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Reduced athletic performance post-COVID-19 is associated with reduced anaerobic threshold
  1. Robert M Barker-Davies1,
  2. Peter Ladlow1,
  3. Rebecca Chamley2,
  4. Edward Nicol3 and
  5. David A Holdsworth2
  1. 1Academic Department of Military Rehabilitation, Loughborough, UK
  2. 2Oxford University Hospitals NHS Trust, Oxford, UK
  3. 3Department of Cardiology, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr David A Holdsworth; david.holdsworth{at}


Detailed characterisation of cardiopulmonary limitations in patients post-COVID-19 is currently limited, particularly in elite athletes. A male elite distance runner in his late 30s experienced chest pain following confirmed COVID-19. He underwent cardiopulmonary exercise testing (CPET) at 5 months postacute illness. Subjective exercise tolerance was reduced compared with normal, he described inability to ‘kick’ (rapidly accelerate). His CPET was compared with an identical protocol 15 months prior to COVID-19. While supranormal maximal oxygen uptake was maintained (155% of peak predicted V̇O2) anaerobic threshold (AT), a better predictor of endurance performance, reduced from 84% to 71% predicted peak V̇O2 maximum. Likewise, fat oxidation at AT reduced by 21%, from 0.35 to 0.28 g/min. Focusing exclusively on V̇O2 maximum risks missing an impairment of oxidative metabolism. Reduced AT suggests a peripheral disorder of aerobic metabolism. This finding may result from virally mediated mitochondrial dysfunction beyond normal ‘deconditioning’, associated with impaired fat oxidation.

  • COVID-19
  • Rehabilitation medicine
  • Sports and exercise medicine
  • Cardiovascular medicine

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  • Contributors RMB-D and DH conceived the idea for the manuscript. RMB-D, DH, and PL collected and processed the raw data. RMB-D wrote the first draft and produced figures 1 and 2. DH and EN edited and completed the first round of manuscript review. DH and EN clinically managed the case and provided clinical and academic supervision.All authors reviewed and edited the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.