Former SARS-CoV-2 Infection Was Related to Decreased VO2 Peak and Exercise Hypertension in Athletes

The impact of former COVID- 19 infection on the performance of athletes is not fully understood. We aimed to identify differences in athletes with and without former COVID19 infections. Competitive athletes who presented for preparticipation screening between April 2020 and October 2021 were included in this study, stratified for former COVID-19 infection, and compared. Overall, 1200 athletes ( mean age 21.9 +/- 11.6 years; 34.3% females) were included in this study from April 2020 to October 2021. Among these, 158 ( 13.1%) athletes previously had COVID-19 infection. Athletes with COVID-19 infection were older ( 23.4 +/- 7.1 vs. 21.7 +/- 12.1 years, p < 0.001) and more often of male sex (87.7% vs. 64.0%, p < 0.001). While systolic/diastolic blood pressure 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 blood pressure ( 70.0 [ 65.0/ 75.0] vs. 70.0 [60.0/75.0] mmHg, p = 0.012) during the exercise test and frequency of exercise hypertension (54.2% vs. 37.8%, p < 0.001) were higher in athletes with COVID-19 infection. While former COVID-19 infection was not independently associated with higher blood pressure at rest and maximum blood pressure during exercise, former COVID-19 infection was related to exercise hypertension (OR 2.13 [ 95% CI 1.39-3.28], p < 0.001). VO2 peak was lower in athletes with 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 negatively (OR 0.94 [95% CI 0.91- 0.97], p < 0.0019). In conclusion, former COVID- 19 infection in athletes was accompanied by a higher frequency of exercise hypertension and reduced VO2 peak.