Analysis of the COVID-19 Lockdown Impact on Biological Parameters and Physical Performance in Football Players

The COVID-19 pandemic has caused significant changes in global sustainability, but specifically, this study analyses the impact of lockdown on health and behavior in the game of football. The 2020/2021 Italian football competitive season (indicated as "post-COVID”), taking place following an obliged lockdown and longer than the normal summery season break, was characterized by very short recovery times and was compared to the 2018–2019 "pre-COVID” season, which had a regular course. The comparisons were about anthropometric and hormonal responses, muscle damage, and the physical performance of players in the major league (Serie A), and were made considering two extreme points of the competitive seasons: before the preparatory period (T0) and at the end of the season (T1). Turning to the results, it is significant to note the following: (1) body fat percentage was lower at the start (T0) of the post-COVID season than at the start of the pre-COVID season. During both seasons, serum CK and LDH increased in T1 and were significantly higher in both T0 and T1 of the post-COVID season. (2) Cortisol and testosterone concentrations increased in both seasons from T0 to T1;however, in the post-COVID season, concentrations of both were higher than in the previous season. The testosterone to cortisol ratio increased at the end of the pre-COVID season, whilst strongly decreasing at T1 of the post-COVID season. (3) Blood lactate concentrations significantly decreased during the pre-COVID season but remained unchanged during the post-COVID season. We may conclude that the enforced suspension period and the consequent rapid resumption of all activities influenced the physical and physiological state of professional footballers.

Cardiopulmonary, functional, cognitive and mental health outcomes post covid, across the range of severity of acute illness, in a physically active working age population: baseline findings from the MCOVID study

BackgroundThe medium-long impact of coronavirus disease 2019 (COVID-19) on active populations is yet to be fully understood, with potential individual and operational impact on military service personnel (SP). The M-COVID study was established to investigate cardiopulmonary, functional, cognitive, and mental health post-COVID-19 SP outcomes, across the spectrum of acute COVID-19 severity.MethodObservational four-cohort study;hospitalised, community-based illness with on-going symptoms (communitysymptomatic), community-based illness now recovered (community-recovered) and age, sex, job-role matched control. Participants underwent extensive clinical assessment involving cardiopulmonary imaging, submaximal and maximal exercise testing, pulmonary function, cognitive assessment, blood tests, electrocardiogram and questionnaires on mental health and physical function.Results113 participants (aged 39±9, 86% male) were recruited;Hospitalised (n=35), community-symptomatic (n=34), community-recovered (n=18) and control (n=26), 159±72 days following acute illness. Hospitalised and community-symptomatic groups were older (p=0.003), with a higher body mass index (p<0.001), and worse mental health (anxiety,p=0.011;depression,p<0.001;post-traumatic stress, p<0.001), fatigue (p<0.001), and quality of life scores (p=0.001), with a mean of 2±2 and 2±1 symptoms, respectively. Hospitalised and community-symptomatic participants also performed less well on sub-maximal (p<0.001) and maximal exercise testing, with hospitalised individuals displaying impaired ventilatory efficiency (p<0.001), less work at the anaerobic threshold and at peak (both p<0.001), and significantly reduced forced vital capacity (p=0.004). Clinically significant abnormal cardiopulmonary imaging findings were present in 6% of hospitalised participants, lower than those seen in other studies. Those who recovered from communitybased, mild-moderate COVID-19 had no significant differences from controls on any parameter.ConclusionsRecovered SP who suffered mild-moderate COVID-19 do not differ from an age, sex and job-role matched controls. This is reassuring for the vast majority of individuals who have had acute COVID-19 not requiring hospital management. Individuals who were hospitalised or continue to suffer symptoms may require a specific, comprehensive clinical and occupational assessment prior to a full return to duty.

Impact of the COVID-19 pandemic on exercise tolerance and patient outcomes with Phase III cardiac rehabilitation in Japan: A multicenter study.

