{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T12:20:08Z","timestamp":1787833208550,"version":"build-2784847793"},"reference-count":36,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0The global coronavirus disease 2019 (COVID-19) pandemic irrevocably influenced our lives, yet research in a diversity of countries is lacking. Cardiorespiratory fitness may be impaired for up to a year post-COVID-19 infection.\n\nObjectives:\u00a0Our study aimed to compare acute and exertional symptoms, fatigue, and exercise performance in masters-age endurance athletes according to their return-to-sport status.\n\nMethod:\u00a0A cross-sectional survey-based observational study of long-distance runners and cyclists was conducted. Data were stratified into two groups: those who returned to their pre-illness level of sport and those who did not and were compared statistically.\n\nResults:\u00a0A total of 308 survey responses were included in the analysis. The mean age of the athletes was 44.9 + 10.2 years, with 55.2% being male. The group that did not return to their pre-illness level of sport (31.5%) had more post-COVID sequelae, worse illness severity, with a higher frequency of resting and exertional symptoms, notably fatigue and dyspnoea. Decreased exercise capacity was correlated with increased physical fatigue scores.\n\nConclusion:\u00a0Almost one-third of endurance athletes suffered protracted exercise tolerance post-COVID-19. Long-term symptoms may be more consequential in this athlete population.\n\nClinical Implications:\u00a0Symptoms that may indicate cardiopulmonary consequences in recreational athletes should be investigated in order to facilitate return to sport and the important mental and physical benefits thereof. This will augment outcomes after respiratory tract infections and management of return to sport and expectations of endurance athletes.<\/jats:p>","DOI":"10.4102\/sajp.v80i1.2063","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T05:59:28Z","timestamp":1723615168000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Protracted exercise tolerance post-coronavirus disease 2019 in endurance athletes: A survey"],"prefix":"10.4102","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5392-512X","authenticated-orcid":false,"given":"Cheryl A.","family":"Haley","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1926-4690","authenticated-orcid":false,"given":"Heleen","family":"van Aswegen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7043-4002","authenticated-orcid":false,"given":"Elena","family":"Libhaber","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9287-8301","authenticated-orcid":false,"given":"Benita","family":"Olivier","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Agha-Alinejad, H., Ahmadi Hekmatikar, AH., Ruhee, R.T., Shamsi, M.M., Rahmati, M., Khoramipour, K. et al., 2022, \u2018A guide to different intensities of exercise, vaccination, and sports nutrition in the course of preparing elite athletes for the management of upper respiratory infections during the COVID-19 pandemic: A narrative review\u2019, International Journal of Environmental Research and Public Health 19(3), 1888. https:\/\/doi.org\/10.3390\/ijerph19031888","DOI":"10.3390\/ijerph19031888"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Braga, F., Domecg, F., Kalichsztein, M., Nobre, G., Kezen, J., Espinosa, G. et al., 2023, \u2018Abnormal exercise adaptation after varying severities of COVID-19: A controlled cross-sectional analysis of 392 survivors\u2019, European Journal of Sport Science 23(5), 829\u2013839. https:\/\/doi.org\/10.1080\/17461391.2022.2054363","DOI":"10.1080\/17461391.2022.2054363"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Burgstahler, C., Plank, C., Niess, A.M., Schobersberger, W., Niebauer, J. & Scharhag, J., 2023, \u2018Effects of the corona pandemic on competitive sports \u2013 An online survey amongst 2981 German and Austrian elite athletes\u2019, German Journal of Sports Medicine\/Deutsche Zeitschrift fur Sportmedizin 74(1), 7\u201312. https:\/\/doi.org\/10.5960\/dzsm.2022.552","DOI":"10.5960\/dzsm.2022.552"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Casasco, M., Iellamo, F., Scorcu, M., Parisi, A., Tavcar, I., Brugin, E. et al., 2022, \u2018Return to play after SARS-CoV-2 infection in