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Gomes-Neto M, Almeida KDO, Correia HF, Santos JC, Gomes VA, Serra JPC, Durães AR, Carvalho VO. Determinants of cardiorespiratory fitness measured by cardiopulmonary exercise testing in COVID-19 survivors: a systematic review with meta-analysis and meta‑regression. Braz J Phys Ther 2024; 28:101089. [PMID: 38936313 PMCID: PMC11259933 DOI: 10.1016/j.bjpt.2024.101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/28/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The relationship between cardiorespiratory fitness and its possible determinants in post-COVID-19 survivors has not been systematically assessed. OBJECTIVES To identify and summarize studies comparing cardiorespiratory fitness measured by cardiopulmonary exercise testing in COVID-19 survivors versus non-COVID-19 controls, as well as to determine the influence of potential moderating factors. METHODS We conducted a systematic search of MEDLINE/PubMed, Cochrane Library, EMBASE, Google Scholar, and SciELO since their inceptions until June 2022. Mean differences (MD), standard mean differences (SMD), and 95% confidence intervals (CI) were calculated. Subgroup and meta-regression analyses were used to evaluate potential moderating factors. RESULTS 48 studies (3372 participants, mean age 42 years, and with a mean testing time of 4 months post-COVID-19) were included, comprising a total of 1823 COVID-19 survivors and 1549 non-COVID-19 controls. After data pooling, VO2 peak (SMD=1.0 95% CI: 0.5, 1.5; 17 studies; N = 1273) was impaired in COVID-19 survivors. In 15 studies that reported VO2 peak values in ml/min/kg, non-COVID-19 controls had higher peak VO2 values than COVID-19 survivors (MD=6.2, 95% CI: 3.5, 8.8; N = 905; I2=84%). In addition, VO2 peak was associated with age, time post-COVID-19, disease severity, presence of dyspnea, and reduced exercise capacity. CONCLUSION This systematic review provides evidence that cardiorespiratory fitness may be impaired in COVID-19 survivors, especially for those with severe disease, presence of dyspnea, and reduced exercise capacity. Furthermore, the degree of reduction of VO2 peak is inversely associated with age and time post-COVID.
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Affiliation(s)
- Mansueto Gomes-Neto
- Physical Therapy Department, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil; Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
| | - Katna de Oliveira Almeida
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Helena França Correia
- Physical Therapy Department, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Juliana Costa Santos
- Physical Therapy Department, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Vinicius Afonso Gomes
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil; Hospital Especializado Otávio Mangabeira, Salvador, BA, Brazil
| | | | - André Rodrigues Durães
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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Tsampasian V, Androulakis E, Catumbela R, Gati S, Papadakis M, Vassiliou VS. Prevalence of Abnormal Cardiovascular Magnetic Resonance Findings in Athletes Recovered from COVID-19 Infection: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3290. [PMID: 38893000 PMCID: PMC11172781 DOI: 10.3390/jcm13113290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/19/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Competitive sports and high-level athletic training result in a constellation of changes in the myocardium that comprise the 'athlete's heart'. With the spread of the COVID-19 pandemic, there have been concerns whether elite athletes would be at higher risk of myocardial involvement after infection with the virus. This systematic review and meta-analysis evaluated the prevalence of abnormal cardiovascular magnetic resonance (CMR) findings in elite athletes recovered from COVID-19 infection. Methods: The PubMed, Cochrane and Web of Science databases were systematically search from inception to 15 November 2023. The primary endpoint was the prevalence of abnormal cardiovascular magnetic resonance findings, including the pathological presence of late gadolinium enhancement (LGE), abnormal T1 and T2 values and pericardial enhancement, in athletes who had recovered from COVID-19 infection. Results: Out of 3890 records, 18 studies with a total of 4446 athletes were included in the meta-analysis. The pooled prevalence of pathological LGE in athletes recovered from COVID-19 was 2.0% (95% CI 0.9% to 4.4%, I2 90%). The prevalence of elevated T1 and T2 values was 1.2% (95% CI 0.4% to 3.6%, I2 87%) and 1.2% (95% CI 0.4% to 3.7%, I2 89%), respectively, and the pooled prevalence of pericardial involvement post COVID-19 infection was 1.1% (95% CI 0.5% to 2.5%, I2 85%). The prevalence of all abnormal CMR findings was much higher among those who had a clinical indication of CMR. Conclusions: Among athletes who have recently recovered from COVID-19 infection, there is a low prevalence of abnormal CMR findings. However, the prevalence is much higher among athletes with symptoms and/or abnormal initial cardiac screening. Further studies and longer follow up are needed to evaluate the clinical relevance of these findings and to ascertain if they are associated with adverse events.
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Affiliation(s)
- Vasiliki Tsampasian
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7UG, UK
- Norfolk and Norwich University Hospital, Norwich NR4 7TJ, UK
| | - Emmanuel Androulakis
- Cardiovascular Clinical Academic Group, St. George’s University of London, London SW17 0RE, UK; (E.A.); (M.P.)
| | | | - Sabiha Gati
- School of Medicine, Imperial College London, London SW7 2BX, UK;
- Royal Brompton Hospital, London SW3 6NP, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St. George’s University of London, London SW17 0RE, UK; (E.A.); (M.P.)
| | - Vassilios S. Vassiliou
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7UG, UK
- Norfolk and Norwich University Hospital, Norwich NR4 7TJ, UK
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Williams Z, Hull JH. Respiratory complications following COVID-19 in athletic populations: A narrative review. Scand J Med Sci Sports 2024; 34:e14275. [PMID: 36539388 PMCID: PMC9880648 DOI: 10.1111/sms.14275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
Athletes typically experience a mild-to-moderate, self-limiting illness following infection with the novel severe acute respiratory syndrome coronavirus 2. Some athletes, however, can develop prolonged symptoms, with breathlessness, cough, and chest tightness impacting return to training and competition. In athletes with persistent cardiopulmonary symptoms following COVID-19, focus is usually placed on the identification and characterization of cardiac complications, such as myocarditis. In this review, we focus on summarizing the literature assessing pulmonary complications and physiological consequences associated with COVID-19 illness in athletes. The review also provides recommendations for clinical assessment of the athlete with pulmonary issues following COVID-19 and directions for future research.