This study aimed to determine how behavioural restrictions due to the emergency declaration following the coronavirus disease 2019 (COVID-19) pandemic affect exercise tolerance and its outcomes in patients in Phase III cardiac rehabilitation programme. This is a multicenter retrospective cohort study. Participants in outpatient cardiac rehabilitation programmes and cardiopulmonary exercise testing before and after the emergency declarations were included. A total of 90 participants were included (median age 75.0 years, 69% male), and the changes in physical function and exercise tolerance were compared before and after the emergency declaration. Patients were divided into a decline-in-peak oxygen uptake (VO2 ) group and a nondecline-in-peak VO2 group. Comparison before and after the emergency declaration showed that the anaerobic threshold declined significantly and peak VO2 exhibited a downward trend. The decline-in-peak VO2 group consisted of 16 patients (17%) with better exercise tolerance, multiple comorbidities, and declined lower extremity muscle strength. These patients also had a higher rate of subsequent composite events (hazard ratio, 5.2; 95% confidence interval, 1.4-18.8, p = 0.01). Before and after the emergency declaration, the patient's exercise tolerance may decline, leading to a poor prognosis. This study suggests the importance of maintaining exercise tolerance during the COVID-19 pandemic.

Long-term cardiopulmonary exercise outcomes among COVID-19 survivors: preliminary insights from an Italian study

Introduction: Early studies on the short- and medium-term cardiopulmonary sequalae of COVID-19 have shown a certain degree of exercise capacity impairment among survivors (Naeije R, Caravita S. Eur Respir J 2021;58:2101763). Whether such condition is reversible at longer follow-up is unknown. Aim(s): To assess the long-term cardiopulmonary exercise outcomes of COVID-19 in survivors who displayed a reduced exercise capacity shortly after recovery. We tested the hypothesis that physical reconditioning following hospital discharge would improve the aerobic performance and exercise capacity. Method(s): In this observational study 19 COVID-19 survivors who displayed a reduced exercise capacity 6 months after discharge (Rinaldo RF et al. Eur Respir J 2021;58:2100870) underwent reevaluation with CPET between April - May 2022. Lung function and CPET data were recorded. Result(s): At 2 year follow-up, the proportion of patients with a normal exercise capacity (12/19) was statistically significantly different from baseline (0/19), p-value 0.000 (exact McNemar's test). Among the parameters of oxygen delivery/utilization there was an overall statistically significant improvement of the anaerobic threshold (47% vs 54%). Conclusion(s): On a small group of patients, our study supports the hypothesis that exercise capacity impairment after COVID-19 is reversible at longer follow-up, with signs of an improved aerobic performance.

Persisting exertional dyspnea and perceived exercise intolerance after mild Covid-19: a critical role for breathing dysregulation?

Background: After mild Covid-19, a subgroup of patients reports post-acute sequelae of Covid-19 (PASC), in which exertional dyspnea and perceived exercise intolerance are common. Underlying pathophysiological mechanisms remain incompletely understood. We studied outcomes from cardiopulmonary exercise test (CPET) in these patients. Method(s): In this observational study, we included patients referred for the analysis of PASC after mild Covid-19 in whom CPET was performed after standard clinical work-up turned out unremarkable. Cardiocirculatory, ventilatory and metabolic response to, and breathing patterns during exercise at physiological limits were analyzed. Result(s): Twenty-one patients (76% female, mean age 40y) who reported severe fatigue (CIS-fatigue >= 35), dyspnea (mMRC 2 (IQR1-2)) and disability in physical role functioning (SF-36) underwent CPET at 32 weeks (IQR 22-52) after Covid-19. Mean peak oxygen uptake was 99% (SD13) of predicted with normal anaerobic thresholds at 62% (SD11) of predicted oxygen uptake. No cardiovascular or gas exchange abnormalities were detected. Twenty out of the 21 patients (95%) demonstrated breathing dysregulation, existing of ventilatory inefficiency (29%), abnormal course of breathing frequency and tidal volume (57%), and acute or chronic respiratory alkalosis in resting blood gases (67%). Conclusion(s): In the absence of deconditioning, breathing dysregulation may explain the experienced exertional dyspnea and exercise intolerance in patients with PASC after mild Covid-19.

