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Mustonen T, Kanerva M, Luukkonen R, Lantto H, Uusitalo A, Piirilä P. Cardiopulmonary exercise testing in long covid shows the presence of dysautonomia or chronotropic incompetence independent of subjective exercise intolerance and fatigue. BMC Cardiovasc Disord 2024; 24:413. [PMID: 39117999 PMCID: PMC11308233 DOI: 10.1186/s12872-024-04081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND After COVID-19 infection, 10-20% of patients suffer from varying symptoms lasting more than 12 weeks (Long COVID, LC). Exercise intolerance and fatigue are common in LC. The aim was to measure the maximal exercise capacity of the LC patients with these symptoms and to analyze whether this capacity was related to heart rate (HR) responses at rest and during exercise and recovery, to find out possible sympathetic overactivity, dysautonomia or chronotropic incompetence. METHODS Cardiopulmonary exercise test was conducted on 101 LC patients, who were admitted to exercise testing. The majority of them (86%) had been treated at home during their acute COVID-19 infection. Peak oxygen uptake (VO2peak), maximal power during the last 4 min of exercise (Wlast4), HRs, and other exercise test variables were compared between those with or without subjective exercise intolerance, fatigue, or both. RESULTS The measurements were performed in mean 12.7 months (SD 5.75) after COVID-19 infection in patients with exercise intolerance (group EI, 19 patients), fatigue (group F, 31 patients), their combination (group EI + F, 37 patients), or neither (group N, 14 patients). Exercise capacity was, in the mean, normal in all symptom groups and did not significantly differ among them. HRs were higher in group EI + F than in group N at maximum exercise (169/min vs. 158/min, p = 0.034) and 10 min after exercise (104/min vs. 87/min, p = 0.028). Independent of symptoms, 12 patients filled the criteria of dysautonomia associated with slightly decreased Wlast4 (73% vs. 91% of sex, age, height, and weight-based reference values p = 0.017) and 13 filled the criteria of chronotropic incompetence with the lowest Wlast4 (63% vs. 93%, p < 0.001), VO2peak (70% vs. 94%, p < 0.001), the lowest increase of systolic blood pressure (50 mmHg vs. 67 mmHg, p = 0.001), and the greatest prevalence of slight ECG-findings (p = 0.017) compared to patients without these features. The highest prevalence of chronotropic incompetence was seen in the group N (p = 0.022). CONCLUSIONS This study on LC patients with different symptoms showed that cardiopulmonary exercise capacity was in mean normal, with increased sympathetic activity in most patients. However, we identified subgroups with dysautonomia or chronotropic incompetence with a lowered exercise capacity as measured by Wlast4 or VO2peak. Subjective exercise intolerance and fatigue poorly foresaw the level of exercise capacity. The results could be used to plan the rehabilitation from LC and for selection of the patients suitable for it.
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Affiliation(s)
- Timo Mustonen
- Department of Clinical Physiology, Peijas Hospital, HUS Medical Diagnostic Center, Helsinki University Hospital and Helsinki University, Stenbäckinkatu 11 C, PL 281, Helsinki, 00029, Finland.
| | - Mari Kanerva
- Department of Internal Medicine and Rehabilitation, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- Department of Infection Control, Turku University Hospital, The wellbeing services county of Southwest Finland, Turku, Finland
| | | | - Hanna Lantto
- Department of Clinical Physiology, Park Hospital, HUS Medical Diagnostic Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Arja Uusitalo
- Division of Clinical Physiology and Nuclear Medicine, HUS Medical Diagnostic Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Päivi Piirilä
- Department of Clinical Physiology, Park Hospital, HUS Medical Diagnostic Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
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Mavroudis I, Petridis F, Petroaie AD, Ciobica A, Kamal FZ, Honceriu C, Iordache A, Ionescu C, Novac B, Novac O. Exploring Symptom Overlaps: Post-COVID-19 Neurological Syndrome and Post-Concussion Syndrome in Athletes. Biomedicines 2024; 12:1587. [PMID: 39062160 PMCID: PMC11274969 DOI: 10.3390/biomedicines12071587] [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: 06/05/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The COVID-19 pandemic has introduced new challenges in managing neurological conditions, particularly among athletes. This paper explores the intersection of post-COVID-19 neurological syndrome (PCNS/PASC) and post-concussion syndrome (PCS), focusing on their implications in sports medicine. Our analysis covers the symptomatology, pathophysiology, and management strategies for PCNS/PASC and PPCS, with special attention paid to the unique challenges faced by athletes recovering from these conditions, including the risk of symptom exacerbation and prolonged recovery. Key findings reveal that both PCNS/PASC and PPCS present with overlapping symptoms such as cognitive difficulties, exercise intolerance, and mental health issues, but differ in specific manifestations like anosmia and ageusia, unique to COVID-19. Pathophysiological analysis reveals similarities in blood-brain barrier disruption (BBB) but differences in the extent of immune activation. Management strategies emphasize a gradual increase in physical activity, close symptom monitoring, and psychological support, with a tailored approach for athletes. Specific interventions include progressive aerobic exercises, resistance training, and cognitive rehabilitation. Furthermore, our study highlights the importance of integrating neurology, psychiatry, physical therapy, and sports medicine to develop comprehensive care strategies. Our findings underscore the dual challenge of COVID-19 and concussion in athletes, necessitating a nuanced, interdisciplinary approach to effective management. Future research should focus on the long-term neurological effects of both conditions and optimizing treatment protocols to improve patient outcomes. This comprehensive understanding is crucial for advancing the management of athletes affected by these overlapping conditions and ensuring their safe return to sports.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK;
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Antoneta Dacia Petroaie
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Centre of Biomedical Research, Romanian Academy, Bd. Carol I, no. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Str. Splaiul Independentei no. 54, Sector 5, 050094 Bucharest, Romania
- “Ioan Haulica” Institute, Apollonia University, Pãcurari Street 11, 700511 Iasi, Romania
| | - Fatima Zahra Kamal
- Higher Institute of Nursing Professions and Health Techniques, Marrakesh 40000, Morocco
- Laboratory of Physical Chemistry of Processes and Materials, Faculty of Sciences and Techniques, Hassan First University, B.P. 539, Settat 26000, Morocco
| | - Cezar Honceriu
- Faculty of Physical Education, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania;
| | - Alin Iordache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Cătălina Ionescu
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Clinical Department, Apollonia University, Păcurari Street 11, 700511 Iasi, Romania
| | - Bogdan Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Otilia Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
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Mone P, Bencivenga L, Santulli G, Rengo G, Guerra G, Komici K. Time to negative conversion and cardiopulmonary performance in athletes with COVID-19. ERJ Open Res 2024; 10:00090-2024. [PMID: 39040592 PMCID: PMC11261377 DOI: 10.1183/23120541.00090-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/13/2024] [Indexed: 07/24/2024] Open
Abstract
Athletes with longer time to negative conversion for COVID-19 do not present reduction of exercise capacity. However, respiratory and ventilatory parameters are modified. https://bit.ly/3TMdrFL.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Casa di Cura “Montevergine”, Mercogliano, Avellino, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gaetano Santulli
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Istituti Clinici Scientifici Maugeri IRCCS – Scientific Institute of Telese, Terme, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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4
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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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Widmann M, Gaidai R, Schubert I, Grummt M, Bensen L, Kerling A, Quermann A, Zacher J, Vollrath S, Bizjak DA, Beckendorf C, Egger F, Hasler E, Mellwig KP, Fütterer C, Wimbauer F, Vogel A, Schoenfeld J, Wüstenfeld JC, Kastner T, Barsch F, Friedmann-Bette B, Bloch W, Meyer T, Mayer F, Wolfarth B, Roecker K, Reinsberger C, Haller B, Niess AM. COVID-19 in Female and Male Athletes: Symptoms, Clinical Findings, Outcome, and Prolonged Exercise Intolerance-A Prospective, Observational, Multicenter Cohort Study (CoSmo-S). Sports Med 2024; 54:1033-1049. [PMID: 38206445 PMCID: PMC11052799 DOI: 10.1007/s40279-023-01976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/12/2024]
Abstract
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.
