Key result
COVID-19 infection in athletes linked to a ~1.8 mL/kg/min lower relative VO2max.
Why the study?
The impact of COVID-19 infection on cardiorespiratory fitness within athletes before and after infection, and between infected athletes and healthy controls, needed systematic review and meta-analysis.
Does COVID-19 infection reduce cardiorespiratory fitness (VO2max) in adult recreational or competitive athletes?
Meta-Analysis (n=1,595)
Does COVID-19 infection reduce cardiorespiratory fitness (VO2max) in adult recreational or competitive athletes?
COVID-19 infection in athletes is associated with reduced VO2max and VEmax, suggesting a negative impact on cardiorespiratory fitness that should be considered for safe return to sport.
Answers are grounded in this paper and cite their sources.
COVID-19 infection was associated with reduced CRF in athletes; leaves open questions on recovery and return-to-play protocols.
Objectives: We aimed to systematically review and meta-analyze the impact of COVID-19 infection on cardiorespiratory fitness (CRF): (1) within-athlete (the same participants before and after infection), and (2) between-athlete (infected vs. healthy reference participants). Methods: In this systematic review (PROSPERO Registry: CRD42024540430) we included observational studies enrolling recreational or competitive athletes ≥18 years old with laboratory confirmation of SARS-CoV-2 infection. The primary outcome was change in relative maximal oxygen uptake (VO2max). Secondary outcomes included changes in absolute VO2max, maximal ventilation (VEmax), and maximal heart rate (HRmax). We searched Embase, PubMed, Medline, Scopus, and Web of Science up to August 9th, 2025. Risk of bias was assessed with the JBI critical appraisal tool. Meta-analyses were performed with a random-effects model. Results: Twelve studies enrolling a total of 1595 participants met the eligibility criteria. COVID-19 infection was associated with lower relative VO2max (MD = −1.83 mL·kg−1·min−1; 95%CI [−3.16, −0.49]; p = 0.007; I2 = 54%) and absolute VO2max (MD = −0.15 L·min−1; 95%CI [−0.29, −0.01]; p = 0.03; I2 = 0%). COVID-19 infection was associated with lower VEmax (MD = −7.99 L·min−1; 95%CI [−12.94, −3.04]; p = 0.002; I2 = 0%) but not with HRmax (MD = −0.34 bpm; 95%CI [−1.54, 0.86]; p = 0.58; I2 = 0%). High heterogeneity of included studies was addressed with subgroup analyses. The risk of bias in most studies was high. The certainty of evidence was very low for each outcome. Conclusions: COVID-19 infection in athletes was associated with reduced VO2max and VEmax. The relationships were highly dependent on the quality of the studies. CRF and athlete profile should be considered when making shared decisions regarding safe return to sport after infection.
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Kasiak et al. (2026) conducted a meta-analysis in COVID-19 infection (n=1,595). COVID-19 infection vs. Pre-infection baseline or healthy reference participants was evaluated on change in relative maximal oxygen uptake (VO2max) (MD -1.83, 95% CI -3.16 to -0.49, p=0.007). COVID-19 infection in athletes was associated with lower relative VO2max.
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