The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19

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Brito, Gisele Mendes ; Leite do Prado, Danilo Marcelo ; Rezende, Diego Augusto ; Nagem Janot de Matos, Luciana Diniz ; Loturco, Irineu ; Campos Vieira, Marcelo Luiz ; de Sa Pinto, Ana Lucia ; Bougleux Alo, Rodrigo Otavio ; Araujo de Albuquerque, Lorena Christine ; Bianchini, Flavia Riva ; Pinto, Ana Jessica ; Roschel, Hamilton ; Lemes, Italo Ribeiro ; Gualano, Bruno

• Document type: Journal article
• Source: FRONTIERS IN MEDICINE; v. 10, p. 9-pg., 2023-04-26.

Abstract

IntroductionCardiopulmonary 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. MethodsParticipants' 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. ResultsA 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). DiscussionA 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. (AU)

• FAPESP's process: 17/13552-2 - Reducing sedentary time in clinical populations: the take a stand for health study
• Grantee: Bruno Gualano
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/19418-9 - Acute and chronic effects of reducing sedentary time in rheumatoid arthritis: the Take a stand for health study
• Grantee: Ana Jéssica Pinto
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate (Direct)
• FAPESP's process: 20/04877-8 - Impact of interleukin-6 receptor blockade on acute response to exercise on insulin sensitivity and muscle glucose uptake in patients with Rheumatoid Arthritis
• Grantee: Ítalo Ribeiro Lemes
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 15/26937-4 - Studies on physical (in)activity in patients with rheumatoid arthritis: characterization, associations with disease and effects of breaking up sedentary time
• Grantee: Ana Jéssica Pinto
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)