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Affiliation(s)
- Manuel Widmann
- Department of Sports Medicine, Medical Clinic, Medical University Hospital Tuebingen, University Hospital of Tuebingen, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany.
| | - Roman Gaidai
- Department of Sports and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Isabel Schubert
- Department of Sports Medicine, Medical Clinic, Medical University Hospital Tuebingen, University Hospital of Tuebingen, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
| | - Maximilian Grummt
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lieselotte Bensen
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arno Kerling
- Clinic for Rehabilitation and sports medicine, Hannover Medical School, Hannover, Germany
| | - Anne Quermann
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Zacher
- Department of Preventative and Rehabilitative Sports and Performance Medicine, Institute of Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Shirin Vollrath
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | | | - Claudia Beckendorf
- Center of Sports Medicine, Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Florian Egger
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Erik Hasler
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Furtwangen University, Furtwangen, Germany
| | - Klaus-Peter Mellwig
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Cornelia Fütterer
- School of Medicine, Institute of AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Fritz Wimbauer
- Department of Prevention and Sports Medicine, University Hospital 'Rechts Der Isar', Technical University of Munich, Munich, Germany
| | - Azin Vogel
- Department of Prevention and Sports Medicine, University Hospital 'Rechts Der Isar', Technical University of Munich, Munich, Germany
| | - Julia Schoenfeld
- Department of Prevention and Sports Medicine, University Hospital 'Rechts Der Isar', Technical University of Munich, Munich, Germany
| | - Jan C Wüstenfeld
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Applied Training Science, Leipzig University, Leipzig, Germany
| | - Tom Kastner
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Applied Training Science, Leipzig University, Leipzig, Germany
| | - Friedrich Barsch
- Medical Faculty, Institute of Exercise and Occupational Medicine, University Freiburg, Freiburg, Germany
| | - Birgit Friedmann-Bette
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Frank Mayer
- Center of Sports Medicine, Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Applied Training Science, Leipzig University, Leipzig, Germany
| | - Kai Roecker
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Furtwangen University, Furtwangen, Germany
| | - Claus Reinsberger
- Department of Sports and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Bernhard Haller
- School of Medicine, Institute of AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Andreas M Niess
- Department of Sports Medicine, Medical Clinic, Medical University Hospital Tuebingen, University Hospital of Tuebingen, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
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Özmen K, Meral M, Kerget B, Yılmazel Uçar E, Sağlam L, Özmen M. Evaluation of Pulmonary Function Tests, Dyspnea Scores, and Antibody Levels at the Six-Month Follow-Up of Patients Hospitalized for COVID-19 Pneumonia. Cureus 2024; 16:e56003. [PMID: 38476506 PMCID: PMC10928457 DOI: 10.7759/cureus.56003] [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] [Accepted: 03/10/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) causes various signs and symptoms, especially lung involvement, during acute infection and in the long term. In this study, we evaluated the follow-up results of patients with chronic COVID-19 over a 24-week period. METHODS The study included a total of 100 post-COVID-19 patients (confirmed by real-time polymerase chain reaction (PCR) of a nasopharyngeal swab) who presented to the post-COVID-19 outpatient clinic with chronic COVID-19 symptoms 12 weeks after diagnosis, between April and June 2021. All of the patients in the study had a history of hospitalization and were grouped based on the severity of the acute COVID-19 infection (moderate: group 1, severe: group 2). RESULTS A comparison of pulmonary function test parameters at week 12 showed that forced expiratory volume (FEV1)%, forced vital capacity (FVC)%, diffusing capacity of the lungs for carbon monoxide (DLCO)%, and DLCO divided by the alveolar volume (DLCO/VA)% values were significantly lower in group 2 than in group 1 (p<0.001 for all). At week 24, only DLCO and DLCO/VA values were lower (<0.001 for both). The mean modified Medical Research Council (mMRC) dyspnea scores of groups 1 and 2 were 1.4 ± 0.9 and 2.8 ± 1.1 at 12 weeks and improved to 0.9 ± 0.6 and 1.6 ± 0.6 at 24 weeks, respectively. The groups' mMRC scores at 12 and 24 weeks differed significantly (p=0.001, p=0.02). There was no difference in levels of IgM and IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein between the groups at 12 or 24 weeks (p>0.05 for all). CONCLUSION Improvement in pulmonary function parameters and mMRC scores may take longer than 24 weeks, especially in patients with severe COVID-19. Our results indicated that the levels of IgM and IgG neutralizing antibodies did not differ between patients with moderate and severe illness at 12 or 24 weeks.