Impact of Personal Protective Masks on Cardiorespiratory Variables in Healthy Subjects and Patients with Heart Failure: An Interim Analysis

Background: protective masks have emerged as a powerful mean to contain the COVID-19 pandemic. However, a general feeling that masks alter the normal dynamics of breathing may reduce the application of this protective device. Patients with heart failure (HF) experience dyspnea even during daily life activities (ADLs). Aim of the study is to evaluate cardiorespiratory parameters during ADLs, cardiopulmonary exercise test (CPET) and sleep to highlight any difference related to protective masks. Method(s): 9 healthy subjects (age 59+/-11, 2 female) and 10 HF patients (age 64+/-11, 2 female, ejection fraction <45%, stable conditions) underwent a set of cardiopulmonary tests twice, wearing a protective surgical mask and without it. We performed the following tests: standard spirometry;CPET;a set of tests recorded by a wearable ergospirometer (Cosmed K5), including ADLs (ADL1: getting dressed, ADL2: folding eight towels, ADL3: putting away 6 bottles, ADL4: making a bed, ADL5: sweeping the floor for 4 minutes, ADL6: climbing 1 flight of stairs carrying a load), six-minute walking test (6MWT) and two 4-minute treadmill exercises (TREAD2 and TREAD3 at a speed of 2 km/h and 3 km/h, respectively);home polysomnography (HPS). Result(s): Both healthy subjects and HF patients completed the protocol with no adverse events. Spirometry showed a reduction of forced expiratory volume in 1s (3.29+/-0.75 L vs 2.65+/-0.57 L as for healthy subjects, p= 0.002;2.45+/-0.6 L vs 1.97 +/-0.54 L as for HF patients, p= 0.002) and forced vital capacity (4.14+/-0.92 L vs 3.39+/-0.83 L as for healthy subjects, p= 0.004;2.93+/-0.76 L vs 2.59+/-0.73 L as for HF patients, p= 0.01) in both the groups from no mask to mask. As for the CPET, both healthy and HF patients showed: a trend of reduction of peak oxygen pulse (p<0.005 in healthy) and peak oxygen consumption (VO2);a decrease of tidal volume (Vt) at peak exercise (peak Vt: 2.283+/-0.449 L vs 1.864+/-0.359 L in healthy, p= 0.022;1.6+/-0.41 L vs 1.448+/-0.431 L in HF, p= 0.02), with no significative variations of resting and peak ventilation (VE). HF patients experienced a statistically significative decrease of VO2 at the anaerobic threshold (AT) (794+/-227 vs 682 +/-151 mL min-1, p=0.01). No significant differences in the other CPET parameters were observed. As for tests recorded by a wearable cart, task-related VO2 was significantly reduced from no mask to mask in ALDs and 6MWT in the healthy, whereas HF patients experienced a significative reduction in ADL1, ADL4, 6MWTand TREADs (probably more physically demanding tasks). Both healthy and HF subjects showed an increase in the basal and task-related ratio of VE vs carbon dioxide production (VE/VCO2) between the two protocol conditions. No difference in the main HPS parameters were observed from no mask to mask. Conclusion(s): Surgical masks slightly influences cardiorespiratory variables in healthy and HF patients at rest and during both mild and maximal physical activity. The physiological impact of the mask is far from being clinically relevant and no main differences between the groups were noted, except for an early AT in patients with HF. Since no main limitations were observed, the use of masks seems to be safe both in the general population and in HF patients. Moreover, it does not have a significant impact on sleep neither in healthy subjects nor in patients with HF, these ones particularly at risk of sleep apneas. These data should be confirmed in a larger group of patients.

