to report chronic fatigue and/or rapid physical exhaustion [ 5 ].…”

Relationship between physical performance and perception of stress and recovery in daily life post COVID-19—An explorative study

“…Hausswirth et al [ 50 ] demonstrated in their study that functionally overreached athletes had a decline in sleep efficacy and 50% of them had a performance loss after six weeks. The observed decreased sleep efficacy and decrease in performance [ 50 ] are similar to long-term symptoms which can occur post COVID-19 [ 5 , 51 ]. Therefore, we assume that overtraining and COVID-19 may altered the immune system and physical functions in a similar way.…”