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Affiliation(s)
- Kadir Özmen
- Department of Pulmonology, Erzurum Ci̇ty Hospi̇tal, Erzurum, TUR
| | - Mehmet Meral
- Department of Pulmonology, Faculty of Medicine, Ataturk University, Erzurum, TUR
| | - Bugra Kerget
- Department of Pulmonology, Faculty of Medicine, Ataturk University, Erzurum, TUR
| | - Elif Yılmazel Uçar
- Department of Pulmonology, Faculty of Medicine, Ataturk University, Erzurum, TUR
| | - Leyla Sağlam
- Department of Pulmonology, Faculty of Medicine, Ataturk University, Erzurum, TUR
| | - Murat Özmen
- Department of Cardiology, Erzurum City Hospital, Erzurum, TUR
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7
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Castelletti S, Gervasi S, Ballardini E, Casasco M, Cavarretta E, Colivicchi F, Contursi M, Cuccaro F, D'Ascenzi F, Gazale G, Mos L, Nistri S, Palmieri V, Patrizi G, Scorcu M, Spampinato A, Tiberi M, Zito GB, Zorzi A, Zeppilli P, Sciarra L. The athlete after COVID-19 infection: what the scientific evidence? What to do? A position statement. Panminerva Med 2024; 66:63-74. [PMID: 36178109 DOI: 10.23736/s0031-0808.22.04723-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The Coronavirus-19 disease (COVID-19) related pandemic have deeply impacted human health, economy, psychology and sociality. Possible serious cardiac involvement in the infection has been described, raising doubts about complete healing after the disease in many clinical settings. Moreover, there is the suspicion that the vaccines, especially those based on mRNA technology, can induce myopericarditis. Myocarditis or pericarditis related scars can represent the substrate for life-threatening arrhythmias, triggered by physical activity. A crucial point is how to evaluate an athlete after a COVID-19 infection ensuring a safe return to play without increasing the number of unnecessary disqualifications from sports competitions. The lack of conclusive scientific data significantly increases the difficulty to propose recommendations and guidelines on this topic. At the same time, the psychological and physical negative consequences of unnecessary sports restriction must be taken into account. The present document aims to provide an updated brief review of the current knowledge about the COVID-19 cardiac involvement and how to recognize it and to offer a roadmap for the management of the athletes after a COVID-19 infections, including subsequent impact on exercise recommendations. Our document exclusively refers to cardiovascular implications of the disease, but pulmonary consequences are also considered.
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Affiliation(s)
| | - Salvatore Gervasi
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Ballardini
- Sports Medicine Centre, Mantova Salus Group, San Pellegrino Hospital, Mantua, Italy
| | | | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | | | - Maurizio Contursi
- Unit of Sports Cardiology, Centro Polidiagnostico Check-up, Salerno, Italy
| | - Francesco Cuccaro
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giovanni Gazale
- Center of Sports Medicine and Sports Cardiology, ASL1, Sassari, Italy
| | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Stefano Nistri
- Cardiology Service-CMSR Veneto Medica, Altavilla Vicentina, Vicenza, Italy
| | - Vincenzo Palmieri
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | - Marco Scorcu
- Department of Sports Medicine and Physical Exercise, ATS Sardegna, Cagliari, Italy
| | | | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV1, Pesaro, Italy
| | | | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Paolo Zeppilli
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Luigi Sciarra
- Department of Cardiology, Casilino Polyclinic, Rome, Italy
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8
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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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Wang CC, Huang YTA, Jiang RS, Liao CA, Kuo LW. Opposite effects of Covid-19 infection on pitchers and batters: a retrospective study on Chinese Professional Baseball League players. J Sports Med Phys Fitness 2023; 63:1350-1357. [PMID: 37800400 DOI: 10.23736/s0022-4707.23.15003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND The influence of COVID-19 infection on elite athletes remains largely unknown, especially on baseball players. The goal of this study is to examine the actual performance of infected elite baseball players from the Chinese Professional Baseball League (CPBL) from a sabermetric point of view. METHODS This was a retrospective observational cohort study. CPBL players who were infected with COVID-19 from April 27th to May 31st, 2022, were eligible for this study. The performance of study participants before and after COVID-19 infection was compared, and statistics from the batters and pitchers were analyzed separately. RESULTS During the study interval, 56 players were infected with COVID-19, including 35 batters and 21 pitchers. After excluding injured players and players with inadequate playing opportunities, 23 batters and 12 pitchers were enrolled. For batters, there were no significant differences before and after COVID-19 infection. However, batters older than 28 years of age showed a decline in slugging percentage (0.372 vs. 0.292, P=0.049). Analysis of pitchers revealed significantly boosted fastball velocity after COVID-19 infection (142.10 km/h vs. 142.82 km/h, P=0.028) and improved strikeouts per nine innings (6.89 vs. 8.56, P=0.021). CONCLUSIONS COVID-19 might have a potential influence on professional baseball players. For batters, veteran players more than 28 years of age were more likely to be negatively affected by COVID-19, whereas the effect of COVID-19 on pitchers was generally positive, with significantly improved fastball velocity and K/9 numbers.
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Affiliation(s)
- Chia-Cheng Wang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yu-Tung Anton Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Ren-Shiang Jiang
- Department of Physical Education, National Taiwan University of Sport, Taichung City, Taiwan
| | - Chien-An Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei City, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan -
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Squeo MR, Monosilio S, Gismondi A, Perrone M, Gregorace E, Lemme E, Di Gioia G, Mango R, Prosperi S, Spataro A, Maestrini V, Di Giacinto B, Pelliccia A. Periodic health evaluation in athletes competing in Tokyo 2020: from SARS-CoV-2 to Olympic medals. BMJ Open Sport Exerc Med 2023; 9:e001610. [PMID: 38046277 PMCID: PMC10689352 DOI: 10.1136/bmjsem-2023-001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Background The Tokyo Olympic games were the only games postponed for a year in peacetime, which will be remembered as the COVID-19 Olympics. No data are currently available on the effect on athlete's performance. Aim To examine the Italian Olympic athletes who have undergone the return to play (RTP) protocol after COVID-19 and their Olympic results. Methods 642 Potential Olympics (PO) athletes competing in 19 summer sport disciplines were evaluated through a preparticipation screening protocol and, when necessary, with the RTP protocol. The protocol comprised blood tests, 12-lead resting ECG, transthoracic echocardiogram, cardiopulmonary exercise test, 24-hour Holter-ECG monitoring and cardiovascular MR based on clinical indication. Results Of the 642 PO athletes evaluated, 384 participated at the Olympic Games, 254 being excluded for athletic reasons. 120 athletes of the total cohort of 642 PO were affected by COVID-19. They were evaluated with the RTP protocol before resuming physical activity after a mean detraining period of 30±13 days. Of them, 100 were selected for Olympic Games participation, 16 were excluded for athletic reasons and 4 were due to RTP results (2 for COVID-19-related myocarditis, 1 for pericarditis and 1 for complex ventricular arrhythmias). Among athletes with a history of COVID-19 allowed to resume physical activity after the RTP and selected for the Olympic Games, no one had abnormalities in cardiopulmonary exercise test parameters, and 28 became medal winners with 6 gold, 6 silver and 19 bronze medals. Conclusions Among athletes with COVID-19, there is a low prevalence of cardiac sequelae. For those athletes allowed to resume physical activity after the RTP evaluation, the infection and the forced period of inactivity didn't have a negative impact on athletic performance.