Cardiopulmonary exercise testing in patients with long covid

ObjectiveExamine the relationship between symptoms and exercise physiological parameters in patients with long covid.MethodsPatients with long covid symptoms 6–12 months after covid19 infection referred to the long covid clinic were invited for Cardiopulmonary Exercise Testing (CPET). None had required ventilatory support during covid19 infection. All patients had normal transthoracic echocardiograms and normal resting flow-volume curves and gas transfer measurements. All patients underwent standard cycle ergometer symptom-limited CPET. Treatment guided by the CPET was offered and follow-up CPET was performed at 3 months.Results32 patients had a first CPET. The commonest symptoms were breathlessness (30/32), fatigue (26/32), cough (7/32), ‘brain fog’ (6/32) and chest pain (5/32). The main CPET physiological abnormalities were a borderline low peak oxygen uptake (mean 82.5% predicted), a low anaerobic threshold (AT, mean 47.6% of predicted maximal oxygen uptake) and a low oxygen uptake/work rate slope (mean 9.4 ml/min/W). The oxygen pulse curve flattened early in exercise, but peak oxygen pulse was normal (mean 88.9%).20 patients underwent a second CPET. 14 patients had improved symptoms: breathlessness (11/20), fatigue (9/20), cough (2/20), ‘brain fog’ (3/20) and chest pain (0/20). Symptom improvement was associated with a rise in peak oxygen uptake (to mean 85.3% predicted) and oxygen pulse (to mean 94.1% predicted) although both remained within the normal range. The AT remained low (mean 46.4% predicted maximal oxygen uptake). The ventilatory equivalent for carbon dioxide (VE/VCO2) was normal 28.6 L/L at AT.6 patients with unchanged symptoms had a reduction in oxygen pulse to mean 81.5% predicted compared to the first CPET but a rise in VE/VCO2 to 33.7 L/L at AT.ConclusionsLong covid is associated with impaired peak oxygen uptake, AT and oxygen pulse. This suggests an oxygen delivery or uptake disorder or deconditioning. The transthoracic echocardiograms were normal suggesting a disorder at the muscle level.A targeted treatment programme based on CPET improves symptoms and physiological parameters in long covid patients.Patients with unchanged symptoms after 3 months of treatment had persistent physiological abnormalities but appeared to develop features of dysfunctional breathing syndrome.

Cardiopulmonary exercise test in children with pediatric inflammatory multisistemic syndrome associated with COVID-19 (PIMS)

Background and Aim: Coronavirus infection (COVID-19) in paedi-atric population has a generally mild course. In Spain, patients under 15 years old have accounted only for 0,4% of hospital admis-sions and 0,7% of intensive care admissions. However, in May 2020, cases of children with a systemic inflammatory syndrome related to a recent COVID-19 infection were described. In severe forms, left ventricular systolic dysfunction, mitral regurgitation, pericardial effusion and coronary artery dilatation or aneurysms have been described. The aim of this study is to describe the results obtained in cardiopulmonary exercise test (CPET) in previously healthy patients with PIMS. Method(s): Prospective study of PIMS patients who performed CPET. Godfrey ramp protocol recommended by European Society of Cardiology (ESC) was used in all cases. Measured var-iables, expressed by predicted values, were: forced vital capacity (FVC), forced expiratory volume (FEV1), ratio of minute venti-lation to carbon dioxide production (VE/VO2 slope), maximal oxygen consumption (VO2 max), oxygen uptake efficiency slope (OUES), oxygen pulse (O2 pulse) and maximum heart rate (HR). Result(s): Eight patients (75% boys) aged 5-14 years (median 10,5 years) performed CPET reaching a mean peak load of 105,87 W (median 112,5 W and mean load per kg of weight 2,34 W/kg). Only 1 patient (12,5%) presented basal spirometric disturb-ances in context of asthma without chronic treatment. Obtained mean respiratory parameters were: FVC 97,88%, FEV1 92,7%, Tiffeneau 83% and VECO2p 32,47. Oxygen satu-ration before and after CPET was greater than 95% in 100% of patients. In 6 patients (75%) the V02max and oxygen pulse was greater than 80% of predicted value (100% of patients reached at least 40% of V02 max at anaerobic threshold). Obtained mean cardiovascular parameters were: VO2 max 1624mL/min (median 1655 ml/min and V02 per kg of weight 36,9 ml/kg), pulse oxygen 9 ml and OUES 1,92. Conclusion(s): PIMS may cause severe cardiac disturbances justifying cardiological monitoring of these patients. CPET allows to assess functional capacity of these children after the disease. In our serie, most of patients had a good functional capacity (75%). Studies with more patients are needed to make extended conclusions.

DECREASED EXERCISE CAPACITY AS A SEQUELA OF COVID-19: INSIGHTS FROM CARDIOPULMONARY RESPONSES TO MAXIMAL EXERCISE BEFORE AND AFTER RECOVERY FROM THE DISEASE

