Former SARS-CoV-2-Infection is related to decreased peak VO2 and exercise hyperten-sion in athletes
Authors: Keller K , Friedrich O , Treiber J , Quermann A , Friedmann-Bette B 
Published: November 2023

Abstract

Background
The COVID-19 pandemic dramatically changed lifestyle worldwide, including sport activities. Although most competitive athletes have an asymptomatic or mildly symptomatic SARS-CoV-2-infection course and are a low-risk population to develop cardiac and other complications after SARS-CoV-2-infection, a post-COVID-19 screening strategy primarily based on symptoms should detect cardiac involvement and other complications from SARS-CoV-2-infection and should enable save and early return-to-sport. However, incidence, complications and performance consequences of COVID-19-infection in athletes are not fully understood.

Purpose
Thus, the primary aim of the present study was to identify differences in athletes with former COVID-19-infections in comparison to those athletes without COVID-19-infection presenting for their preparticipation screening examination.

Methods
Competitive athletes of any age, who presented for preparticipation screening 04/2020-10/2021 were included in this study and stratified for former COVID-19-infection. Athletes with and without former COVID-19-infection were compared.
Exercise hypertension was defined on the basis of the systolic blood pressure (BP)/MET slope-method: The Δ regarding systolic BP was calculated as maximum systolic BP during exercise–systolic BP at rest and was indexed by the increase in MET from rest (Δ regarding MET was calculated as peak MET – 1) to obtain the systolic BP/MET slope. In accordance with previous studies, a cut-off value &gt; 6.2 mmHg/MET was used to define an exercise hypertension.

Results
Overall, 1200 athletes (mean age 21.9±11.6years; 34.3% females) were included in this study 04/2020-10/2021. Among these, 158 (13.1%) athletes had former COVID-19-infection. Athletes with former COVID-19-infection were older (23.4±7.1 vs. 21.7±12.1years, P&lt;0.001) and more often of male sex (87.7% vs. 64.0%, P&lt;0.001). While systolic/diastolic BP at rest was comparable between both groups, maximum systolic (190.0 [170.0/210.0] vs. 180.0 [160.0/205.0] mmHg, P=0.007) and diastolic BP (70.0 [65.0/75.0] vs. 70.0 [60.0/75.0] mmHg, P=0.012) during exercise-test and frequency of exercise hypertension (54.2% vs. 37.8%, P&lt;0.001) were both higher in athletes with COVID-19-infection. While former COVID-19-infection was not independently associated with higher BP values at rest and maximum BP values during exercise, former COVID-19-infection was related with exercise hypertension (OR 2.13 [95%CI 1.39–3.28], P&lt;0.001).
VO2-peak value during exercise was lower in athletes with former COVID-19-infection compared to those without COVID-19-infection (43.4 [38.3/48.0] vs. 45.3 [39.1/50.6] ml/min/kg, P=0.010). SARS-CoV-2-Infection affected VO2 peak during exercise negatively (OR 0.94 [95%CI 0.91–0.97], P&lt;0.0019) independent of age, sex and body-mass-index.

Conclusions
Former COVID-19-infection in athletes was accompanied by higher frequency of exercise hypertension and reduced peak VO2 during exercise testing.