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Affiliation(s)
- Maria Rosaria Squeo
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Sara Monosilio
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Alessandro Gismondi
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Marco Perrone
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Emanuele Gregorace
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Erika Lemme
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Giuseppe Di Gioia
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Ruggiero Mango
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Silvia Prosperi
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Antonio Spataro
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Viviana Maestrini
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Barbara Di Giacinto
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Antonio Pelliccia
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
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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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13
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Dhokane NB, Lonare AL, Pophali NP, Bharshankar J, Kherde P, Karwate SS, Dhanvijay AKD. Impact of COVID-19 on Physical Fitness in Central Indian Athletes Aged 20-30 Years: A Cross-Sectional Pilot Study. Cureus 2023; 15:e46126. [PMID: 37900375 PMCID: PMC10612432 DOI: 10.7759/cureus.46126] [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] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background Physical fitness is of utmost importance to athletes as it ensures better performance in competitive sports. Athletes who contracted COVID-19 frequently experienced persistent symptoms for weeks or months afterward. Due to the direct effects of COVID-19 infection on pulmonary, cardiovascular, and neurological systems, combined with the negative effects of isolation and inactivity, it has been observed that physical fitness decreases in individuals. This study aimed to evaluate the physical fitness of young athletes in the age group of 20 to 30 years after mild-to-moderate COVID-19 infection and compare them with unaffected athletes of the same age group. Methodology A field-based, cross-sectional, comparative study was conducted from July 2022 to August 2022 in Nagpur, India. Physical fitness levels of 50 young athletes in the age group of 20-30 years who never got infected with COVID-19 were compared to 50 athletes with a recent history of mild-to-moderate COVID-19 infection using the Harvard step test, breath-holding test, and peak expiratory flow rate measurement. Participants were included based on COVID-19 diagnosis using standard procedures and confirmation of recovery through negative reverse transcriptase polymerase chain reaction tests. Results Overall physical fitness of athletes who suffered from mild-to-moderate COVID-19 infection was significantly less than those who were not infected. Compared to their non-COVID-19 counterparts, the COVID-19-recovered athletes showed reduced physical fitness index (p < 0.0001 for males and p = 0.0003 for females), reduced peak expiratory flow rate (p < 0.0001 for males and p < 0.0001 for females), and reduced breath-holding time (p < 0.0001 for males and p < 0.0001 for females). Conclusions COVID-19 had a significant impact on various components of physical fitness which may potentially affect the athletic performance and overall well-being of young athletes.
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Affiliation(s)
- Nitin B Dhokane
- Physiology, Government Medical College, Sindhudurg, Sindhudurg, IND
| | - Aman L Lonare
- Physiology, Government Medical College, Nagpur, Nagpur, IND
| | - Narhari P Pophali
- Physiology, Shri Vasantrao Naik Government Medical College, Yavatmal, Yavatmal, IND
| | | | - Piyush Kherde
- Physiology, Government Medical College, Nagpur, Nagpur, IND
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Komici K, Bencivenga L, Rengo G, Bianco A, Guerra G. Ventilatory efficiency in post-COVID-19 athletes. Physiol Rep 2023; 11:e15795. [PMID: 37734918 PMCID: PMC10513909 DOI: 10.14814/phy2.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/11/2023] [Accepted: 08/07/2023] [Indexed: 09/23/2023] Open
Abstract
Limitation in exercise capacity has not been described in athletes affected by SARS-CoV-2 infection. However, patients who have recovered from COVID-19 without cardiopulmonary impairment show exaggerated ventilatory response during exercise. Therefore, we aimed to evaluate the ventilatory efficiency (VEf) in competitive athletes recovered from COVID-19 and to characterize the ventilation versus carbon dioxide relationship (VE/VCO2 ) slope in this population. Thirty-seven competitive athletes with COVID-19 were recruited for this study. All participants underwent spirometry, echocardiography, and cardiopulmonary exercise testing (CPET). z-FVC values and end-title pressure of CO2 (PET CO2 ) were lower in the third tertile compared with the first tertile: -0.753 ± 0.473 vs. 0.037 ± 0.911, p = 0.05; 42.2 ± 2.7 vs. 37.1 ± 2.5 mmHg, p < 0.01. VE/VCO2 slope was significantly correlated to maximal VCO2 /VE and maximal VO2 /VE: coefficient = -0.5 R2 = 0.58, p < 0.0001 and coefficient = -0.3 R2 = 0.16, p = 0.008. Competitive athletes affected by SARS-CoV-2 infection, without cardio-respiratory disease sequel, may present ventilatory inefficiency (ViE), without exercise capacity limitation. FVC is higher in athletes with better ventilatory performance during exercise, and increased VE/VCO2 slope is inversely correlated to max VCO2 /VE and max VO2 /VE.
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Affiliation(s)
- Klara Komici
- Department of Medicine and Health SciencesUniversity of MoliseCampobassoItaly
- Exercise and Sports Medicine UnitAntonio Cardarelli HospitalCampobassoItaly
| | - Leonardo Bencivenga
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Giuseppe Rengo
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
- Istituti Clinici Scientifici Maugeri IRCCS‐Scientific Institute of Telese TermeTelese TermeItaly
| | - Andrea Bianco
- Department of Translational Medical SciencesUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Germano Guerra
- Department of Medicine and Health SciencesUniversity of MoliseCampobassoItaly
- Exercise and Sports Medicine UnitAntonio Cardarelli HospitalCampobassoItaly
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Gagiannis D, Hackenbroch C, Bloch W, Zech F, Kirchhoff F, Djudjaj S, von Stillfried S, Bülow R, Boor P, Steinestel K. Clinical, Imaging, and Histopathological Features of Pulmonary Sequelae after Mild COVID-19. Am J Respir Crit Care Med 2023; 208:618-621. [PMID: 37315323 PMCID: PMC10492248 DOI: 10.1164/rccm.202302-0285le] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/14/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
| | | | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Cologne, Germany; and
| | - Fabian Zech
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Frank Kirchhoff
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Sonja Djudjaj
- Institute of Pathology, Aachen University Hospital, Aachen, Germany
| | | | - Roman Bülow
- Institute of Pathology, Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, Aachen University Hospital, Aachen, Germany
| | - Konrad Steinestel
- Institute of Pathology and Molecular Pathology, Bundeswehr Hospital Ulm, Ulm, Germany
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16
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Raza SS, Zafar U, Shehwar DE, Amin H. Comparison of Pulmonary Functions After Induction of Stress Between Post-COVID and Healthy Adults. Cureus 2023; 15:e43612. [PMID: 37719508 PMCID: PMC10504465 DOI: 10.7759/cureus.43612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Since the emergence of COVID in 2019, it has spread worldwide. COVID has affected all the systems of the human body. The present research aimed to assess the effects of COVID-19 on the pulmonary system after stress induction. Healthy and affected individuals between the age of 18 and 40 years were made to perform the 6-minute walk test and their pulmonary functions were compared before and after the stressor. Individuals who were three months post-COVID-19 infection were included as cases. Healthy individuals with no history of COVID were included as controls. The pulmonary functions were performed and noted both at baseline and after the 6-minute walk test. The forced expiratory flow 25 (FEF 25) and peak expiratory flow (PEF) showed statistical significance between both groups (p=0.033 and p=0.007, respectively). FEF 25, 50, and 75, maximum voluntary ventilation (MVV) index, and PEF were positively correlated with all respiratory parameters. Forced expiratory volume % (FEV%) was negatively correlated with vital capacity (VC) and forced vital capacity (FVC). This research helped us establish that the effect on the lungs due to COVID is not due to airway restriction or obstruction but reduced lung volume.
