Protracted exercise tolerance post-coronavirus disease 2019 in endurance athletes: A survey.

This was a cross-sectional survey, so it can show associations but cannot show that COVID-19 or any symptom caused delayed return to sport. Participants were recruited by snowball sampling from South African athletic clubs, so a response rate cannot be calculated and the sample may not represent all athletes. Diagnosis was not confirmed in everyone; some participants relied on symptoms or contact, and testing was not uniform. Exercise capacity and return to sport were self-reported, with no objective cardiopulmonary testing, pace measurement, or power measurement. Recall bias is possible because athletes reported symptoms and training changes after illness, and time from illness varied between participants. Vaccine status and viral strain were not recorded, and home oxygen use was not asked, so illness severity may be misclassified. ICU survivors were excluded, so the findings do not apply to athletes who had critical illness or ICU-acquired weakness. The study mostly involved masters-age endurance athletes in South Africa, so it may not apply to younger elite athletes or other countries.

The authors reported no financial support for the research, authorship, or publication.

Do not conclude that these symptoms caused delayed return or that any specific training advice will speed return. The study was a self-report survey with no objective testing, and it cannot show cause and effect.