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Affiliation(s)
- Zander Williams
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
| | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
- Institute of Sport, Exercise and Health (ISEH), Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
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Kaulback K, Schwellnus M, Sewry N, Jordaan E, Wood P. Rating of Perceived Exertion Associated With Acute Symptoms in Athletes With Recent SARS-CoV-2 Infection: Athletes With Acute Respiratory InfEction (AWARE) VI Study. J Athl Train 2024; 59:90-98. [PMID: 37347179 PMCID: PMC10783475 DOI: 10.4085/1062-6050-0632.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
CONTEXT SARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported. OBJECTIVE To (1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with a recent SARS-CoV-2 infection and (2) identify factors affecting exercise responses. DESIGN Cross-sectional, experimental study. PATIENTS OR OTHER PARTICIPANTS Male and female athletes (age = 24.2 ± 6.3 years) with a recent (<28 days) SARS-CoV-2 infection (n = 72). SETTING A COVID-19 Recovery Clinic for athletes. MAIN OUTCOME MEASURE(S) Heart rate, SBP, and RPE were measured during submaximal exercise (modified Bruce protocol) at 10 to 28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, comorbidities, preinfection training variables, and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models. RESULTS Heart rate, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (P = .0001). At stage 5 (10.1 metabolic equivalents), a higher HR and a higher SBP during exercise were associated with younger age (P = .0007) and increased body mass index (BMI; P = .009), respectively. Higher RPE during exercise was significantly associated with a greater number of whole-body (P = .006) and total number (P = .004) of symptoms during the acute phase of infection. CONCLUSIONS A greater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes at 10 to 28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection, as this may indicate disease severity and be valuable for tracking progress, recovery, and return to sport.
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Affiliation(s)
- Kelly Kaulback
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
- International Olympic Committee Research Centre of South Africa, Pretoria
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
- International Olympic Committee Research Centre of South Africa, Pretoria
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council (SAMRC), Cape Town
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Paola Wood
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
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Schellenberg J, Matits L, Bizjak DA, Kersten J, Kirsten J, Vollrath S, Steinacker JM. Assessment of myocardial function and cardiac performance using left ventricular global longitudinal strain in athletes after COVID-19: a follow-up study. Front Cardiovasc Med 2023; 10:1240278. [PMID: 37876776 PMCID: PMC10591089 DOI: 10.3389/fcvm.2023.1240278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background It has not yet been conclusively determined whether reduced left ventricular global longitudinal strain (LV GLS) after COVID-19 contributes to a reduction in exercise capacity. Our own studies showed a possible mild myocardial involvement in the form of reduced LV GLS in athletes after COVID-19 compared with healthy athletes. The aims of this prospective follow-up study were to investigate the development of LV GLS over a 3-month period in athletes after COVID-19 and the possible relationship between LV GLS and physical performance. Methods LV GLS was determined in four-, two-, and three-chamber views and assessed offline by a blinded investigator in 96 recreational athletes (mean age 33.15 ± 12.40 years, 53 male, peak VO2 38.82 ± 11.14 ml/min/kg) at a median of two (t0) and five months (t1) after COVID-19. Cardiopulmonary exercise testing (CPET) was performed on a bicycle ergometer on both examination dates. Results LV GLS improved significantly between t0 and t1 (t0 -18.82 ± 2.02 vs. t1 -19.46 ± 2.05, p < 0.001). Echocardiographic and spiroergometric parameters were within the normal clinical reference range. Maximum power increased significantly from t0 to t1 (t0 283.17 ± 83.20 vs. t1 286.24 ± 85.22 Watt, p = 0.009) and there was a trend toward increased peak oxygen uptake (t0 36.82 ± 11.14 vs. t1 38.68 ± 10.26 ml/min/kg, p = 0.069). We found no correlation between LV GLS and performance parameters, except for the respiratory exchange ratio (RER) [ρ -0.316, (-0.501; -0.102), p < 0.050]. Conclusions Significant improvement in LV GLS approximately five months after COVID-19 may be due to mild myocardial involvement during or shortly after COVID-19, which seems to recover. There was no correlation between LV GLS and performance parameters, except for an inverse correlation of LV GLS and RER, suggesting insufficient exercise intolerance at lower GLS values. Further studies on the development of GLS in athletes or in the general population with moderate and severe disease courses would be informative as well as the comparison of pre-COVID-19 with post-COVID-19 echocardiography to evaluate the effects of COVID-19 on cardiac function.
