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ObjectiveTo assess the prevalence and clinical implications of persistent or exertional cardiopulmonary symptoms in young competitive athletes following SARS-CoV-2 infection.MethodsThis observational cohort study from the Outcomes Registry for Cardiac Conditions in Athletes included 3597 US collegiate athletes after SARS-CoV-2 infection. Clinical characteristics, advanced diagnostic testing and SARS-CoV-2-associated sequelae were compared between athletes with persistent symptoms >3 weeks, exertional symptoms on return to exercise and those without persistent or exertional symptoms.ResultsAmong 3597 athletes (mean age 20 years (SD, 1 year), 34% female), data on persistent and exertional symptoms were reported in 3529 and 3393 athletes, respectively. Persistent symptoms >3 weeks were present in 44/3529 (1.2%) athletes with 2/3529 (0.06%) reporting symptoms >12 weeks. Exertional cardiopulmonary symptoms were present in 137/3393 (4.0%) athletes. Clinical evaluation and diagnostic testing led to the diagnosis of SARS-CoV-2-associated sequelae in 12/137 (8.8%) athletes with exertional symptoms (five cardiac involvement, two pneumonia, two inappropriate sinus tachycardia, two postural orthostatic tachycardia syndrome and one pleural effusion). No SARS-CoV-2-associated sequelae were identified in athletes with isolated persistent symptoms. Of athletes with chest pain on return to exercise who underwent cardiac MRI (CMR), 5/24 (20.8%) had probable or definite cardiac involvement. In contrast, no athlete with exertional symptoms without chest pain who underwent CMR (0/20) was diagnosed with probable or definite SARS-CoV-2 cardiac involvement.ConclusionCollegiate athletes with SARS-CoV-2 infection have a low prevalence of persistent or exertional symptoms on return to exercise. Exertional cardiopulmonary symptoms, specifically chest pain, warrant a comprehensive evaluation.

The purpose of this study was to examine the relationship between the blood lactate response during a laboratory exercise test and time trial (TT) performance on the road across a training season. Nine competitive master level male cyclists (44 ± 6.4 yrs) completed 18 weeks of structured training using power meters. Testing occurred at baseline (P0) and after each 6-week block of training. For each test week, subjects completed a maximal exercise test on a cycle ergometer in the laboratory and a 16.1 km TT on a road course. Heart rate, blood lactate, rating of perceived exertion, and oxygen consumption (VO2) were recorded at each 3-min stage during the exercise test. VO2 (52.0 ± 5.2 to 57.6 ± 6.9 ml·kg·min−1) and peak power (319.2 ± 39.5 to 352.8 ± 49.1 watts) increased (p=<0.0001) 11% from baseline to the end of training. Power at lactate threshold, 4 mmol·L −1 of lactate, Dmax, second ventilatory threshold, and onset of blood lactate accumulation (OBLA) increased most during the first 6 weeks of training and only power at OBLA continued to increase for the next 12 weeks. TT times (28.1 ± 3.2 to 25.9 ± 2.2 min, p=0.0008) and average watts per kg (3.5 ± 0.6 to 3.8 ± 0.2 watts·kg −1, p=0.002) improved 8% from baseline to the end of training. Time trial performance in watts·kg−1 after each phase of training correlated most with peak watts (R2 = 0.83–0.88, p = 0.001) and VO2 max (R2 = 0.76–0.86, p = 0.01) attained during the maximal exercise test.