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Affiliation(s)
- Syed S Raza
- Department of Physiology, Gajju Khan Medical College, Swabi, PAK
- Robert and Suzanne Tomsich Department of Cardiothoracic Surgery, Cleveland Clinic Florida, Peshawar, PAK
| | - Umema Zafar
- Department of Physiology, Khyber Medical University, Peshawar, PAK
- Department of Physiology, Rehman Medical College, Peshawar, PAK
| | - Dur E Shehwar
- Department of Physiology, Khyber Medical College, Peshawar, PAK
| | - Hunya Amin
- Department of Physiology, Khyber Medical College, Peshawar, PAK
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Stojmenovic D, Stojmenovic T, Andjelkovic M, Trunic N, Dikic N, Kilibarda N, Nikolic I, Nedeljkovic I, Ostojic M, Purkovic M, Radovanovic J. The Influence of Different SARS-CoV-2 Strains on Changes in Maximal Oxygen Consumption, Ventilatory Efficiency and Oxygen Pulse of Elite Athletes. Diagnostics (Basel) 2023; 13:diagnostics13091574. [PMID: 37174965 PMCID: PMC10177849 DOI: 10.3390/diagnostics13091574] [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: 03/17/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the influence of different SARS-CoV-2 strains on the functional capacity of athletes. METHODS In total, 220 athletes underwent cardiopulmonary exercise testing (CPET) after coronavirus infection and before returning to sports activities. Eighty-eight athletes were infected by the Wuhan virus, and 66 were infected during the Delta and Omicron strain periods of the pandemic. RESULTS The CPET results showed significantly decreased maximal oxygen consumption, ventilatory efficiency, and oxygen pulse in athletes who were infected with Wuhan and Delta strains compared to athletes who suffered from Omicron virus infection. An early transition from aerobic to anaerobic metabolic pathways for energy production was observed in the Wuhan and Delta groups but not in athletes who were infected with the Omicron strain. There were no differences in the obtained results when Wuhan and Delta virus variants were compared. CONCLUSION These results suggest that the Wuhan and Delta virus strains had a significantly greater negative impact on the functional abilities of athletes compared to the Omicron virus variant, especially in terms of aerobic capacity and cardiorespiratory function.
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Affiliation(s)
- Dragutin Stojmenovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tamara Stojmenovic
- Faculty of Physical Education and Sports Management, University of Singidunum, 11000 Belgrade, Serbia
- Department of Pharmacy, University of Singidunum, 11000 Belgrade, Serbia
| | - Marija Andjelkovic
- Department of Pharmacy, University of Singidunum, 11000 Belgrade, Serbia
| | - Nenad Trunic
- Faculty of Physical Education and Sports Management, University of Singidunum, 11000 Belgrade, Serbia
| | - Nenad Dikic
- Faculty of Physical Education and Sports Management, University of Singidunum, 11000 Belgrade, Serbia
- Department of Pharmacy, University of Singidunum, 11000 Belgrade, Serbia
| | - Natasa Kilibarda
- Department of Pharmacy, University of Singidunum, 11000 Belgrade, Serbia
| | - Ivan Nikolic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ivana Nedeljkovic
- Cardiology Department, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marina Ostojic
- Cardiology Department, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milos Purkovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Jovana Radovanovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Brito GM, do Prado DML, Rezende DA, de Matos LDNJ, Loturco I, Vieira MLC, de Sá Pinto AL, Alô ROB, de Albuquerque LCA, Bianchini FR, Pinto AJ, Roschel H, Lemes ÍR, Gualano B. The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19. Front Med (Lausanne) 2023; 10:1128414. [PMID: 37181373 PMCID: PMC10169680 DOI: 10.3389/fmed.2023.1128414] [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: 12/20/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. Methods Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. Results A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). Discussion A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.
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Affiliation(s)
- Gisele Mendes Brito
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Diego Augusto Rezende
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Irineu Loturco
- Nucleous of High Performance in Sport, São Paulo, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ana Lúcia de Sá Pinto
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Ana Jéssica Pinto
- Division of Endocrinology, Metabolism, and Diabetes and Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ítalo Ribeiro Lemes
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
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Brunese MC, Fantozzi MR, Fusco R, De Muzio F, Gabelloni M, Danti G, Borgheresi A, Palumbo P, Bruno F, Gandolfo N, Giovagnoni A, Miele V, Barile A, Granata V. Update on the Applications of Radiomics in Diagnosis, Staging, and Recurrence of Intrahepatic Cholangiocarcinoma. Diagnostics (Basel) 2023; 13:diagnostics13081488. [PMID: 37189589 DOI: 10.3390/diagnostics13081488] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This paper offers an assessment of radiomics tools in the evaluation of intrahepatic cholangiocarcinoma. METHODS The PubMed database was searched for papers published in the English language no earlier than October 2022. RESULTS We found 236 studies, and 37 satisfied our research criteria. Several studies addressed multidisciplinary topics, especially diagnosis, prognosis, response to therapy, and prediction of staging (TNM) or pathomorphological patterns. In this review, we have covered diagnostic tools developed through machine learning, deep learning, and neural network for the recurrence and prediction of biological characteristics. The majority of the studies were retrospective. CONCLUSIONS It is possible to conclude that many performing models have been developed to make differential diagnosis easier for radiologists to predict recurrence and genomic patterns. However, all the studies were retrospective, lacking further external validation in prospective and multicentric cohorts. Furthermore, the radiomics models and the expression of results should be standardized and automatized to be applicable in clinical practice.
