Rating of Perceived Exertion Associated With Acute Symptoms in Athletes With Recent SARS-CoV-2 Infection: Athletes With Acute Respiratory InfEction (AWARE) VI Study

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Abstract
Context: SARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported. Objective: To (1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with a recent SARS-CoV-2 infection and (2) identify factors affecting exercise responses. Design: Cross-sectional, experimental study. Patients or Other Participants: Male and female athletes (age = 24.2 ± 6.3 years) with a recent (<28 days) SARS-CoV-2 infection (n = 72). Setting: A COVID-19 Recovery Clinic for athletes. Main Outcome Measure(s): Heart rate, SBP, and RPE were measured during submaximal exercise (modified Bruce protocol) at 10 to 28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, comorbidities, preinfection training variables, and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models. Results: Heart rate, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (P = .0001). At stage 5 (10.1 metabolic equivalents), a higher HR and a higher SBP during exercise were associated with younger age (P = .0007) and increased body mass index (BMI; P = .009), respectively. Higher RPE during exercise was significantly associated with a greater number of whole-body (P = .006) and total number (P = .004) of symptoms during the acute phase of infection. Conclusions: A greater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes at 10 to 28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection, as this may indicate disease severity and be valuable for tracking progress, recovery, and return to sport.

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