Arq. Bras. Cardiol. 2025; 122(9): e20250094

Cardiopulmonary Resilience in Highly Active Individuals: Pre–Post COVID-19 Cardiopulmonary Exercise Testing Analysis

Fabrício Braga, Gabriel Espinosa, Amanda Monteiro, Mauricio Milani , Juliana Paiva, Juliana Goulart Prata Oliveira Milani, Leandro Franzoni , Ricardo Stein, Gerson Cipriano Jr. , Jonas Lírio Gurgel, Ricardo Mourilhe-Rocha

DOI: 10.36660/abc.20250094i

This Original Article is referred by the Short Editorial "Analysis of Cardiopulmonary Exercise Test in Pre- and Post-COVID-19".

Abstract

Background:

The COVID-19 pandemic has affected millions globally, with persistent impacts extending beyond the acute phase. One such effect is post-COVID (long COVID), characterized by symptoms such as fatigue and exercise intolerance lasting more than 60 days. Although regular exercise is associated with reduced risk of severe outcomes, reports of decreased athletic performance after COVID-19 — even among highly active individuals (HAIs) — have raised concerns regarding the long-term effects on physical health. Cardiopulmonary exercise testing (CPET) is a valuable tool to assess exercise intolerance and to investigate the metabolic and ventilatory consequences of COVID-19.

Objectives:

To evaluate the impact of COVID-19 on cardiopulmonary function in HAIs by analyzing metabolic and ventilatory responses using CPET before and after infection.

Methods:

CPET data were retrospectively analyzed from HAIs of both sexes. Primary outcomes included changes in peak oxygen uptake (O₂peak) and ventilatory efficiency (E/CO₂ slope). Statistical significance was set at 5% (p < 0.05).

Results:

A total of 43 HAIs (72.1% male; 44 ± 10 years) were included. The median interval between CPETs was 479 days, with testing performed a mean of 44 ± 27 days after COVID-19. O₂peak decreased by a mean of 1.5 mL/kg/min (p = 0.017), representing a 3.84% reduction in predicted O₂peak values (p = 0.045). E/CO₂ slope increased by 1.2 (p = 0.017).

Conclusion:

Although HAIs are not immune to the effects of COVID-19, their high baseline physical activity levels appear to confer substantial cardiopulmonary resilience. Only minimal post-infection alterations were observed, which suggests that maintaining fitness may provide protective benefits against long-term sequelae of COVID-19.