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Affiliation(s)
- Maria Chiara Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | | | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria delle Marche", 60121 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L'Aquila, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L'Aquila, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria delle Marche", 60121 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
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20
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Emeran A, Lambert EV, Paruk T, Bosch A. Changes in training activity post COVID-19 infection in recreational runners and cyclists. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2023; 34:v34i1a13758. [PMID: 36815935 PMCID: PMC9924504 DOI: 10.17159/2078-516x/2022/v34i1a13758] [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] [Indexed: 11/05/2022] Open
Abstract
Background Anecdotal evidence suggests that athletes struggle to return to exercise post COVID-19 infection. However, studies evaluating the effect of COVID-19 on athletes' exercise activity are limited. Objectives The objectives of this study were: (i) to describe the perceptions of recreational runners and cyclists recovering from COVID-19 on their training activity and general well-being, (ii) to compare device-measured training data in runners and cyclists pre- and post COVID-19, with non-infected controls that had a training interruption. Methods Participants who were recruited via social media completed an online questionnaire (n=61), including demographic, health and COVID-19 descriptive data. In a sub-sample, device-measured training data (heart rate, time, distance and speed, n=27) were obtained from GPS devices for four weeks before infection and on resumption of training. Similar data were collected for the control group (n=9) whose training had been interrupted but by factors excluding COVID-19. Results Most participants experienced a mild to moderate illness (91%) that was associated with a training interruption time of two-four weeks. Decreases in heart rate, relative exercise intensity, speed, time and distance were observed during the first week of returning to training for both groups, followed by an increase from Week two onwards. Discussion Results failed to support a 'COVID-19 effect' on exercise activity as reductions in training variables occurred in both the COVID-19 and control groups. A possible explanation for the reductions observed is a deliberate gradual return to training by athletes post-COVID-19. Conclusion More research is needed using device-measured training data prior to and post COVID-19 infection to better understand the impact of the SARS-CoV-2 virus on the exercise activity of athletes.
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Affiliation(s)
- A Emeran
- UCT Research Centre for Health through Physical Activity Lifestyle and Sport (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town,
South Africa,International Federation of Sports Medicine (FIMS) Collaborative Centre of Sports Medicine, University of Cape Town, Cape Town,
South Africa,National Research Foundation (NRF), Cape Town,
South Africa
| | - EV Lambert
- UCT Research Centre for Health through Physical Activity Lifestyle and Sport (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town,
South Africa,International Federation of Sports Medicine (FIMS) Collaborative Centre of Sports Medicine, University of Cape Town, Cape Town,
South Africa
| | - T Paruk
- UCT Research Centre for Health through Physical Activity Lifestyle and Sport (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town,
South Africa,International Federation of Sports Medicine (FIMS) Collaborative Centre of Sports Medicine, University of Cape Town, Cape Town,
South Africa
| | - A Bosch
- UCT Research Centre for Health through Physical Activity Lifestyle and Sport (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town,
South Africa,International Federation of Sports Medicine (FIMS) Collaborative Centre of Sports Medicine, University of Cape Town, Cape Town,
South Africa
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21
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Mińko A, Turoń-Skrzypińska A, Rył A, Szylińska A, Denisewicz I, Rotter I. Effects of Comprehensive Rehabilitation on Pulmonary Function in Patients Recovering from COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3985. [PMID: 36900996 PMCID: PMC10001994 DOI: 10.3390/ijerph20053985] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study is to evaluate the effect of inpatient rehabilitation on pulmonary function in patients recovering from COVID-19, a multifaceted disease caused by the SARS-CoV-2 virus. This aspect of recovery is crucial, as pneumonia associated with this disease can cause lung-function abnormalities with varying degrees of hypoxemia. This study involved 150 patients qualified for inpatient rehabilitation following SARS-CoV-2 infection. Functional assessment of the lungs was performed by spirometry. The mean age of patients was 64.66 (±11.93) years, and the mean body mass index (BMI) was 29.16 (±5.68). The tests showed a statistically significant improvement in spirometric parameters. The rehabilitation program based on aerobic, strength, and endurance exercises improved lung-function parameters in the long term. The improvement in spirometric parameters in patients after COVID-19 may be related to body mass index (BMI).
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Affiliation(s)
- Alicja Mińko
- Department and Unit of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
| | - Agnieszka Turoń-Skrzypińska
- Department and Unit of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
| | - Aleksandra Rył
- Department and Unit of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
| | - Aleksandra Szylińska
- Department and Unit of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
| | - Iwona Denisewicz
- Saint Charles Borromeo Rehabilitation Hospital, 71-899 Szczecin, Poland
| | - Iwona Rotter
- Department and Unit of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
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22
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Houston A, Tovey C, Rogers-Smith K, Thompson K, Ladlow P, Barker-Davies R, Bahadur S, Goodall D, Gough M, Norman J, Phillip R, Turner P, Cranley M, O'Sullivan O. Changing characteristics of post-COVID-19 syndrome: Cross-sectional findings from 458 consultations using the Stanford Hall remote rehabilitation assessment tool. BMJ Mil Health 2023:e002248. [PMID: 36702521 DOI: 10.1136/military-2022-002248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND In the UK, there have been multiple waves of COVID-19, with a five-tier alert system created to describe the transmission rate and appropriate restrictions. While acute mortality decreased, there continued to be a significant morbidity, with individuals suffering from persistent, life-restricting symptoms for months to years afterwards. A remote rehabilitation tool was created at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall to assess post-COVID-19 symptoms and their impact on the UK military.This study aims to understand changes in post-COVID-19 syndrome between wave 1 and wave 2, identify interactions between alert level and symptoms and investigate any predictive nature of acute symptoms for postacute symptomology in a young, physically active population. METHODS Cross-sectional study of 458 consecutive remote rehabilitation assessments performed at DMRC Stanford Hall between 2 April 2020 and 29 July 2021. Consultations were coded, anonymised, and statistical analysis was performed to determine associations between acute and postacute symptoms, and between symptoms, alert levels and waves. RESULTS 435 assessments were eligible; 174 in wave 1 and 261 in wave 2. Post-COVID-19 syndrome prevalence reduced from 43% to 2% between the waves. Acutely, widespread pain was more prevalent in wave 2 (p<0.001). Postacutely, there was increased anxiety (p=0.10) in wave 1 and increased sleep disturbance (p<0.001), memory/concentration issues (p<0.001) and shortness of breath/cough (p=0.017) in wave 2. Increasing alert level was associated with increased postacute symptom prevalence (p=0.046), with sleep disturbance increasing at higher alert level (p=0.016). Acute symptoms, including fatigue, sleep disturbance and myalgia, were associated with multiple postacute symptoms. CONCLUSIONS This study reports the overall prevalence and symptom burden in the UK military in the first two waves of COVID-19. By reporting differences in COVID-19 in different waves and alert level, this study highlights the importance of careful assessment and contextual understanding of acute and postacute illnesses for individual management plans.