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Affiliation(s)
- J. Schellenberg
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - L. Matits
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - D. A. Bizjak
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - J. Kersten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - J. Kirsten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - S. Vollrath
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - J. M. Steinacker
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
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Schellenberg J, Ahathaller M, Matits L, Kirsten J, Kersten J, Steinacker JM. Left Ventricular Global Longitudinal Strain as a Parameter of Mild Myocardial Dysfunction in Athletes after COVID-19. J Cardiovasc Dev Dis 2023; 10:jcdd10050189. [PMID: 37233156 DOI: 10.3390/jcdd10050189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Whether symptoms during COVID-19 contribute to impaired left ventricular (LV) function remains unclear. We determine LV global longitudinal strain (GLS) between athletes with a positive COVID-19 test (PCAt) and healthy control athletes (CON) and relate it to symptoms during COVID-19. GLS is determined in four-, two-, and three-chamber views and assessed offline by a blinded investigator in 88 PCAt (35% women) (training at least three times per week/>20 MET) and 52 CONs from the national or state squad (38% women) at a median of two months after COVID-19. The results show that the GLS is significantly lower (GLS -18.53 ± 1.94% vs. -19.94 ± 1.42%, p < 0.001) and diastolic function significantly reduces (E/A 1.54 ± 0.52 vs. 1.66 ± 0.43, p = 0.020; E/E'l 5.74 ± 1.74 vs. 5.22 ± 1.36, p = 0.024) in PCAt. There is no association between GLS and symptoms like resting or exertional dyspnea, palpitations, chest pain or increased resting heart rate. However, there is a trend toward a lower GLS in PCAt with subjectively perceived performance limitation (p =0.054). A significantly lower GLS and diastolic function in PCAt compared with healthy peers may indicate mild myocardial dysfunction after COVID-19. However, the changes are within the normal range, so that clinical relevance is questionable. Further studies on the effect of lower GLS on performance parameters are necessary.
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Affiliation(s)
- Jana Schellenberg
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
| | - Magdalena Ahathaller
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
| | - Lynn Matits
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, 89075 Ulm, Germany
| | - Johannes Kirsten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
| | - Johannes Kersten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
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Ruberg FL, Baggish AL, Hays AG, Jerosch-Herold M, Kim J, Ordovas KG, Reddy G, Shenoy C, Weinsaft JW, Woodard PK. Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2023; 16:e014106. [PMID: 36541203 PMCID: PMC9848221 DOI: 10.1161/circimaging.122.014106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The global pandemic of COVID-19 caused by infection with SARS-CoV-2 is now entering its fourth year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. Although pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play) following resolution of infection. A variety of different testing combinations that leverage ECG, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance imaging have been proposed and implemented to mitigate risk. Cardiovascular magnetic resonance in particular affords high sensitivity for myocarditis but has been employed and interpreted nonuniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to return to play. This consensus document synthesizes available evidence to contextualize the appropriate utilization of cardiovascular magnetic resonance in the return to play assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.
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Affiliation(s)
- Frederick L. Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (F.L.R.)
| | - Aaron L. Baggish
- Cardiac Performance Program, Harvard Medical School/Massachusetts General Hospital, Boston, MA (A.L.B.)
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (A.G.H.)
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Section, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA (M.J.-H.)
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY (J.K., J.W.W.)
| | - Karen G. Ordovas
- Department of Radiology, University of Washington School of Medicine, Seattle, WA (K.G.O., G.R.)
| | - Gautham Reddy
- Department of Radiology, University of Washington School of Medicine, Seattle, WA (K.G.O., G.R.)
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (C.S.)
| | - Jonathan W. Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY (J.K., J.W.W.)
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO (P.K.W.)
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Koryagina YV, Ter-Akopov GN, Abutalimova SM, Nopin SV, Akhkubekova NK, Ukhanova OP, Mikhailova AA. [Effect of hyperoxic inhalations for athletes of different sports, including those who had COVID-19, when training in the middle altitude]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:46-51. [PMID: 38289304 DOI: 10.17116/kurort202310006146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To identify hyperoxic inhalations on the functional state of the cardiorespiratory system of athletes of different sports, who have previously had COVID-19, when training in the middle altitude. MATERIAL AND METHODS The study included 64 elite athletes during the preparatory period. The studies were conducted in Kislovodsk in the middle altitude (1240 meters) on the Maloe Sedlo mountain, in the conditions of training camps. We studied the parameters of heart rate variability and functional state of cardiovascular and respiratory systems. Hyperoxic inhalations were performed with the JAY-10 oxygen concentrator (LONGFIAN SCITECH CO., LTD., China). The oxygen concentration in the mixture was 93±3%, capacity - 5 l/min, exposure time - 20 min. RESULTS Athletes specializing in sports with predominantly anaerobic lactate and mixed mechanism of energy supply, respectively experiencing hypoxia in the process of their athletic activity during training can experience hypoxia at rest as well. The state of hypoxia during exercise in the middle altitude in such athletes is shown in heart rate variability indices (high values of heart rate and stress index, low power of high frequency waves), low saturation, increased oxygen uptake from the blood microcirculation system. The use of oxygen therapy in athletes promotes positive dynamics of the functional state, consisting in a reduced stress of regulatory mechanisms, strengthened tone of the parasympathetic nervous system in the heart rate regulation, increased economization of the central hemodynamics' parameters, improved functions of the external respiratory system. CONCLUSION Application of hyperoxic inhalations during intense exercise in the middle altitude has a favorable effect on the functional state of the cardiorespiratory system in all the studied sports, especially in athletes who have previously had COVID-19.