competitive athletes of distinct sport disciplines in Italy: A FMSI (Italian Federation of Sports Medicine) study\u2019, Journal of Cardiovascular Development and Disease 9(2), 59. https:\/\/doi.org\/10.3390\/jcdd9020059","DOI":"10.3390\/jcdd9020059"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y. et al., 2020, \u2018Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study\u2019, The Lancet 395(2), 507\u2013513. https:\/\/doi.org\/10.1016\/S0140-6736(20)30211-7","DOI":"10.1016\/S0140-6736(20)30211-7"},{"key":"ref5","unstructured":"COVID-19 Treatment Guidelines 2023, NIH: Clinical spectrum of SARS-CoV-2 infection, viewed 13 February 2023, from http:\/\/www.covid19treatmentguidelines.nih.gov\/overwiew\/clinical-spectrum."},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Crameri, G.A.G., Bielecki, M., Zust, R., Buehrer, T.W., Stanga Z. & Deuel, J.W., 2020, \u2018Reduced maximal aerobic capacity after COVID-19 in young adult recruits, Switzerland, May 2020\u2019, Eurosurveillance. European Centre for Disease Prevention and Control (EDC) 25(36), 2001542. https:\/\/doi.org\/10.2807\/1560-7917.ES.2020.25.36.2001542","DOI":"10.2807\/1560-7917.ES.2020.25.36.2001542"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"DeJong, A.F., Fish, P.N. & Hertel, J., 2021, \u2018Running behaviors, motivations, and injury risk during the COVID-19 pandemic: A survey of 1147 runners\u2019, PloS One 16(2), e0246300. https:\/\/doi.org\/10.1371\/journal.pone.0246300","DOI":"10.1371\/journal.pone.0246300"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Durstenfeld, M.S., Sun, K., Tahir, P., Peluso, M.J., Deeks, S.G., Aras, M.A. et al. 2022, \u2018Use of cardiopulmonary exercise testing to evaluate long COVID-19 symptoms in adults: A systematic review and meta-analysis\u2019, JAMA Network Open 5(10), e2236057\u2013e2236057. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.36057","DOI":"10.1001\/jamanetworkopen.2022.36057"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Elliott, N., Martin, R., Heron, N., Elliott, J., Grimstead, D. & Biswas, A., 2020, \u2018Infographic. Graduated return to play guidance following COVID-19 infection\u2019, British Journal of Sports Medicine 54(19), 1174\u20131175. https:\/\/doi.org\/10.1136\/bjsports-2020-102637","DOI":"10.1136\/bjsports-2020-102637"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Emeran, A., Lambert, E.V., Paruk, T. & Bosch, A., 2022, \u2018Changes in training activity post COVID-19 infection in recreational runners and cyclists\u2019, South African Journal of Sports Medicine 34(1), 1\u20137. https:\/\/doi.org\/10.17159\/2078-516X\/2022\/v34i1a13758","DOI":"10.17159\/2078-516X\/2022\/v34i1a13758"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Gluckman, T.J., Bhave, N.M., Allen, L.A., Chung, E.H., Spatz, E.S., Ammirati, E. et al., 2022, \u20182022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: Myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: A report of the American College of Cardiology Solution Set Oversight Committee\u2019, Journal of the American College of Cardiology 79(17), 1717\u20131756. https:\/\/doi.org\/10.1016\/j.jacc.2022.02.003","DOI":"10.1016\/j.jacc.2022.02.003"},{"key":"ref12","unstructured":"GO FAIR, FAIR principles, 2016, GO FAIR, viewed 13 May 2023, from https:\/\/www.go-fair.org\/fair-principles\/."},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Hughes, D.C., Orchard, J.W., Partridge, E.M., La Gerche, A. & Broderick, C., 2022, \u2018Return to exercise post-COVID-19 infection: A pragmatic approach in mid-2022\u2019, Journal of Science and Medicine in Sport 25(7), 544\u2013547. https:\/\/doi.org\/10.1016\/j.jsams.2022.06.001","DOI":"10.1016\/j.jsams.2022.06.001"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Joyner, M.J. & Coyle, E.F., 2008, \u2018Endurance exercise performance: The physiology of champions\u2019, The Journal of Physiology 586(1), 35\u201344. https:\/\/doi.org\/10.1113\/jphysiol.2007.143834","DOI":"10.1113\/jphysiol.2007.143834"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Juh\u00e1sz, V., Szab\u00f3, L., Pavlik, A., T\u00e1llay, A., Balla, D., Kiss, O. et al., 2022, \u2018Short and mid-term characteristics of COVID-19 disease course in athletes: A high-volume, single-center study\u2019, Scandinavian Journal of Medicine & Science