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Affiliation(s)
- Andrew Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - C Tovey
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - K Rogers-Smith
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - K Thompson
- Headquarters Army Medical Services (HQ AMS), Camberley, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Loughborough University, Loughborough, UK
| | - S Bahadur
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - D Goodall
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - M Gough
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - J Norman
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - R Phillip
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - P Turner
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - M Cranley
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
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23
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Androulakis E, Perone F. Multimodality Cardiac Imaging in Young and Veteran Athletes: Updates on Atrial Function Assessment, Arrhythmia Predisposition and Pathology Discrimination. J Clin Med 2023; 12:jcm12030797. [PMID: 36769443 PMCID: PMC9917427 DOI: 10.3390/jcm12030797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Sports physicians and physiologists have aimed to assess exercise in young and master athletes so as to work out their conditioning levels and design training programs accordingly [...].
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Affiliation(s)
- Emmanuel Androulakis
- Sports Cardiology & Inherited Cardiac Conditions Department, St George’s Hospital NHS Foundation Trust, London SW17 0QT, UK
- Correspondence:
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy
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24
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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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25
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Śliż D, Wiecha S, Gąsior JS, Kasiak PS, Ulaszewska K, Postuła M, Małek ŁA, Mamcarz A. The Influence of Nutrition and Physical Activity on Exercise Performance after Mild COVID-19 Infection in Endurance Athletes-CESAR Study. Nutrients 2022; 14:nu14245381. [PMID: 36558540 PMCID: PMC9788030 DOI: 10.3390/nu14245381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
COVID-19 and imposed restrictions are linked with numerous health consequences, especially among endurance athletes (EA). Unfavorable changes in physical activity and nutrition may affect later sports and competition performance. The aims of this study were: (1) to assess the impact of COVID-19 infection and pandemic restrictions on the nutrition and physical activity of EAs and (2) to compare them with the results of cardiopulmonary exercise testing (CPET). In total, 49 EAs (nmale = 43, nfemale = 6, mean age = 39.9 ± 7.8 year., height = 178.4 ± 6.8 cm, weight = 76.3 ± 10.4 kg; BMI = 24.0 ± 2.6 kg·m−2) underwent pre- and post-COVID-19 CPET and fulfilled the dietary and physical activity survey. COVID-19 infection significantly deteriorated CPET performance. There was a reduction in oxygen uptake and in heart rate post-COVID-19 (both p < 0.001). Consuming processed meat and replacing meat with plant-based protein affected blood lactate concentration (p = 0.035). Fat-free mass was linked with consuming unsaturated fatty acids (p = 0.031). Adding salt to meals influenced maximal speed/power (p = 0.024) and breathing frequency (p = 0.033). Dietary and Fitness Practitioners and Medical Professionals should be aware of possible COVID-19 infection and pandemic consequences among EA. The results of this study are a helpful guideline to properly adjust the treatment, nutrition, and training of EA.
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Affiliation(s)
- Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
- School of Public Health, Postgraduate Medical Education Center, 01-813 Warsaw, Poland
- Correspondence: (D.Ś.); (S.W.)
| | - Szczepan Wiecha
- Department of Physical Education and Health, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland
- Correspondence: (D.Ś.); (S.W.)
| | - Jakub S. Gąsior
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Przemysław Seweryn Kasiak
- Students’ Scientific Group of Lifestyle Medicine, 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
| | - Katarzyna Ulaszewska
- Students’ Scientific Group of Lifestyle Medicine, 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
| | - Marek Postuła
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Łukasz A. Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, 04-635 Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
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26
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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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27
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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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Vollrath S, Bizjak DA, Zorn J, Matits L, Jerg A, Munk M, Schulz SVW, Kirsten J, Schellenberg J, Steinacker JM. Recovery of performance and persistent symptoms in athletes after COVID-19. PLoS One 2022; 17:e0277984. [PMID: 36477204 PMCID: PMC9728914 DOI: 10.1371/journal.pone.0277984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
- Shirin Vollrath
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
- * E-mail:
| | - Daniel Alexander Bizjak
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Jule Zorn
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Lynn Matits
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Achim Jerg
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Moritz Munk
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | | | - Johannes Kirsten
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Jana Schellenberg
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Jürgen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
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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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Electrical Impedance Tomography (EIT) in a Patient Suffering from Post-COVID Syndrome with Dyspnea: A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12102284. [DOI: 10.3390/diagnostics12102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Long-term health consequences following COVID-19 disease constitute an increasing problem worldwide. A considerable number of patients still suffer from various symptoms, most commonly dyspnea, months or even years after the acute infection. In these patients, a classical pulmonary function test often yields no significant findings. Subsequently, treating those patients is a challenge for any physician as there are currently no evidence-based treatment plans. Case and methods: We reported the case of a 58-year-old patient who was still suffering from resting dyspnea six months after severe COVID-19 pneumonia. The dyspnea was so pronounced that the patient was supplied with home oxygen, which they used as needed. The regional distribution of ventilation in the lungs was studied twice utilizing noninvasive electrical impedance tomography (EIT). The first examination showed distinct inhomogeneities of regional ventilation, a regional ventilation delay (RVD) of 15%, and pronounced pendelluft phenomena. Seven weeks after treatment with budesonide and physical therapy, the patient reported a clear subjective improvement in complaints. Accordingly, the regional distribution of ventilation also improved. Conclusion: Electrical impedance tomography might be a promising method to assess lung function in post-COVID patients; however, controlled and larger studies are necessary.