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: SARS-CoV-2 infection can lead to persistent, long-term sequelae after recovery from the acute disease process. One such reported sequelae is reduced exercise capacity (i.e., low peak pulmonary O2uptake;V̇O2peak). However, only cross-sectional approaches that did not account for baseline (i.e., before COVID-19) V̇O2peak support this assumption. As such, whether reduced exercise capacity is a consequence of or in fact predates SARS-CoV-2 infection remains unknown. Accordingly, we compared the cardiopulmonary responses to maximal incremental exercise (CPET) before and after COVID-19. Specifically, we determined whether COVID-19 is associated with a decrease in V̇O2peak. METHODS: We retrospectively reviewed CPET data collected across the Mayo Clinic Enterprise between Oct 2018 and Mar 2022. 42 individual patients who completed a CPET before and after a COVID-19 diagnosis were included (36, 4, and 2 patients experienced mild, moderate, or severe illness, respectively). In addition, we included a control group of 25 individual patients who performed two separate CPETs but did not contract SARS-CoV-2 (CTL). All patients were clinically stable between the two CPETs, defined as no worsening/change in disease status or medication, and performed the same CPET protocol for both tests. A mixed within- and between-subjects design was used to examine differences in cardiopulmonary responses to CPET both across time and between the COVID-19 and CTL groups. RESULTS: The COVID-19 and CTL groups were matched for sex (36 vs. 32% female;P = 0.757), age (49 ± 15 vs. 50 ± 16 y, P = 0.652), BMI (29.1 ± 5.4 vs. 29.7 ± 5.2 kg/m2;P = 0.868), and time between the two CPETs (489 ± 225 vs. 534 ± 257 days, P = 0.662). In the COVID-19 group, the first and second CPET were performed 312 ± 232 days before and 176 ± 110 days after SARS-CoV-2 infection, respectively. Exercise time, peak heart rate, peak systolic pressure, O2pulse (V̇O2/heart rate), anaerobic threshold, peak ventilation, and ventilatory efficiency (V̇E/V̇CO2 slope) were not different between the groups. There was a small but significant reduction in V̇O2peak from before to after SARS-CoV-2 infection (−1.4 ± 0.5 mL/Kg/min, P = 0.038);however, the change in V̇O2peak between the two CPETs was not different between COVID-19 vs. CTL (−5 ± 13 vs. −3 ± 15%, P = 0.585). The change in V̇O2peak in the groups likely falls within the normal error of the measurement during CPET. CONCLUSIONS: Accounting for baseline measures of V̇O2peak, we find no substantial evidence for decreased exercise capacity within one to 15 months after SARS-CoV-2 infection, especially when compared to patients who did not suffer COVID-19. CLINICAL IMPLICATIONS: Our findings suggest that care may need to be taken when reporting a consequential impairment in exercise capacity secondary to COVID-19 when prior baseline (i.e., before COVID-19) data are not available. DISCLOSURES: No relevant relationships by Arvind Balavenkataraman No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes no disclosure on file for Scott Helgeson;No relevant relationships by Neal Patel Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support

Exercise performance before and after introduction of elexacaftor/tezacaftor/ivacaftor (Kaftrio®) in Scottish children with cystic fibrosis: a 2-centre retrospective study

Objectives: Elexacaftor/tezacaftor/ivacaftor (ETI) combination therapy - Kaftrio® was approved for use in the UK in August 2020 for those aged >12 years. Our study aimed to study the effects of ETI therapy on lung function and exercise performance. Methods: Two-centre retrospective analysis of clinical data obtained during patients’ annual review assessments. Patients had undergone spirometry and static lung volume measurements followed by an incremental maximal ramp cardiopulmonary exercise testing (CPET) performed on a cycle ergometer. Data were analysed using a paired sample t-test. Results: Lung function improvement did not reach statistical significance. Of note, four patients had a baseline (pre-ETI) FEV1 belowthe lower limit of normal (LLN <-1.64 Z scores), and one improved their FEV1 from 41% predicted to 87% with Kaftrio®. Five had a VO2peak% predicted below the LLN (< 85% predicted) prior to treatment and 8 post treatment. Therewas a significant fall in VO2peak % predicted, p = 0.03. However, this was not seen in the VO2peak relative to bodyweight, p = 0.07. There was also a significant fall in VO2 at anaerobic threshold (AT) as a % of predicted VO2peak, p = 0.01. Table 1. (Table Presented) (Table Presented) Conclusions: This real-world study suggests Kaftrio® does not improve exercise capacity in the majority of CF patients. It is hypothesised that the lack of improvement may be due to a reduced physical activity over the study period as a result of feeling better on Kaftrio® and also the SARSCoV2 pandemic. The decrease in VO2 at AT would support the hypothesis of physical deconditioning. The reasons for not seeing statistical differences in lung function are likely to represent the relatively high baseline FEV1 alongside small study numbers. In summary, whilst having the potential to be a performance-enhancing drug, performance gains on Kaftrio® can only occur if matched by training, and studies to investigate the training potential of Kaftrio® are required.