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Affiliation(s)
- Yu V Koryagina
- North Caucasian Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, Essentuki, Russia
| | - G N Ter-Akopov
- North Caucasian Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, Essentuki, Russia
| | - S M Abutalimova
- North Caucasian Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, Essentuki, Russia
| | - S V Nopin
- North Caucasian Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, Essentuki, Russia
| | - N K Akhkubekova
- North Caucasian Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, Essentuki, Russia
| | - O P Ukhanova
- North Caucasian Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, Essentuki, Russia
| | - A A Mikhailova
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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Astin R, Banerjee A, Baker MR, Dani M, Ford E, Hull JH, Lim PB, McNarry M, Morten K, O'Sullivan O, Pretorius E, Raman B, Soteropoulos DS, Taquet M, Hall CN. Long COVID: mechanisms, risk factors and recovery. Exp Physiol 2023; 108:12-27. [PMID: 36412084 PMCID: PMC10103775 DOI: 10.1113/ep090802] [Citation(s) in RCA: 70] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
NEW FINDINGS What is the topic of this review? The emerging condition of long COVID, its epidemiology, pathophysiological impacts on patients of different backgrounds, physiological mechanisms emerging as explanations of the condition, and treatment strategies being trialled. The review leads from a Physiological Society online conference on this topic. What advances does it highlight? Progress in understanding the pathophysiology and cellular mechanisms underlying Long COVID and potential therapeutic and management strategies. ABSTRACT Long COVID, the prolonged illness and fatigue suffered by a small proportion of those infected with SARS-CoV-2, is placing an increasing burden on individuals and society. A Physiological Society virtual meeting in February 2022 brought clinicians and researchers together to discuss the current understanding of long COVID mechanisms, risk factors and recovery. This review highlights the themes arising from that meeting. It considers the nature of long COVID, exploring its links with other post-viral illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome, and highlights how long COVID research can help us better support those suffering from all post-viral syndromes. Long COVID research started particularly swiftly in populations routinely monitoring their physical performance - namely the military and elite athletes. The review highlights how the high degree of diagnosis, intervention and monitoring of success in these active populations can suggest management strategies for the wider population. We then consider how a key component of performance monitoring in active populations, cardiopulmonary exercise training, has revealed long COVID-related changes in physiology - including alterations in peripheral muscle function, ventilatory inefficiency and autonomic dysfunction. The nature and impact of dysautonomia are further discussed in relation to postural orthostatic tachycardia syndrome, fatigue and treatment strategies that aim to combat sympathetic overactivation by stimulating the vagus nerve. We then interrogate the mechanisms that underlie long COVID symptoms, with a focus on impaired oxygen delivery due to micro-clotting and disruption of cellular energy metabolism, before considering treatment strategies that indirectly or directly tackle these mechanisms. These include remote inspiratory muscle training and integrated care pathways that combine rehabilitation and drug interventions with research into long COVID healthcare access across different populations. Overall, this review showcases how physiological research reveals the changes that occur in long COVID and how different therapeutic strategies are being developed and tested to combat this condition.
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Affiliation(s)
- Rónan Astin
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
- Centre for Human Health and PerformanceInstitute for Sport Exercise and HealthUniversity College LondonLondonUK
| | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
- Department of CardiologyBarts Health NHS TrustLondonUK
| | - Mark R. Baker
- Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Melanie Dani
- Imperial Syncope UnitImperial College Healthcare NHS TrustLondonUK
| | | | - James H. Hull
- Institute of SportExercise and Health (ISEH)Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Royal Brompton HospitalLondonUK
| | - Phang Boon Lim
- Imperial Syncope UnitImperial College Healthcare NHS TrustLondonUK
| | - Melitta McNarry
- Applied Sports, Technology, Exercise and Medicine Research CentreSwansea UniversitySwanseaUK
| | - Karl Morten
- Applied Sports, Technology, Exercise and Medicine Research CentreSwansea UniversitySwanseaUK
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | - Oliver O'Sullivan
- Academic Department of Military RehabilitationDefence Medical Rehabilitation Centre Stanford HallLoughboroughUK
- School of MedicineUniversity of NottinghamNottinghamUK
| | - Etheresia Pretorius
- Department of Physiological SciencesFaculty of ScienceStellenbosch UniversityStellenboschSouth Africa
- Department of Biochemistry and Systems BiologyInstitute of SystemsMolecular and Integrative BiologyFaculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Betty Raman
- Radcliffe Department of MedicineDivision of Cardiovascular MedicineUniversity of OxfordOxfordUK
- Radcliffe Department of MedicineDivision of Cardiovascular MedicineOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | - Maxime Taquet
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Catherine N. Hall
- School of Psychology and Sussex NeuroscienceUniversity of SussexFalmerUK
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10
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Ruberg FL, Baggish AL, Hays AG, Jerosch-Herold M, Kim J, Ordovas KG, Reddy G, Shenoy C, Weinsaft JW, Woodard PK. Utilization of cardiovascular magnetic resonance (CMR) imaging for resumption of athletic activities following COVID-19 infection: an expert consensus document on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention (CVRI) Leadership and endorsed by the Society for Cardiovascular Magnetic Resonance (SCMR). J Cardiovasc Magn Reson 2022; 24:73. [PMID: 36539786 PMCID: PMC9767806 DOI: 10.1186/s12968-022-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory suyndrome coronavirus 2 (SARS-CoV-2) is now entering its 4th year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. While pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play, RTP) following resolution of infection. A variety of different testing combinations that leverage the electrocardiogram, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance (CMR) imaging have been proposed and implemented to mitigate risk. CMR in particular affords high sensitivity for myocarditis but has been employed and interpreted non-uniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to RTP. This consensus document synthesizes available evidence to contextualize the appropriate utilization of CMR in the RTP assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.