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Komici K, Bencivenga L, Rengo G. Editorial: Post COVID-19 physical performance and functional capacity. Front Med (Lausanne) 2022; 9:920645. [PMID: 35966844 PMCID: PMC9373793 DOI: 10.3389/fmed.2022.920645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- *Correspondence: Klara Komici
| | - Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Toulouse, France
- Leonardo Bencivenga
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Istituti Clinici Scientifici Maugeri SpA Societa Benefit (ICS Maugeri SpA SB), Telese Terme, Italy
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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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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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Huntley CC, Patel K, Bil Bushra SES, Mobeen F, Armitage MN, Pye A, Knight CB, Mostafa A, Kershaw M, Mughal AZ, McKemey E, Turner AM, Burge PS, Walters GI. Pulmonary function test and computed tomography features during follow-up after SARS, MERS and COVID-19: a systematic review and meta-analysis. ERJ Open Res 2022; 8:00056-2022. [PMID: 35642193 PMCID: PMC9035766 DOI: 10.1183/23120541.00056-2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background The COVID-19 pandemic follows severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus epidemics. Some survivors of COVID-19 infection experience persistent respiratory symptoms, yet their cause and natural history remain unclear. Follow-up after SARS and MERS may provide a model for predicting the long-term pulmonary consequences of COVID-19. Methods This systematic review and meta-analysis aims to describe and compare the longitudinal pulmonary function test (PFT) and computed tomography (CT) features of patients recovering from SARS, MERS and COVID-19. Meta-analysis of PFT parameters (DerSimonian and Laird random-effects model) and proportion of CT features (Freeman-Tukey transformation random-effects model) were performed. Findings Persistent reduction in the diffusing capacity for carbon monoxide following SARS and COVID-19 infection is seen at 6 months follow-up, and 12 months after MERS. Other PFT parameters recover in this time. 6 months after SARS and COVID-19, ground-glass opacity, linear opacities and reticulation persist in over 30% of patients; honeycombing and traction dilatation are reported less often. Severe/critical COVID-19 infection leads to greater CT and PFT abnormality compared to mild/moderate infection. Interpretation Persistent diffusion defects suggestive of parenchymal lung injury occur after SARS, MERS and COVID-19 infection, but improve over time. After COVID-19 infection, CT features are suggestive of persistent parenchymal lung injury, in keeping with a post-COVID-19 interstitial lung syndrome. It is yet to be determined if this is a regressive or progressive disease.
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Affiliation(s)
- Christopher C. Huntley
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK,Institute of Applied Health Research, University of Birmingham, Birmingham, UK,Corresponding author: Christopher C. Huntley ()
| | - Ketan Patel
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK,UHB NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK,UHB NHS Foundation Trust, Birmingham, UK
| | - P. Sherwood Burge
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK
| | - Gareth I. Walters
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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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: 29] [Impact Index Per Article: 14.5] [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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Ladlow P, O'Sullivan O, Bennett AN, Barker-Davies R, Houston A, Chamley R, May S, Mills D, Dewson D, Rogers-Smith K, Ward C, Taylor J, Mulae J, Naylor J, Nicol ED, Holdsworth DA. The effect of medium-term recovery status after COVID-19 illness on cardiopulmonary exercise capacity in a physically active adult population. J Appl Physiol (1985) 2022; 132:1525-1535. [PMID: 35608204 PMCID: PMC9190734 DOI: 10.1152/japplphysiol.00138.2022] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high-functioning populations ranging from frontline emergency services to professional or amateur/recreational athletes. The aim of the study is to describe the medium-term cardiopulmonary exercise profiles of individuals with “persistent symptoms” and individuals who feel “recovered” after hospitalization or mild-moderate community infection following COVID-19 to an age, sex, and job-role matched control group. A total of 113 participants underwent cardiopulmonary functional tests at a mean of 159 ± 7 days (∼5 mo) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered); and 26 controls. Hospitalized groups had the least favorable body composition (body mass, body mass index, and waist circumference) compared with controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇o2) at peak exercise (hospitalized-symptomatic, 29.9 ± 5.0 mL/kg/min; community-symptomatic, 34.4 ± 7.2 mL/kg/min; vs. control 43.9 ± 3.1 mL/kg/min, both P < 0.001). Hospitalized-symptomatic individuals had a steeper V̇e/V̇co2 slope (lower ventilatory efficiency) (30.5 ± 5.3 vs. 25.5 ± 2.6, P = 0.003) versus. controls. Hospitalized-recovered had a significantly lower oxygen uptake at peak (32.6 ± 6.6 mL/kg/min vs. 43.9 ± 13.1 mL/kg/min, P = 0.015) compared with controls. No significant differences were reported between community-recovered individuals and controls in any cardiopulmonary parameter. In conclusion, medium-term findings suggest that community-recovered individuals did not differ in cardiopulmonary fitness from physically active healthy controls. This suggests their readiness to return to higher levels of physical activity. However, the hospitalized-recovered group and both groups with persistent symptoms had enduring functional limitations, warranting further monitoring, rehabilitation, and recovery. NEW & NOTEWORTHY At 5 mo postinfection, community-treated individuals who feel recovered have comparable cardiopulmonary exercise profiles to the physically trained and active controls, suggesting a readiness to return to higher intensity/volumes of exercise. However, both symptomatic groups and the hospital-recovered group have persistent functional limitations when compared with active controls, supporting the requirement for ongoing monitoring, rehabilitation, and recovery.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- Headquarters Army Medical Directorate, Robertson House, Camberley, United Kingdom
| | - Alexander N. Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Robert Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Andrew Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Samantha May
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Daniel Mills
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Dominic Dewson
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Kasha Rogers-Smith
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Christopher Ward
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - John Taylor
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Joseph Mulae
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Jon Naylor
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Edward D. Nicol
- Royal Brompton Hospital, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - David A. Holdsworth
- Academic Department of Military Medicine, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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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: 25] [Impact Index Per Article: 12.5] [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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Romero-Ortuno R, Jennings G, Xue F, Duggan E, Gormley J, Monaghan A. Predictors of Submaximal Exercise Test Attainment in Adults Reporting Long COVID Symptoms. J Clin Med 2022; 11:2376. [PMID: 35566502 PMCID: PMC9099491 DOI: 10.3390/jcm11092376] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 02/08/2023] Open
Abstract
Adults with long COVID often report intolerance to exercise. Cardiopulmonary exercise testing (CPET) has been used in many settings to measure exercise ability but has been conducted in a few long COVID cohorts. We conducted CPET in a sample of adults reporting long COVID symptoms using a submaximal cycle ergometer protocol. We studied pre-exercise predictors of achieving 85% of the age-predicted maximum heart rate (85%HRmax) using logistic regression. Eighty participants were included (mean age 46 years, range 25−78, 71% women). Forty participants (50%) did not reach 85%HRmax. On average, non-achievers reached 84% of their predicted 85%HRmax. No adverse events occurred. Participants who did not achieve 85%HRmax were older (p < 0.001), had more recent COVID-19 illness (p = 0.012) with higher frequency of hospitalization (p = 0.025), and had been more affected by dizziness (p = 0.041) and joint pain (p = 0.028). In the logistic regression model including age, body mass index, time since COVID-19, COVID-19-related hospitalization, dizziness, joint pain, pre-existing cardiopulmonary disease, and use of beta blockers, independent predictors of achieving 85%HRmax were younger age (p = 0.001) and longer time since COVID-19 (p = 0.008). Our cross-sectional findings suggest that exercise tolerance in adults with long COVID has potential to improve over time. Longitudinal research should assess the extent to which this may occur and its mechanisms. ClinicalTrials.gov identifier: NCT05027724 (TROPIC Study).
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Affiliation(s)
- Roman Romero-Ortuno
- School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland; (G.J.); (F.X.); (E.D.); (J.G.); (A.M.)
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