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome.

BACKGROUND AND AIM: Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome. METHODS: A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis. RESULTS: A total of 200 patients (mean age 48.8±14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8±8.1mL/min/kg vs. 28.8±9.6mL/min/kg, p=0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p<0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p=0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders. CONCLUSION: Our data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.

Physiological Aspects of World Elite Competitive German Winter Sport Athletes

Nine Ski mountaineering (Ski-Mo), ten Nordic-Cross Country (NCC) and twelve world elite biathlon (Bia) athletes were evaluated for cardiopulmonary exercise test (CPET) performance as the primary aim of our descriptive preliminary report. A multicenter retrospective analysis of CPET data was performed in 31 elite winter sports athletes, which were obtained in 2021 during the annual medical examination. The matched data of the elite winter sports athletes (14 women, 17 male athletes, age: 18–32 years) were compared for different CPET parameters, and athlete’s physique data and sport-specific training schedules. All athletes showed, as estimated in elite winter sport athletes, excellent performance data in the CPET analyses. Significant differences were revealed for VE VT2 (respiratory minute volume at the second ventilatory threshold (VT2)), highest maximum respiratory minute volume (VEmaximum), the indexed ventilatory oxygen uptake (VO2) at VT2 (VO2/kg VT2), the oxygen pulse at VT2, and the maximum oxygen pulse level between the three professional winter sports disciplines. This report provides new evidence that in different world elite winter sport professionals, significant differences in CPET parameters can be demonstrated, against the background of athlete’s physique as well as training control and frequency.

Change of exercise capacity on the patients with cardiovascular disease after the covid19 pandemic

Background: When the COVID19 pandemic had begun, lowering physical function had been predicted. In fact, many patients with cardiovascular disease had been staying home for long time. This study aimed to clarify a change of exercise capacity of patients with cardiovascular disease after the COVID19 pandemic. Methods: We retrospectively evaluated peak O2 uptake (VO2) and Anaerobic threshold (AT) of 23 cardiovascular patients who underwent cardiopulmonary exercise test (CPX) in our hospital for follow-up after outpatient cardiac rehabilitation both between July and September in 2020 (after the COVID19 pandemic) and between December in 2019 and April in 2020 (before the COVID19 pandemic). And of them, 13 patients had undergone CPX also between July and September in 2019. We evaluated their exercise capacity to consider a seasonal effect of summer. Results: Peak VO2 after the COVID19 pandemic was significantly lower and decreased by 20% in a short term (20.6 ml/kg/min [±7.75] vs 17.17 ml/kg/min [±6.79];p<0.001). AT was also the same result (12.9 ml/kg/min [±3.34] vs 10.96 ml/kg/min [±2.78];p<0.001). In regard to comparison with exercise capacity 1 year ago, both peak VO2 (19.28 ml/kg/min [±7.45] vs 17.22 ml/kg/min [±7.15];p=0.003) and AT (19.28 ml/kg/min [±7.45] vs 17.22 ml/kg/min [±7.15];p=0.003) after the COVID19 pandemic were significantly lower. Despite the same season, exercise capacity had decreased after the COVD19 pandemic. Conclusion: After the COVID19 pandemic, exercise capacity of patients with cardiovascular disease had been falling. There is a possibility that it will be important problem in new-normal life.

Comparison of Anthropometric and Physiological Profiles of Hungarian Female Rowers across Age Categories, Rankings, and Stages of Sports Career

There is very little research on the anthropometric and physiological profiles of lower-ranked young female athletes, even though, in most rowing clubs, such rowers constitute the vast majority. Therefore, this study investigated the anthropometric and physiological profiles of young Hungarian female rowers of different age categories and sports rankings (international vs. club). Anthropometric and physiological profiles were created for 36 junior (15–16 years), 26 older-junior (17–18 years), and 8 senior (19–21 years) female rowers who were club and international ranked members of seven of the largest Hungarian rowing clubs. Rowers >17-years-old with international rankings significantly outperformed their age-group peers with club rankings in terms of power, absolute VO2 max, and time to cover 2000 m, among other differences, but such differences were not observed with junior rowers. In all age groups, the length of the athletes’ sports career was not significantly associated with differences in anthropometric and physiological characteristics. This study suggests that ranking is not associated with differences in the anthropometric and physiological characteristics of juniors. Thus, with non-elite juniors, it can be more difficult to predict competition outcomes based on differences in anthropometric and physiological profiles.

