Cardiopulmonary, Functional, Cognitive and Mental Health Outcomes Post-COVID-19, Across the Range of Severity of Acute Illness, in a Physically Active, Working-Age Population

Oliver O’Sullivan, David A. Holdsworth, Peter Ladlow, Robert M. Barker-Davies, Rebecca Chamley, Andrew Houston, Samantha May, Dominic Dewson, Daniel Mills, Kayleigh Pierce, James Mitchell, Cheng Xie, Edward Sellon, Jon Naylor, Joseph Mulae, Mark Cranley, Nick P. Talbot, Oliver J. Rider, Edward D. Nicol, Alexander N. Bennett

Research output: Contribution to journalArticlepeer-review

7 Citations (SciVal)


Background: The COVID-19 pandemic has led to significant morbidity and mortality, with the former impacting and limiting individuals requiring high physical fitness, including sportspeople and emergency services. Methods: Observational cohort study of 4 groups: hospitalised, community illness with on-going symptoms (community-symptomatic), community illness now recovered (community-recovered) and comparison. A total of 113 participants (aged 39 ± 9, 86% male) were recruited: hospitalised (n = 35), community-symptomatic (n = 34), community-recovered (n = 18) and comparison (n = 26), approximately five months following acute illness. Participant outcome measures included cardiopulmonary imaging, submaximal and maximal exercise testing, pulmonary function, cognitive assessment, blood tests and questionnaires on mental health and function. Results: Hospitalised and community-symptomatic groups were older (43 ± 9 and 37 ± 10, P = 0.003), with a higher body mass index (31 ± 4 and 29 ± 4, P < 0.001), and had worse mental health (anxiety, depression and post-traumatic stress), fatigue and quality of life scores. Hospitalised and community-symptomatic participants performed less well on sub-maximal and maximal exercise testing. Hospitalised individuals had impaired ventilatory efficiency (higher VE/V̇CO2 slope, 29.6 ± 5.1, P < 0.001), achieved less work at anaerobic threshold (70 ± 15, P < 0.001) and peak (231 ± 35, P < 0.001), and had a reduced forced vital capacity (4.7 ± 0.9, P = 0.004). Clinically significant abnormal cardiopulmonary imaging findings were present in 6% of hospitalised participants. Community-recovered individuals had no significant differences in outcomes to the comparison group. Conclusion: Symptomatically recovered individuals who suffered mild-moderate acute COVID-19 do not differ from an age-, sex- and job-role-matched comparison population five months post-illness. Individuals who were hospitalised or continue to suffer symptoms may require a specific comprehensive assessment prior to return to full physical activity.

Original languageEnglish
Article number7
JournalSports Medicine - Open
Issue number1
Publication statusPublished - 2 Feb 2023

Bibliographical note

Funding Information:
To all the participants, administrative staff and support teams at DMRC Stanford Hall and OUH, we acknowledge, and thank, your hard work, dedication and valuable input.

Availability of data and materials
Data relate to the serving population of the Ministry of Defence and thus
are sensitive. Research teams requesting data are invited to contact the cor‑
responding author and appropriate permissions will be sought for release


  • Cardiopulmonary exercise testing
  • Coronavirus disease 2019
  • Long Covid
  • Outcomes
  • Post-COVID-19 syndrome

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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