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Affiliation(s)
- Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, School of Medicine/Boston Medical Center, Boston University, 72 E Concord St, Boston, MA, 02118, USA.
| | - Aaron L Baggish
- Cardiac Performance Program, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Section, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Karen G Ordovas
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Gautham Reddy
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jonathan W Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
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11
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Śliż D, Wiecha S, Ulaszewska K, Gąsior JS, Lewandowski M, Kasiak PS, Mamcarz A. COVID-19 and athletes: Endurance sport and activity resilience study-CAESAR study. Front Physiol 2022; 13:1078763. [PMID: 36589442 PMCID: PMC9800893 DOI: 10.3389/fphys.2022.1078763] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The COVID-19 pandemic and imposed restrictions influenced athletic societies, although current knowledge about mild COVID-19 consequences on cardiopulmonary and physiologic parameters remains inconclusive. This study aimed to assess the impact of mild COVID-19 inflection on cardiopulmonary exercise test (CPET) performance among endurance athletes (EA) with varied fitness level. Materials and Methods: 49 EA (nmale = 43, nfemale = 6, mean age = 39.94 ± 7.80 yr, height = 178.45 cm, weight = 76.62 kg; BMI = 24.03 kgm-2) underwent double treadmill or cycle ergometer CPET and body analysis (BA) pre- and post-mild COVID-19 infection. Mild infection was defined as: (1) without hospitalization and (2) without prolonged health complications lasting for >14 days. Speed, power, heart rate (HR), oxygen uptake (VO2), pulmonary ventilation, blood lactate concentration (at the anaerobic threshold (AT)), respiratory compensation point (RCP), and maximum exertion were measured before and after COVID-19 infection. Pearson's and Spearman's r correlation coefficients and Student t-test were applied to assess relationship between physiologic or exercise variables and time. Results: The anthropometric measurements did not differ significantly before and after COVID-19. There was a significant reduction in VO2 at the AT and RCP (both p < 0.001). Pre-COVID-19 VO2 was 34.97 ± 6.43 ml kg·min-1, 43.88 ± 7.31 ml kg·min-1 and 47.81 ± 7.81 ml kg·min-1 respectively for AT, RCP and maximal and post-COVID-19 VO2 was 32.35 ± 5.93 ml kg·min-1, 40.49 ± 6.63 ml kg·min-1 and 44.97 ± 7.00 ml kg·min-1 respectively for AT, RCP and maximal. Differences of HR at AT (p < 0.001) and RCP (p < 0.001) was observed. The HR before infection was 145.08 ± 10.82 bpm for AT and 168.78 ± 9.01 bpm for RCP and HR after infection was 141.12 ± 9.99 bpm for AT and 165.14 ± 9.74 bpm for RCP. Time-adjusted measures showed significance for body fat (r = 0.46, p < 0.001), fat mass (r = 0.33, p = 0.020), cycling power at the AT (r = -0.29, p = 0.045), and HR at RCP (r = -0.30, p = 0.036). Conclusion: A mild COVID-19 infection resulted in a decrease in EA's CPET performance. The most significant changes were observed for VO2 and HR. Medical Professionals and Training Specialists should be aware of the consequences of a mild COVID-19 infection in order to recommend optimal therapeutic methods and properly adjust the intensity of training.
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Affiliation(s)
- Daniel Śliż
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warsaw, Poland,Students’ Scientific Group of Lifestyle Medicine, 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland,Polish Society of Lifestyle Medicine, Warsaw, Poland,School of Public Health, Postgraduate Medical Education Center, Warsaw, Poland
| | - Szczepan Wiecha
- Department of Physical Education and Health in Biala Podlaska, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland,*Correspondence: Szczepan Wiecha, ; Przemysław Seweryn Kasiak,
| | - Katarzyna Ulaszewska
- Students’ Scientific Group of Lifestyle Medicine, 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jakub S. Gąsior
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Lewandowski
- Department of Pharmacology and Clinical Pharmacology Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Przemysław Seweryn Kasiak
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warsaw, Poland,Students’ Scientific Group of Lifestyle Medicine, 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland,*Correspondence: Szczepan Wiecha, ; Przemysław Seweryn Kasiak,
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warsaw, Poland,Polish Society of Lifestyle Medicine, Warsaw, Poland
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12
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Babity M, Zamodics M, Konig A, Kiss AR, Horvath M, Gregor Z, Rakoczi R, Kovacs E, Fabian A, Tokodi M, Sydo N, Csulak E, Juhasz V, Lakatos BK, Vago H, Kovacs A, Merkely B, Kiss O. Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection. Sci Rep 2022; 12:21686. [PMID: 36522351 PMCID: PMC9753018 DOI: 10.1038/s41598-022-24486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
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.
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Affiliation(s)
- Mate Babity
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Mark Zamodics
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Albert Konig
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Anna Reka Kiss
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Marton Horvath
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Zsofia Gregor
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Reka Rakoczi
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Eva Kovacs
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Alexandra Fabian
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Marton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Nora Sydo
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Vencel Juhasz
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Balint Karoly Lakatos
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary.
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary.
