COVID-19's Impact on Athletes: Reduced Cardiorespiratory fitness after a SARS-CoV-2 Infection.

OBJECTIVE: This study aimed to identify potential changes in cardiorespiratory fitness among athletes who had previously been infected with SARS-CoV-2. METHODS: In this prospective observational multicenter hybrid study (CoSmo-S), cardiopulmonary exercise testing on treadmills or bicycle ergometers involving 2314 athletes (39.6% female) was conducted. German federal squad members (59.6%) and non-squad athletes were included in the study. 1170 (37.2% female) subjects were tested positive for SARS-CoV-2 via PCR from which we had pre-SARS-CoV-2 infection examinations available for 289 subjects. Mixed effect models were employed to analyze amongst others the following dependent variables: Power output at individual anaerobic threshold (POIAT/kg), maximal power output (POmax/kg), measured V̇O2max/kg, heart rate at individual anaerobic threshold (HRIAT) and maximal heart rate (HRmax). RESULTS: A SARS-CoV-2 infection was associated with a decrease in POIAT/kg (-0.123 W/kg, p < 0.001), POmax/kg (-0.099 W/kg, p = 0.002), measured V̇O2max/kg (-1.70 ml/min/kg, p = 0.050) and an increase HRIAT (2.50 b/min, p = 0.008), HRmax (2.59 b/min, p < 0.001) within the first 60 days after SARS-CoV-2 infection. Using the pandemic onset in Germany as longitudinal reference point, the healthy control group showed no change over time in these variables respectively an increase in POmax (+0.126 W/kg, p = 0.039) during the first 60 days after the reference point. Subgroup analyses showed that both squad members and endurance athletes experienced greater decreases in cardiorespiratory fitness compared to non-squad members respectively athletes from explosive power sports. CONCLUSIONS: A SARS-CoV-2 infection is associated with a decline in cardiorespiratory fitness in athletes for approximately 60 days. Potential factors contributing to this outcome seem to be cardio-pulmonary and vascular alterations in consequence of SARS-CoV-2. A minor effect on cardiorespiratory fitness has training interruption due to acute symptoms and/or quarantine.

COVID-19 in Female and Male Athletes: Symptoms, Clinical Findings, Outcome, and Prolonged Exercise Intolerance-A Prospective, Observational, Multicenter Cohort Study (CoSmo-S).

BACKGROUND: An infection with SARS-CoV-2 can lead to a variety of symptoms and complications, which can impair athletic activity. OBJECTIVE: We aimed to assess the clinical symptom patterns, diagnostic findings, and the extent of impairment in sport practice in a large cohort of athletes infected with SARS-CoV-2, both initially after infection and at follow-up. Additionally, we investigated whether baseline factors that may contribute to reduced exercise tolerance at follow-up can be identified. METHODS: In this prospective, observational, multicenter study, we recruited German COVID elite-athletes (cEAs, n = 444) and COVID non-elite athletes (cNEAs, n = 481) who tested positive for SARS-CoV-2 by PCR (polymerase chain reaction test). Athletes from the federal squad with no evidence of SARS-CoV-2 infection served as healthy controls (EAcon, n = 501). Questionnaires were used to assess load and duration of infectious symptoms, other complaints, exercise tolerance, and duration of training interruption at baseline and at follow-up 6 months after baseline. Diagnostic tests conducted at baseline included resting and exercise electrocardiogram (ECG), echocardiography, spirometry, and blood analyses. RESULTS: Most acute and infection-related symptoms and other complaints were more prevalent in cNEA than in cEAs. Compared to cEAs, EAcon had a low symptom load. In cNEAs, female athletes had a higher prevalence of complaints such as palpitations, dizziness, chest pain, myalgia, sleeping disturbances, mood swings, and concentration problems compared to male athletes (p < 0.05). Until follow-up, leading symptoms were drop in performance, concentration problems, and dyspnea on exertion. Female athletes had significantly higher prevalence for symptoms until follow-up compared to male. Pathological findings in ECG, echocardiography, and spirometry, attributed to SARS-CoV-2 infection, were rare in infected athletes. Most athletes reported a training interruption between 2 and 4 weeks (cNEAs: 52.9%, cEAs: 52.4%), while more cNEAs (27.1%) compared to cEAs (5.1%) had a training interruption lasting more than 4 weeks (p < 0.001). At follow-up, 13.8% of cNEAs and 9.9% of cEAs (p = 0.24) reported their current exercise tolerance to be under 70% compared to pre-infection state. A persistent loss of exercise tolerance at follow-up was associated with persistent complaints at baseline, female sex, a longer break in training, and age > 38 years. Periodical dichotomization of the data set showed a higher prevalence of infectious symptoms such as cough, sore throat, and coryza in the second phase of the pandemic, while a number of neuropsychiatric symptoms as well as dyspnea on exertion were less frequent in this period. CONCLUSIONS: Compared to recreational athletes, elite athletes seem to be at lower risk of being or remaining symptomatic after SARS-CoV-2 infection. It remains to be determined whether persistent complaints after SARS-CoV-2 infection without evidence of accompanying organ damage may have a negative impact on further health and career in athletes. Identifying risk factors for an extended recovery period such as female sex and ongoing neuropsychological symptoms could help to identify athletes, who may require a more cautious approach to rebuilding their training regimen. TRIAL REGISTRATION NUMBER: DRKS00023717; 06.15.2021-retrospectively registered.