Background

An infection with SARS-CoV-2 can lead to a variety of symptoms and complications, which can impair athletic activity.

Objective

We aimed to assess the clinical symptom patterns, diagnostic findings, and the extent of impairment in sport practice in a large cohort of athletes infected with SARS-CoV-2, both initially after infection and at follow-up. Additionally, we investigated whether baseline factors that may contribute to reduced exercise tolerance at follow-up can be identified.

Methods

In this prospective, observational, multicenter study, we recruited German COVID elite-athletes (cEAs, n = 444) and COVID non-elite athletes (cNEAs, n = 481) who tested positive for SARS-CoV-2 by PCR (polymerase chain reaction test). Athletes from the federal squad with no evidence of SARS-CoV-2 infection served as healthy controls (EAcon, n = 501). Questionnaires were used to assess load and duration of infectious symptoms, other complaints, exercise tolerance, and duration of training interruption at baseline and at follow-up 6 months after baseline. Diagnostic tests conducted at baseline included resting and exercise electrocardiogram (ECG), echocardiography, spirometry, and blood analyses.

Results

Most acute and infection-related symptoms and other complaints were more prevalent in cNEA than in cEAs. Compared to cEAs, EAcon had a low symptom load. In cNEAs, female athletes had a higher prevalence of complaints such as palpitations, dizziness, chest pain, myalgia, sleeping disturbances, mood swings, and concentration problems compared to male athletes (p < 0.05). Until follow-up, leading symptoms were drop in performance, concentration problems, and dyspnea on exertion. Female athletes had significantly higher prevalence for symptoms until follow-up compared to male. Pathological findings in ECG, echocardiography, and spirometry, attributed to SARS-CoV-2 infection, were rare in infected athletes. Most athletes reported a training interruption between 2 and 4 weeks (cNEAs: 52.9%, cEAs: 52.4%), while more cNEAs (27.1%) compared to cEAs (5.1%) had a training interruption lasting more than 4 weeks (p < 0.001). At follow-up, 13.8% of cNEAs and 9.9% of cEAs (p = 0.24) reported their current exercise tolerance to be under 70% compared to pre-infection state. A persistent loss of exercise tolerance at follow-up was associated with persistent complaints at baseline, female sex, a longer break in training, and age > 38 years. Periodical dichotomization of the data set showed a higher prevalence of infectious symptoms such as cough, sore throat, and coryza in the second phase of the pandemic, while a number of neuropsychiatric symptoms as well as dyspnea on exertion were less frequent in this period.

Conclusions

Compared to recreational athletes, elite athletes seem to be at lower risk of being or remaining symptomatic after SARS-CoV-2 infection. It remains to be determined whether persistent complaints after SARS-CoV-2 infection without evidence of accompanying organ damage may have a negative impact on further health and career in athletes. Identifying risk factors for an extended recovery period such as female sex and ongoing neuropsychological symptoms could help to identify athletes, who may require a more cautious approach to rebuilding their training regimen.

Trial Registration Number

DRKS00023717; 06.15.2021—retrospectively registered.

中文翻译：

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女性和男性运动员中的 COVID-19：症状、临床发现、结果和长期运动不耐受——一项前瞻性、观察性、多中心队列研究 (CoSmo-S)

背景

感染 SARS-CoV-2 可导致多种症状和并发症，从而损害运动活动。

客观的

我们的目的是评估一大群感染 SARS-CoV-2 的运动员的临床症状模式、诊断结果以及运动实践受损的程度，包括感染后的初始情况和随访时的情况。此外，我们还调查了是否可以确定可能导致随访时运动耐量降低的基线因素。

方法

在这项前瞻性、观察性、多中心研究中，我们招募了德国新冠肺炎精英运动员 (cEA，n  = 444) 和新冠肺炎非精英运动员 (cNEA，n  = 481)，他们通过 PCR（聚合酶链）检测结果呈 SARS-CoV-2 阳性反应测试）。来自联邦队且没有 SARS-CoV-2 感染证据的运动员作为健康对照（EAcon，n  = 501）。问卷用于评估基线时和基线后 6 个月随访时的感染症状负荷和持续时间、其他主诉、运动耐量以及训练中断持续时间。基线时进行的诊断测试包括静息和运动心电图 (ECG)、超声心动图、肺活量测定和血液分析。

结果

大多数急性症状和感染相关症状以及其他主诉在 cNEA 中比在 cEA 中更为普遍。与 cEA 相比，EAcon 的症状负荷较低。在 cNEA 中，与男运动员相比，女运动员出现心悸、头晕、胸痛、肌痛、睡眠障碍、情绪波动和注意力不集中等症状的比例更高（p  < 0.05）。直至随访，主要症状是表现下降、注意力不集中和劳累时呼吸困难。与男性运动员相比，女性运动员在随访之前出现症状的患病率明显更高。心电图、超声心动图和肺活量测定中归因于 SARS-CoV-2 感染的病理结果在受感染的运动员中很少见。大多数运动员报告训练中断时间为 2 至 4 周（cNEA：52.9%，cEA：52.4%），而与 cEA（5.1%）相比，更多 cNEA（27.1%）的训练中断持续超过 4 周（p < 0.001  ） ）。随访时，13.8% 的 cNEA 和 9.9% 的 cEA ( p  = 0.24) 报告称，与感染前状态相比，他们当前的运动耐量低于 70%。随访时运动耐量持续丧失与基线时持续抱怨、女性、训练中断时间较长以及年龄 > 38 岁有关。数据集的定期二分法显示，在大流行的第二阶段，咳嗽、喉咙痛和鼻炎等感染症状的发生率较高，而在此期间，一些神经精神症状以及劳力性呼吸困难的发生率较低。

结论

与休闲运动员相比，精英运动员在感染 SARS-CoV-2 后出现或保持症状的风险似乎较低。SARS-CoV-2 感染后没有证据表明伴随器官损伤的持续症状是否会对运动员的进一步健康和职业生涯产生负面影响，仍有待确定。识别延长恢复期的风险因素，例如女性和持续的神经心理症状，可能有助于识别运动员，他们可能需要更谨慎的方法来重建他们的训练方案。

试用注册号

DRKS00023717；2021 年 6 月 15 日——追溯注册。