Prior sars-cov-2 infection is associated with subclinical changes in the cardiovascular morphology, function, energetics and exercise capacity

Background: COVID-19 has documented multisystem effects. Whether clinically significant cardiac involvement is related to severity of disease in a working age military population remains unknown, but has implications for occupational grading and ability to deploy. Aims: To determine in the military population 1) whether prior SARS-CoV-2 infection causes clinically significant cardiac disease and 2) whether changes are related to disease severity. Methods: 105 military personnel were recruited, 85 with prior SARS-CoV-2 infection (39±10 years, 87% male;50 mild (community), 35 severe (hospitalized) and 20 healthy volunteers (mean age 39 ±8.4 years, 90% male) underwent comprehensive cardiopulmonary investigations including;cardiopulmonary exercise test, exercise echocardiography, cardiac31MRI and P-MR spectroscopy (rest and dobutamine stress). Results: Prior SARS-CoV-2 infection was related to lower VO2max (110±18.2 vs 133±6.7% predicted, p<0.05), anaerobic threshold (45±10 vs 56±14% of peak VO2, p<0.05), VO2/HR (102±21 vs 128±24% predicted, p<0.05) and VE/VCO2 slope (28.3±5.0 vs 25.8±2.7, p<0.05) and an increase in average E/e' change from rest to exercise stress (+1.49±2.4 vs-0.16±3.6, p<0.05). Whilst resting myocardial energetics were similar, prior SARS-CoV-2 infection was associated with a fall in PCr/ATP during stress (by 8%, p=<0.01) which was not seen in healthy controls. When groups were ordered normal> mild> severe disease, RVEDVi, RV stroke volume, VO2peak, VO2pulse and VE/VCO slope were reduced (Jonckheere-Terpstra, all p<0.05). Conclusion: In a young military population, prior SARS-CoV-2 infection is associated with subclinical cardiovascular changes including;lower right ventricular volumes, reduced markers of exercise capacity and reduced myocardial energetics during stress.

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

During the pandemic, several studies were carried out on the short-term effects of acute SARS-CoV-2 infection in athletes. As some cases of young athletes with serious complications like myocarditis or thromboembolism and even sudden death were reported, strict recommendations for return to sport were published. However, we have less data about athletes who have already returned to high-intensity trainings after a SARS-CoV-2 infection. Athletes underwent cardiology screening (personal history, physical examination, 12-lead resting ECG, laboratory tests with necroenzyme levels and echocardiography) 2 to 3 weeks after suffering a SARS-CoV-2 infection. In case of negative results, they were advised to start low intensity trainings and increase training intensity regularly until achieving maximal intensity a minimum of 3 weeks later. A second step of cardiology screening was also carried out after returning to maximal intensity trainings. The above mentioned screening protocol was repeated and was completed with vita maxima cardiopulmonary exercise testing (CPET) on running treadmill. If the previous examinations indicated, 24h Holter ECG recording, 24h ambulatory blood pressure monitoring or cardiac MR imaging were also carried out. Data are presented as mean±SD. Two-step screening after SARS-CoV-2 infection was carried out in 111 athletes (male:74, age:22.4±7.4y, elite athlete:90%, training hours:14.8±5.8 h/w, ice hockey players:31.5%, water polo players:22.5%, wrestlers:18.9%, basketball players:18.0%). Second screenings were carried out 94.5±31.5 days after the first symptoms of the infection. A 5% of the athletes was still complaining of tiredness and decreased exercise capacity. Resting heart rate was 70.3±13.0 b.p.m., During CPET examinations, athletes achieved a maximal heart rate of 187.3±11.6 b.p.m., maximal relative aerobic capacity of 49.2±5.5 ml/kg/min, and maximal ventilation of 138.6±31.2 l/min. The athletes reached their anaerobic threshold at 87.8±6.3% of their maximal aerobic capacity, with a heart rate of 93.3±3.7% of their maximal values. Heart rate recovery was 29.9±9.2/min. During the CPET examinations, short supraventricular runs, repetititve ventricular premature beats + ventricular quadrigeminy and inferior ST depression were found in 1-1 cases. Slightly higher pulmonary pressure was measured on the echocardiography in 4 cases. Hypertension requiring drug treatment was found in 5.4% of the cases. Laboratory examinations revealed decreased vitamin D3 levels in 26 cases, decreased iron storage levels in 18 athletes. No SARS-CoV-2 infection related CMR changes were revealed in our athlete population. Three months after SARS-CoV-2 infection, most of the athletes examined had satisfactory fitness levels. However, some cases of decreased exercise capacity, decreased vitamin D3 or iron storage levels, arrhythmias, hypertension and elevated pulmonary pressure requiring further examinations, treatment or follow-up were revealed.

