Cardiopulmonary Profiling of Athletes with Post-Exertional Malaise after COVID-19 Infection-A Single-Center Experience.
Wernhart, Simon, Weihe, Eberhard, Totzeck, Matthias et al. · Journal of clinical medicine · 2023 · DOI
Quick Summary
This study tested athletes who had lingering exercise problems and post-exertional malaise (feeling worse after physical activity) following COVID-19. Researchers used a special exercise test to measure how their hearts, lungs, and muscles responded to activity. They found that some athletes showed abnormal responses on these tests, particularly in how efficiently their bodies used oxygen during exercise, which may help identify who needs to limit their training intensity.
Why It Matters
This research provides objective testing methods to identify exercise limitations in post-COVID athletes with ME/CFS-like symptoms, potentially helping clinicians and patients make safer training decisions. The findings suggest that standard cardiopulmonary testing may reveal abnormalities not apparent from symptoms alone, supporting the physiological basis of post-exertional malaise rather than attributing it solely to deconditioning.
Observed Findings
Elite athletes had higher adequate cardiopulmonary response rates (70.0%) compared to recreational athletes (39.5%)
Ventilatory efficiency was markedly different between groups: 97.7% of elite vs 65% of recreational athletes had VE/VCO2 <30
O2 pulse plateau occurred in 11.6% of elite and 22.5% of recreational athletes, and was associated with absence of adequate cardiopulmonary response
Perturbed ventilatory efficiency (elevated VE/VCO2) and O2 pulse plateau are objective markers of exercise limitation in athletes with post-exertional malaise after COVID-19
Not all athletes with subjective exercise intolerance meet criteria for adequate cardiopulmonary response, suggesting genuine physiological limitations rather than deconditioning alone
Training intensities should be individualized based on objective CPET findings rather than fitness level, particularly in recreational athletes
Remaining Questions
Do these cardiopulmonary abnormalities persist longitudinally, or do they improve over time with appropriate management?
How do these findings in athletes compare to non-athletes with post-COVID ME/CFS, and are the patterns generalizable across populations?
What This Study Does Not Prove
This study does not establish causation between COVID-19 and these cardiopulmonary abnormalities, nor does it prove that CPET abnormalities cause post-exertional malaise. The cross-sectional design cannot determine whether these findings persist long-term or improve with time. Results are specific to this athlete population and may not generalize to non-athletes with post-COVID ME/CFS or to different geographic/demographic populations.