in Sports 33(3), 341\u2013352. https:\/\/doi.org\/10.1111\/sms.14265","DOI":"10.1111\/sms.14265"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Lopes, L.R., Miranda, V.A., Goes, R.A., Souza, G.G., Souza, G.R., Rocha, J.C. et al., 2021, \u2018Repercussions of the COVID-19 pandemic on athletes: A cross-sectional study\u2019, Biology of Sport 38(4), 703\u2013711. https:\/\/doi.org\/10.5114\/biolsport.2021.106147","DOI":"10.5114\/biolsport.2021.106147"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Magnusson, K., Kristoffersen, D.T., Dell\u2019Isola, A., Kiadaliri, A., Turkiewicz, A., Runhaar, J. et al., 2022, \u2018Post-covid medical complaints following infection with SARS-CoV-2 Omicron vs Delta variants\u2019, Nature Communications 13(1), 7363. https:\/\/doi.org\/10.1038\/s41467-022-35240-2","DOI":"10.1038\/s41467-022-35240-2"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Marcora, S.M., Staiano, W. & Manning, V., 2009, \u2018Mental fatigue impairs physical performance in humans\u2019, Journal of Applied Physiology 106(3), 857\u2013864. https:\/\/doi.org\/10.1152\/japplphysiol.91324.2008","DOI":"10.1152\/japplphysiol.91324.2008"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Marshall, J.C., Murthy, S., Diaz, J., Adhikari, N.K., Angus, D.C., Arabi, Y.M. et al., 2020, \u2018A minimal common outcome measure set for COVID-19 clinical research\u2019, The Lancet Infectious Diseases 20(8), e192\u2013e197. https:\/\/doi.org\/10.1016\/S1473-3099(20)30483-7","DOI":"10.1016\/S1473-3099(20)30483-7"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"McKinney, J., Velghe, J., Fee, J., Isserow, S. & Drezner, J.A., 2019, \u2018Defining athletes and exercisers\u2019, The American Journal of Cardiology 123(3), 532\u2013535. https:\/\/doi.org\/10.1016\/j.amjcard.2018.11.001","DOI":"10.1016\/j.amjcard.2018.11.001"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Mihalick, V.L., Canada, J.M., Arena, R., Abbate, A. & Kirkman, D.L., 2021, \u2018Cardiopulmonary exercise testing during the COVID-19 pandemic\u2019, Progress in Cardiovascular Diseases 67, 35\u201339. https:\/\/doi.org\/10.1016\/j.pcad.2021.04.005","DOI":"10.1016\/j.pcad.2021.04.005"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Monosilio, S., Prosperi, S., Squeo, M.R., Spataro, S., Spataro, A. & Maestrini, V., 2023, \u2018Short and long-term cardiovascular sequelae after SARS-CoV-2 infection: A narrative review focusing on athletes\u2019, Viruses 15(2), 493. https:\/\/doi.org\/10.3390\/v15020493","DOI":"10.3390\/v15020493"},{"key":"ref23","unstructured":"National Institute for Health and Care Excellence (NICE) SIGN (SIGN) and RC of GP (RCGP), 2021, COVID-19 rapid guideline: Managing the long-term effects of COVID-19, Updated November 2021, viewed 08 February 2023, from https:\/\/www.nice.org.uk\/guidance\/ng188."},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Oswald, F., Campbell, J., Williamson, C., Richards, J. & Kelly, P., 2020, \u2018A scoping review of the relationship between running and mental health\u2019, International Journal of Environmental Research and Public Health 17(21), 8059. https:\/\/doi.org\/10.3390\/ijerph17218059","DOI":"10.3390\/ijerph17218059"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Pelliccia, A., Sharma, S., Gati, S., B\u00e4ck, M., B\u00f6rjesson, M., Caselli, S. et al., 2021, \u20182020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease: The task force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)\u2019, European Heart Journal 42(1), 17\u201396. https:\/\/doi.org\/10.1093\/eurheartj\/ehaa605","DOI":"10.1093\/eurheartj\/ehaa605"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Petek, B.J., Moulson, N., Baggish, A.L., Kliethermes, S.A., Patel, M.R., Churchill, T.W. et al., 2022, \u2018Prevalence and clinical implications of persistent or exertional cardiopulmonary symptoms following SARS-CoV-2 infection in 3597 collegiate athletes: A study from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA)\u2019, British Journal of Sports Medicine 56(16), 913\u2013918. https:\/\/doi.org\/10.1136\/bjsports-2021-104644","DOI":"10.1136\/bjsports-2021-104644"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Ruuskanen, O., Luoto, R., Valtonen, M., Heinonen, O.J. & Waris, M., 2022, \u2018Respiratory viral infections in athletes: Many unanswered questions\u2019, Sports Medicine 52(9), 2013\u20132021. https:\/\/doi.org\/10.1007\/s40279-022-01660-9","DOI":"10.1007\/s40279-022-01660-9"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Schroeder, A.N., Getzin, A.R., Creswell, L.L. & Asplund, C.A., 2023, \u2018Recovery from COVID-19 in adult recreational athletes: A survey of American triathletes\u2019, Exercise, Sport, and Movement 1(2), e00005. https:\/\/doi.org\/10.1249\/ESM.0000000000000005","DOI":"10.1249\/ESM.0000000000000005"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Schwellnus, M., Sewry, N., Snyders, C., Kaulback, K., Wood, P.S., Seocharan, I. et al., 2021, \u2018Symptom cluster is associated with prolonged return-to-play in symptomatic athletes with acute respiratory illness (including COVID-19): A cross-sectional study-AWARE study I\u2019, British Journal of Sports Medicine 55(20), 1144\u20131152. https:\/\/doi.org\/10.1136\/bjsports-2020-103782","DOI":"10.1136\/bjsports-2020-103782"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Sewry, N., Schwellnus, M., Readhead, C., Swanevelder, S. & Jordaan, E., 2022, \u2018The incidence and transmission of SARS-CoV-2 infection in South African professional rugby players-AWARE II\u2019, Journal of Science and Medicine in Sport 25(8), 639\u2013643. https:\/\/doi.org\/10.1016\/j.jsams.2022.06.004","DOI":"10.1016\/j.jsams.2022.06.004"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Smets, E.M.A., Garssen, B., Bonke, B.D. & De Haes, J.C.J.M., 1995, \u2018The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue\u2019, Journal of Psychosomatic Research 39(3), 315\u2013325. https:\/\/doi.org\/10.1016\/0022-3999(94)00125-O","DOI":"10.1016\/0022-3999(94)00125-O"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Snyders, C., Schwellnus, M., Sewry, N., Kaulback, K., Wood, P., Seocharan, I. et al., 2023, \u2018Symptom number and reduced preinfection training predict prolonged return to training after SARS-CoV-2 in athletes: AWARE IV\u2019, Medicine and Science in Sports and Exercise 55(1), 1\u20138. https:\/\/doi.org\/10.1249\/MSS.0000000000003027","DOI":"10.1249\/MSS.0000000000003027"},{"key":"ref33","unstructured":"Steinacker, J.M., Schellenberg, J., Bloch, W., Deibert, P., Friedmann-Bette, B., Grim, C. et al., 2022, \u2018Recommendations for return-to-sport after COVID-19: Expert consensus\u2019, German Journal of Sports Medicine\/Deutsche Zeitschrift fur Sportmedizin 73(4), 127\u2013136. https:\/\/doi.org\/10.5960\/dzsm.2022.532"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Van Aerde, N., Van den Berghe, G., Wilmer, A., Gosselink, R. & Hermans, G., 2020, \u2018Intensive care unit acquired muscle weakness in COVID-19 patients\u2019, Intensive Care Medicine 46, 2083\u20132085. https:\/\/doi.org\/10.1007\/s00134-020-06244-7","DOI":"10.1007\/s00134-020-05927-5"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Vollrath, S., Bizjak, D.A., Zorn, J., Matits, L., Jerg, A., Munk, M. et al., 2022, \u2018Recovery of performance and persistent symptoms in athletes after COVID-19\u2019, PloS One 17(12), e0277984. https:\/\/doi.org\/10.1371\/journal.pone.0277984","DOI":"10.1371\/journal.pone.0277984"}],"container-title":["South African Journal of Physiotherapy"],"original-title":[],"link":[{"URL":"https:\/\/sajp.co.za\/index.php\/sajp\/article\/viewFile\/2063\/3662","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/sajp.co.za\/index.php\/sajp\/article\/viewFile\/2063\/3663","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/sajp.co.za\/index.php\/sajp\/article\/viewFile\/2063\/3664","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/sajp.co.za\/index.php\/sajp\/article\/viewFile\/2063\/3665","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/sajp.co.za\/index.php\/sajp\/article\/view\/2063\/3665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:43:12Z","timestamp":1787830992000},"score":1,"resource":{"primary":{"URL":"https:\/\/sajp.co.za\/index.php\/sajp\/article\/view\/2063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,14]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/sajp.v80i1.2063","relation":{},"ISSN":["0379-6175","2410-8219"],"issn-type":[{"value":"0379-6175","type":"print"},{"value":"2410-8219","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,14]]},"article-number":"a2063"}}