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
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13
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Repeated cardiopulmonary performance measurements in young competitive handball players with and without SARS-CoV-2 infection. BMC Sports Sci Med Rehabil 2022; 14:197. [PMID: 36419174 PMCID: PMC9685117 DOI: 10.1186/s13102-022-00591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The SARS-CoV-2 virus and its long-term consequences in adolescents have a global impact on upcoming medical issues. The aim of this study was to investigate the effects of a SARS-CoV-2 infection on cardiorespiratory parameters in young athletes. METHODS In a cohort study involving repeated measurements during a six-month period, cardiorespiratory parameters were assessed in infected (SCoV) and non-infected (noSCoV) athletes. We evaluated handball players (17.2 ± 1.0 years) via performance diagnostics and a specific examination after a SARS-CoV-2 infection or without. RESULTS We observed no significant differences between the two groups at the first visit. But between the first and second visit, the SCoV group's maximum power output was significantly lower than the noSCoV group's (- 48.3 ± 12.5; p ≤ 0.01 vs. - 15.0 ± 26.0 W; p = 0.09). At the second visit, lung diffusion capacity (DLCO/VA, %predicted) did not differ between groups (111.6 ± 11.5 vs. 116.1 ± 11.8%; p = 0.45). HR during comparative stress showed no group differences. The SCoV group's mean oxygen uptake during incremental exercise was lower (Two-way-ANOVA: 1912 vs. 2106 ml; p ≤ 0.01; mean difference: - 194 ml; 95% CI - 317 to - 71); we also noted a significantly lower stroke volume course during exercise (Two-way-ANAOVA: 147.5 vs. 169.5 ml; mean difference: - 22 ml; p ≤ 0.01; 95% CI - 34.2 to - 9.9). The probability of premature ventricular complexes after a SARS-CoV-2 infection yielded an odds ratio of 1.6 (95% CI 0.24-10.81). CONCLUSIONS The physical performance of young athletes infected with SARS-CoV-2 was impaired. This decreased performance is probably due to cardiac and/or peripheral deconditioning. Studies with larger cohorts are needed to make more profound conclusions.
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14
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Juhász V, Szabó L, Pavlik A, Tállay A, Balla D, Kiss O, Babity M, Sydó N, Csulak E, Benczúr A, Országh A, Gregor Z, Becker D, Merkely B, Vágó H. Short and mid-term characteristics of COVID-19 disease course in athletes: A high-volume, single-center study. Scand J Med Sci Sports 2022; 33:341-352. [PMID: 36337005 PMCID: PMC9877648 DOI: 10.1111/sms.14265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION At the pandemic's beginning, significant concern has risen about the prevalence of myocardial involvement after SARS-CoV-2 infection. We assessed the cardiovascular burden of SARS-CoV-2 in a large cohort of athletes and identified factors that might affect the disease course. We included 633 athletes in our study on whom we performed extensive cardiology examinations after recovering from SARS-CoV-2 infection. More than half of the athletes (n = 322) returned for a follow-up examination median of 107 days after the commencement of their infection. RESULTS Troponin T positivity was as low as 1.4% of the athletes, where the subsequently performed examinations did not show definitive, ongoing myocardial injury. Altogether, 31% of the athletes' rapid training rebuild was hindered by persistent or reoccurring symptoms. Female athletes reported a higher prevalence of return to play (RTP) symptoms than their male counterparts (34% vs. 19%, p = 0.005). The development of long COVID symptoms was independently predicted by increasing age and acute symptoms' severity in a multiple regression model (AUC 0.75, CI 0.685-0.801). Athletes presenting with either or both cough and ferritin levels higher than >150 μg/L had a 4.1x (CI 1.78-9.6, p = 0.001) higher odds ratio of developing persistent symptoms. CONCLUSION While SARS-CoV-2 rarely affects the myocardium in athletes, about one in three of them experience symptoms beyond the acute phase. Identifying those athletes with a predisposition to developing long-standing symptoms may aid clinicians and trainers in finding the optimal return-to-play timing and training load rebuild pace.
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Affiliation(s)
- Vencel Juhász
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Liliána Szabó
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Attila Pavlik
- Department of Sports MedicineSemmelweis UniversityBudapestHungary
| | - András Tállay
- Department of Sports MedicineSemmelweis UniversityBudapestHungary
| | - Dorottya Balla
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Orsolya Kiss
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary,Department of Sports MedicineSemmelweis UniversityBudapestHungary
| | - Máté Babity
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Nóra Sydó
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary,Department of Sports MedicineSemmelweis UniversityBudapestHungary
| | - Emese Csulak
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - András Benczúr
- Institute for Computer Science and ControlBudapestHungary
| | - Anna Országh
- Institute for Computer Science and ControlBudapestHungary
| | - Zsófia Gregor
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Dávid Becker
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Béla Merkely
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary,Department of Sports MedicineSemmelweis UniversityBudapestHungary
| | - Hajnalka Vágó
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary,Department of Sports MedicineSemmelweis UniversityBudapestHungary
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15
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Kaulback K, Pyne DB, Hull JH, Snyders C, Sewry N, Schwellnus M. The effects of acute respiratory illness on exercise and sports performance outcomes in athletes - a systematic review by a subgroup of the IOC consensus group on "Acute respiratory illness in the athlete". Eur J Sport Sci 2022:1-19. [PMID: 35695464 DOI: 10.1080/17461391.2022.2089914] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute respiratory infections (ARinf) are common in athletes, but their effects on exercise and sports performance remain unclear. This systematic review aimed to determine the acute (short-term) and longer-term effects of ARinf, including SARS-CoV-2 infection, on exercise and sports performance outcomes in athletes. Data sources searched included PubMed, Web of Science, and EBSCOhost, from January 1990-31 December 2021. Eligibility criteria included original research studies published in English, measuring exercise and/or sports performance outcomes in athletes/physically active/military aged 15-65years with ARinf. Information regarding the study cohort, diagnostic criteria, illness classification, and quantitative data on the effect on exercise/sports performance were extracted. Database searches identified 1707 studies. After full text screening, 17 studies were included (n = 7793). Outcomes were acute or longer-term effects on exercise (cardiovascular or pulmonary responses), or sports performance (training modifications, change in standardised point scoring systems, running biomechanics, match performance or ability to start/finish an event). There was substantial methodological heterogeneity between studies. ARinf was associated with acute decrements in sports performance outcomes (4 studies) and pulmonary function (3 studies), but minimal effects on cardiorespiratory endurance (7 studies in mild ARinf). Longer-term detrimental effects of ARinf on sports performance (6 studies) were divided. Training mileage, overall training load, standardised sports performance-dependent points and match play can be affected over time. Despite few studies, there is a trend towards impairment in acute and longer-term exercise and sports outcomes after ARinf in athletes. Future research should consider a uniform approach to explore relationships between ARinf and exercise/sports performance.
