TY - JOUR AB - Abstract Background An infection with SARS-CoV-2 can lead to a variety of symptoms and complications, which can impair athletic activity. Objective We aimed to assess the clinical symptom patterns, diagnostic findings, and the extent of impairment in sport practice in a large cohort of athletes infected with SARS-CoV-2, both initially after infection and at follow-up. Additionally, we investigated whether baseline factors that may contribute to reduced exercise tolerance at follow-up can be identified. Methods In this prospective, observational, multicenter study, we recruited German COVID elite-athletes (cEAs, n = 444) and COVID non-elite athletes (cNEAs, n = 481) who tested positive for SARS-CoV-2 by PCR (polymerase chain reaction test). Athletes from the federal squad with no evidence of SARS-CoV-2 infection served as healthy controls (EAcon, n = 501). Questionnaires were used to assess load and duration of infectious symptoms, other complaints, exercise tolerance, and duration of training interruption at baseline and at follow-up 6 months after baseline. Diagnostic tests conducted at baseline included resting and exercise electrocardiogram (ECG), echocardiography, spirometry, and blood analyses. Results Most acute and infection-related symptoms and other complaints were more prevalent in cNEA than in cEAs. Compared to cEAs, EAcon had a low symptom load. In cNEAs, female athletes had a higher prevalence of complaints such as palpitations, dizziness, chest pain, myalgia, sleeping disturbances, mood swings, and concentration problems compared to male athletes (p < 0.05). Until follow-up, leading symptoms were drop in performance, concentration problems, and dyspnea on exertion. Female athletes had significantly higher prevalence for symptoms until follow-up compared to male. Pathological findings in ECG, echocardiography, and spirometry, attributed to SARS-CoV-2 infection, were rare in infected athletes. Most athletes reported a training interruption between 2 and 4 weeks (cNEAs: 52.9%, cEAs: 52.4%), while more cNEAs (27.1%) compared to cEAs (5.1%) had a training interruption lasting more than 4 weeks (p < 0.001). At follow-up, 13.8% of cNEAs and 9.9% of cEAs (p = 0.24) reported their current exercise tolerance to be under 70% compared to pre-infection state. A persistent loss of exercise tolerance at follow-up was associated with persistent complaints at baseline, female sex, a longer break in training, and age > 38 years. Periodical dichotomization of the data set showed a higher prevalence of infectious symptoms such as cough, sore throat, and coryza in the second phase of the pandemic, while a number of neuropsychiatric symptoms as well as dyspnea on exertion were less frequent in this period. Conclusions Compared to recreational athletes, elite athletes seem to be at lower risk of being or remaining symptomatic after SARS-CoV-2 infection. It remains to be determined whether persistent complaints after SARS-CoV-2 infection without evidence of accompanying organ damage may have a negative impact on further health and career in athletes. Identifying risk factors for an extended recovery period such as female sex and ongoing neuropsychological symptoms could help to identify athletes, who may require a more cautious approach to rebuilding their training regimen. Trial Registration Number DRKS00023717; 06.15.2021—retrospectively registered. AU - Widmann, Manuel AU - Gaidai, Roman AU - Schubert, Isabel AU - Grummt, Maximilian AU - Bensen, Lieselotte AU - Kerling, Arno AU - Quermann, Anne AU - Zacher, Jonas AU - Vollrath, Shirin AU - Bizjak, Daniel Alexander AU - Beckendorf, Claudia AU - Egger, Florian AU - Hasler, Erik AU - Mellwig, Klaus-Peter AU - Fütterer, Cornelia AU - Wimbauer, Fritz AU - Vogel, Azin AU - Schoenfeld, Julia AU - Wüstenfeld, Jan C. AU - Kastner, Tom AU - Barsch, Friedrich AU - Friedmann-Bette, Birgit AU - Bloch, Wilhelm AU - Meyer, Tim AU - Mayer, Frank AU - Wolfarth, Bernd AU - Roecker, Kai AU - Reinsberger, Claus AU - Haller, Bernhard AU - Niess, Andreas M. AU - Birnbaum, Mike Peter AU - Burgstahler, Christof AU - Cassel, Michael AU - Deibert, Peter AU - Esefeld, Katrin AU - Erz, Gunnar AU - Greiss, Franziska AU - Halle, Martin AU - Hesse, Judith AU - Keller, Karsten AU - Kopp, Christine AU - Matits, Lynn AU - Predel, Hans Georg AU - Rüdrich, Peter AU - Schneider, Gerald AU - Stapmanns, Philipp AU - Steinacker, Jürgen Michael AU - Szekessy, Sarah AU - Venhorst, Andreas AU - Zapf, Stephanie AU - Zickwolf, Christian ID - 50798 JF - Sports Medicine KW - Physical Therapy KW - Sports Therapy and Rehabilitation KW - Orthopedics and Sports Medicine SN - 0112-1642 TI - COVID-19 in Female and Male Athletes: Symptoms, Clinical Findings, Outcome, and Prolonged Exercise Intolerance—A Prospective, Observational, Multicenter Cohort Study (CoSmo-S) ER - TY - JOUR AU - Benjaminse, A AU - Webster, KE AU - Gokeler, A ID - 20421 IS - 8 JF - Sports Med SN - 0112-1642 TI - Reply to Koller and Schobersberger: Comment on: "Revised Approach to the Role of Fatigue in Anterior Cruciate Ligament Injury Prevention: A Systematic Review with Meta-analyses". VL - 49 ER - TY - JOUR AU - Gokeler, A AU - Neuhaus, D AU - Benjaminse, A AU - Grooms, DR AU - Baumeister, Jochen ID - 20425 IS - 6 JF - Sports Med SN - 0112-1642 TI - Correction to: Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury. VL - 49 ER - TY - JOUR AU - Gokeler, Alli AU - Neuhaus, D AU - Benjaminse, A AU - Grooms, DR AU - Baumeister, Jochen ID - 15425 IS - 6 JF - Sports Med SN - 0112-1642 TI - Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury. VL - 49 ER - TY - JOUR AU - Benjaminse, Anne AU - Webster, Kate E. AU - Kimp, Alexander AU - Meijer, Michelle AU - Gokeler, Alli ID - 45113 IS - 4 JF - Sports Medicine KW - Physical Therapy KW - Sports Therapy and Rehabilitation KW - Orthopedics and Sports Medicine SN - 0112-1642 TI - Revised Approach to the Role of Fatigue in Anterior Cruciate Ligament Injury Prevention: A Systematic Review with Meta-Analyses VL - 49 ER -