Cardiopulmonary And Cognitive Testing Pre And Post Covid-19 Diagnosis

History: 23-year-old, athletic male, non-smoker enrolled in a research study to assess the impact of maximal exercise on cognitive performance. He completed a baseline cardiopulmonary exercise test (CPX) with concurrent cognitive tasks on a cycle ergometer and tested positive for COVID-19 6 days later. We conducted a second test 138 days later to examine impact of COVID-19 on CPX outcomes and cognitive performance. Physical Exam: During his first assessment, he presented afebrile with no signs of acute illness and passed the symptom and isolation status screener upon entry to the testing facility. He demonstrated normal exercise capacity (VO2) on the CPX (40.48 mL/min/Kg, 11.6 METs) and appropriate ventilatory and cardiovascular responses to exercise, reporting terminal muscular fatigue at 275 Watts (RER = 1.01, MHR = 175 bpm). A cognitive test of simple reaction speed at peak exertion yielded a score of 279 ms averaging 96.2% accuracy. Differential Diagnosis: COVID-19 associated impairment in exercise capacity Tests and Results: The participant described his illness as mild and did not require treatment or hospitalization. He reported symptoms such as headache, anosmia, dysgeusia, polydipsia, and palpitations, which resolved prior to the second CPX, and a weight loss of 3.5 kg was observed. CPX results revealed test duration (-3.25 min), peak VO2 (-1.68 mL/min/kg or -204.57 mL/min) terminating the CPX due to dyspnea at 250 W (RER = 1.03, MHR = 171 bpm). Cognitive testing revealed an 8% decrease in accuracy (96.2% to 88.5%) while no differences were noted in reaction speed. SpO2 was mildly reduced (-1%) but was not clinically significant. Additionally, heart rate recovery at 1-minute was impaired (31 to 27 bpm). Following recovery, accuracy on the cognitive test remained reduced (96.4% compared to 100% pre-COVID). Final/Working Diagnosis: impairment in exercise capacity and accuracy Treatment and Outcomes: Minor impairments in exercise capacity and cognitive performance were observed during CPX and cognitive testing following recovery from mild COVID-19 illness in this trained athlete, however, he had recovered with endurance sufficient to return to occupational and recreational activities.