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Affiliation(s)
- Kelly Kaulback
- Sport, Exercise Medicine, Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa.,Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Africa
| | - David B Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, 2617, Australia
| | - James H Hull
- Institute of Sport, Exercise and Health (ISEH), University College London, UK.,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Carolette Snyders
- Sport, Exercise Medicine, Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine, Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre of South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine, Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre of South Africa
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16
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Gattoni C, Conti E, Casolo A, Nuccio S, Baglieri C, Capelli C, Girardi M. COVID-19 disease in professional football players: symptoms and impact on pulmonary function and metabolic power during matches. Physiol Rep 2022; 10:e15337. [PMID: 35699134 PMCID: PMC9194973 DOI: 10.14814/phy2.15337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/30/2022] [Accepted: 05/16/2022] [Indexed: 05/24/2023] Open
Abstract
This study aimed at: (1) Reporting COVID-19 symptoms and duration in professional football players; (2) comparing players' pulmonary function before and after COVID-19; (3) comparing players' metabolic power (Pmet ) before and after COVID-19. Thirteen male players (Age: 23.9 ± 4.0 years, V̇O2peak : 49.7 ± 4.0 mL/kg/min) underwent a medical screening and performed a running incremental step test and a spirometry test after COVID-19. Spirometric data were compared with the ones collected at the beginning of the same season. Players' mean Pmet of the 10 matches played before COVID-19 was compared with mean Pmet of the 10 matches played after COVID-19. Players completed a questionnaire on COVID-19 symptoms and duration 6 months following the disease. COVID-19 positivity lasted on average 15 ± 5 days. "General fatigue" and "muscle fatigue" symptoms were reported by all players during COVID-19 and persisted for 77% (general fatigue) and 54% (muscle fatigue) of the players for 37 ± 28 and 38 ± 29 days after the disease, respectively. No significant changes in spirometric measurements were found after COVID-19, even though some impairments at the individual level were observed. Conversely, a linear mixed-effects model analysis showed a significant reduction of Pmet (-4.1 ± 3.5%) following COVID-19 (t = -2.686, p < 0.05). "General fatigue" and "muscle fatigue" symptoms may persist for several weeks following COVID-19 in professional football players and should be considered for a safer return to sport. Players' capacity to compete at high intensities might be compromised after COVID-19.
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Affiliation(s)
- Chiara Gattoni
- Institute of Orthopaedics and Musculoskeletal ScienceUniversity College LondonRoyal National Orthopaedic HospitalStanmoreUK
| | - Emanuele Conti
- School of Sport, Rehabilitation and Exercise SciencesUniversity of EssexColchesterUK
| | - Andrea Casolo
- Department of Biomedical SciencesUniversity of PaduaPaduaItaly
| | - Stefano Nuccio
- Department of Movement, Human and Health SciencesUniversity of Rome “Foro Italico”RomeItaly
| | - Carmine Baglieri
- School of Sport, Rehabilitation and Exercise SciencesUniversity of EssexColchesterUK
| | - Carlo Capelli
- Department of Neuroscience, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Michele Girardi
- School of Sport, Rehabilitation and Exercise SciencesUniversity of EssexColchesterUK
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17
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Lemes IR, Smaira FI, Ribeiro WJD, Favero NK, Matos LDNJ, Pinto ALDS, Dolan E, Gualano B. Acute and post-acute COVID-19 presentations in athletes: a systematic review and meta-analysis. Br J Sports Med 2022; 56:941-947. [PMID: 35623887 DOI: 10.1136/bjsports-2022-105583] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe acute/postacute COVID-19 presentations in athletes. DESIGN Systematic review and meta-analysis. DATA SOURCES The search was conducted in four databases (MEDLINE, EMBASE, SCOPUS, SPORTDiscus) and restricted to studies published from 2019 to 6 January 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were required to (1) include professional, amateur or collegiate/university athletes with COVID-19; (2) present data on acute/postacute COVID-19 symptoms and (3) have an observational design. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. RESULTS 43 studies with 11 518 athletes were included. For acute presentation, the pooled event rates for asymptomatic and severe COVID-19 were 25.5% (95% CI: 21.1% to 30.5%) and 1.3% (95% CI: 0.7% to 2.3%), respectively. For postacute presentations, the pooled estimate of persistent symptoms was 8.3% (95% CI: 3.8% to 17.0%). Pooled estimate for myocardial involvement was 5.0% (95% CI: 2.5% to 9.8%) in athletes undergoing any cardiac testing, and 2.5% (95% CI: 1.0% to 5.8%) in athletes undergoing MRI, although clinical symptoms were not characterised. None of the studies with a control group (eg, non-infected athletes) could confirm a causal relationship between COVID-19 and myocardial involvement. CONCLUSION This broad characterisation of COVID-19 presentations in athletes indicates that ~94% exhibited mild or no acute symptoms. The available evidence did not confirm a causal relationship between COVID-19 and myocardial involvement. A small proportion of athletes experienced persistent symptoms while recovering from infection, which were mostly mild in nature, but could affect return-to-play decisions and timing.