EMG breakpoints for detecting anaerobic threshold and respiratory compensation point in recovered COVID-19 patients.

INTRODUCTION: A huge number of COVID-19 patients should be referred to rehabilitation programmes. Individualizing the exercise intensity by metabolic response provide good physiological results. The aim of this study was to investigate the validity of EMG as a non-invasive determinant of the anaerobic threshold and respiratory compensation point, for more precise exercise intensity prescription. METHODS: An observational cross-sectional study with 66 recovered COVID-19 patients was carried out. The patients underwent a cardiopulmonary exercise test with simultaneous assessment of muscle electromyography in vastus lateralis. EMG breakpoints were analyzed during the ramp-up protocol. The first and second EMG breakpoints were used for anaerobic threshold and respiratory compensation point determination. RESULTS: EMG and gas exchange analysis presented strong correlation in anaerobic threshold (r = 0.97, p < 0.0001) and respiratory compensation point detection (r = 0.99, p < 0.0001) detection. Bland-Altman analysis demonstrated a bias = -4.7 W (SD = 6.2 W, limits of agreement = -16.9 to 7.6) for anaerobic threshold detection in EMG compared to gas exchange analysis. In respiratory compensation point detection, Bland-Altman analysis demonstrated a bias = -2.1 W (SD = 4.5 W, limits of agreement = -10.9 to 6.6) in EMG compared to gas exchange analysis. EMG demonstrated a small effect size compared to gas exchange analysis in oxygen uptake and power output at anaerobic threshold and respiratory compensation point detection. CONCLUSIONS: EMG analysis detects anaerobic threshold and respiratory compensation point without clinical significant difference than gas exchange analysis (gold standard method) in recovered COVID-19 patients.

Playing around the anaerobic threshold during COVID-19 pandemic: advantages and disadvantages of adding bouts of anaerobic work to aerobic activity in physical treatment of individuals with obesity.

INTRODUCTION: Obesity is a condition that generally limits work capacity and predisposes to a number of comorbidities and related diseases, the last being COVID-19 and its complications and sequelae. Physical exercise, together with diet, is a milestone in its management and rehabilitation, although there is still a debate on intensity and duration of training. Anaerobic threshold (AT) is a broad term often used either as ventilatory threshold or as lactate threshold, respectively, detected by respiratory ventilation and/or respiratory gases (VCO2 and VO2), and by blood lactic acid. AIMS AND METHODOLOGY: This review outlines the role of AT and of the different variations of growth hormone and catecholamine, in subjects with obesity vs normal weight individuals below and beyond AT, during a progressive increase in exercise training. We present a re-evaluation of the effects of physical activity on body mass and metabolism of individuals with obesity in light of potential benefits and pitfalls during COVID-19 pandemic. Comparison of a training program at moderate-intensity exercise (< AT) with training performed at moderate intensity (< AT) plus a final bout of high-intensity (> AT) exercise at the end of the aerobic session will be discussed. RESULTS: Based on our data and considerations, a tailored strategy for individuals with obesity concerning the most appropriate intensity of training in the context of rehabilitation is proposed, with special regard to potential benefits of work program above AT. CONCLUSION: Adding bouts of exercise above AT may improve lactic acid and H+ disposal and improve growth hormone. Long-term aerobic exercise may improve leptin reduction. In this way, the propensity of subjects with obesity to encounter a serious prognosis of COVID-19 may be counteracted and the systemic and cardiorespiratory sequelae that may ensue after COVID-19, can be overcome. Individuals with serious comorbidities associated with obesity should avoid excessive exercise intensity.