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. 2022 Dec 7;17(12):e0277984.
doi: 10.1371/journal.pone.0277984. eCollection 2022.

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

Shirin Vollrath  1 , Daniel Alexander Bizjak  1 , Jule Zorn  1 , Lynn Matits  1   2 , Achim Jerg  1 , Moritz Munk  1 , Sebastian Viktor Waldemar Schulz  1 , Johannes Kirsten  1 , Jana Schellenberg  1 , Jürgen Michael Steinacker  1
Affiliations

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

Shirin Vollrath et al. PLoS One. .

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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Development of symptom status.
Symptom status of all 60 athletes at t0 (first examination date) and t1 (3.3 ± 0.5 months post first examination). 35 of 44 athletes, who had persistent symptoms at t0 still stated persistent symptoms at t1 (progression group PS-PS). Nine athletes became symptom-free over three months (progression group PS-SF). 14 of the 16 athletes remained symptom-free over the observation period (SF-SF). Two athletes developed symptoms over time. Data were collected with medical history and the International Consensus CFS questionnaire [24].
Fig 2
Fig 2. Course of symptom categories over investigation period.
Number of athletes who stated at least one symptom in the eight symptom categories at t0 (first examination date) and t1 (3.3 ± 0.5 months post first examination). Data of symptom categories were collected with medical history and the International Consensus CFS questionnaire [24]. In total 44 athletes stated at least one symptom at t0 and 37 athletes at t1 (3.3 ± 0.5 months post first examination). Athletes could state symptoms in multiple categories.
Fig 3
Fig 3. Differences between predVO2 and Peak VO2/BM.
Significant differences of means between the calculated Peak VO2 (predVO2) and in PS and SF at t0 (first examination). In both groups the measured values were significantly below the values predicted for the time before infection. **p<0.01, ***p<0.001.
Fig 4
Fig 4. Differences in CPET between SF and PS at study inclusion.
SF (symptom-free) had significantly higher mean values for (A) Max Power/BM, (B) Max Power/lbm, (C) Peak VO2, Peak VO2/BM, (E) Peak VO2/lbm, (F) Peak VO2/HR, and (G) Peak VE at t0 (first examination date). PS (persistent symptoms) had higher mean value for (I) VE/VCO2-Slope compared to SF at t0. (H) Without confounder, a significantly higher mean value of Peak Vt in SF could be observed. *p<0.05, **p<0.01, ***p<0.001.
Fig 5
Fig 5. Change of CPET variables over three months.
(A) Variable Max Power/BM had in SF-SF (symptom-free–symptom free) significantly higher mean values at t1 (three months post first examination) than at t0 (first examination date). (B) Variable Max Power/lbm had in SF-SF significantly higher mean values at t1 than at t0. (C) Variable VE/VCO2-Slope had in PS-PS significantly lower mean values at t1 than at t0. *p<0.05, **p<0.01.
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