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Affiliation(s)
- Italo Ribeiro Lemes
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Willian J D Ribeiro
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Natalia Koenig Favero
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Ana Lúcia de Sá Pinto
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Universidade de Sao Paulo, Sao Paulo, Brazil
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Moulson N, Gustus SK, Scirica C, Petek BJ, Vanatta C, Churchill TW, Guseh JS, Baggish A, Wasfy MM. Diagnostic evaluation and cardiopulmonary exercise test findings in young athletes with persistent symptoms following COVID-19. Br J Sports Med 2022; 56:bjsports-2021-105157. [PMID: 35584886 PMCID: PMC9157326 DOI: 10.1136/bjsports-2021-105157] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Persistent or late-onset cardiopulmonary symptoms following COVID-19 may occur in athletes despite a benign initial course. We examined the yield of cardiac evaluation, including cardiopulmonary exercise testing (CPET), in athletes with cardiopulmonary symptoms after COVID-19, compared CPETs in these athletes and those without COVID-19 and evaluated longitudinal changes in CPET with improvement in symptoms. METHODS This prospective cohort study evaluated young (18-35 years old) athletes referred for cardiopulmonary symptoms that were present>28 days from COVID-19 diagnosis. CPET findings in post-COVID athletes were compared with a matched reference group of healthy athletes without COVID-19. Post-COVID athletes underwent repeat CPET between 3 and 6 months after initial evaluation. RESULTS Twenty-one consecutive post-COVID athletes with cardiopulmonary symptoms (21.9±3.9 years old, 43% female) were evaluated 3.0±2.1 months after diagnosis. No athlete had active inflammatory heart disease. CPET reproduced presenting symptoms in 86%. Compared with reference athletes (n=42), there was similar peak VO2 but a higher prevalence of abnormal spirometry (42%) and low breathing reserve (42%). Thirteen athletes (62%) completed longitudinal follow-up (4.8±1.9 months). The majority (69%) had reduction in cardiopulmonary symptoms, accompanied by improvement in peak VO2 and oxygen pulse, and reduction in resting and peak heart rate (all p<0.05). CONCLUSION Despite a high burden of cardiopulmonary symptoms after COVID-19, no athlete had active inflammatory heart disease. CPET was clinically useful to reproduce symptoms with either normal testing or identification of abnormal spirometry as a potential therapeutic target. Improvement in post-COVID symptoms was accompanied by improvements in CPET parameters.
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Affiliation(s)
- Nathaniel Moulson
- Cardiology Division, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah K Gustus
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christina Scirica
- Pediatric Pulmonary Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bradley J Petek
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caroyln Vanatta
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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19
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Dubey AK, Chaudhry SK, Singh HB, Gupta VK, Kaushik A. Perspectives on nano-nutraceuticals to manage pre and post COVID-19 infections. BIOTECHNOLOGY REPORTS (AMSTERDAM, NETHERLANDS) 2022; 33:e00712. [PMID: 35186674 PMCID: PMC8832856 DOI: 10.1016/j.btre.2022.e00712] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/10/2022] [Indexed: 12/12/2022]
Abstract
Optimized therapeutic bio-compounds supported by bio-acceptable nanosystems (i.e., precise nanomedicine) have ability to promote health via maintaining body structure, organ function, and controlling chronic and acute effects. Therefore, nano-nutraceuticals (designed to neutralize virus, inhibit virus bindings with receptors, and support immunity) utilization can manage COVID-19 pre/post-infection effects. To explore these approaches well, our mini-review explores optimized bio-active compounds, their ability to influence SARS-CoV-2 infection, improvement in performance supported by precise nanomedicine approach, and challenges along with prospects. Such optimized pharmacologically relevant therapeutic cargo not only affect SARS-CoV-2 but will support other organs which show functional alternation due to SARS-CoV-2 for example, neurological functions. Hence, coupling the nutraceuticals with the nano-pharmacology perspective of higher efficacy via targeted delivery action can pave a novel way for health experts to plan future research needed to manage post COVID-19 infection effect where a longer efficacy with no side-effects is a key requirement.
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Affiliation(s)
- Ankit Kumar Dubey
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Tamil Nadu, 600036, India
- Institute of Scholars (InSc), Bengaluru, 560091, Karnataka, India
| | - Suman Kumar Chaudhry
- Department of Computer Science and Engineering, Tezpur University, Sonitpur, Assam, 784028, India
| | | | - Vijai Kumar Gupta
- Biorefining and Advanced Materials Research Center, SRUC, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, United Kingdom
- Center for Safe and Improved Food, SRUC, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, United Kingdom
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Health Systems Engineering, Department of Natural Sciences, Florida Polytechnic University, Lakeland, FL, 33805, United States of America
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