key: cord-0996599-gyq0xco7 authors: Siopis, George title: Elite athletes maintain peak performance after testing positive for SARS-CoV-2 date: 2021-09-20 journal: J Sci Med Sport DOI: 10.1016/j.jsams.2021.08.010 sha: 568514814c1d8b27259266da4cf8be36f33f566a doc_id: 996599 cord_uid: gyq0xco7 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has to date resulted in more than 200 million cases and more than four million deaths. Following a few months of hiatus, as part of the initial response to the pandemic, professional sporting activities resumed throughout the world. To ensure a safe return-to-play, the effects of SARS-CoV-2 infections on elite athletes were carefully monitored. Several elite professional athletes tested positive for SARS-CoV-2. A few reports of persistent and residual symptoms of infections emerged. However, peak athletic performance in elite athletes did not seem to be affected, with some athletes recording historical performances both in the weeks following as well as several months after contracting the novel coronavirus. This manuscript presents these data along with a discussion on the potential protective mechanisms in athletes. These findings raise further awareness about the importance of performing regular physical activity and maintaining a favourable body composition and overall fitness, and emphasise the need for public health initiatives and actions to promote a healthy lifestyle on a population level. Given that SARS-CoV-2, with its mutations, will be a chronic public health issue, preventive medicine measures such as advocacy and incentives to lead a healthy lifestyle are warranted as another shield, along with vaccines, in the arsenal against SARS-CoV-2. led his team to its first victory in the 2021 NBA finals, just two weeks after testing positive for SARS-CoV-2. 8 These observations extend to other sports. Famous football player Chistiano Ronaldo tested positive for SARS-CoV-2 on multiple occasions yet his performance not only was not affected, but he continued to climb the record books in his sport by becoming the top goal scorer in the history of football. Renowned tennis player Novak Djokovic won the Australian open just a few months after contracting SARS-CoV-2 in 2020 and is en route to winning all "Grand slam" tournaments in 2021, having already won the Australian open, the Roland Garros and the Wimbledon tournaments this year. Formula 1 driver Lewis Hamilton won the championship in 2020, despite having to miss a race after contracting SARS-CoV-2. There are numerous other examples of elite athletes recording peak performances shortly following as well as several months after testing positive for SARS-CoV-2, indicating no decline in athletic performance indices such as acceleration, endurance or reaction rate and therefore suggesting no serious adverse effects of SARS-CoV-2 on the anaerobic and aerobic capacity and the nervous system of these athletes, as it has been previously reported in other populations. 9,10 Although the reasons for the absence of these adverse effects are not known with certainty, the protective effects of physical activity in reducing the risk of adverse effects from SARS-CoV-2 infections have been described. 11 In addition to the health benefits active people experience, physical activity appears to confer protection for many years following its cessation, with people who had better cardiorespiratory fitness and muscular strength at a younger age being at reduced risk of adverse outcomes from SARS-CoV-2 infections in later life. 12 The association of physical activity with reduced morbidity from COVID-19 is independent of the body mass index. 12 However, obesity has been reported as the strongest risk factor for morbidity and mortality from COVID-19. 13 Therefore, another reason for the ability of athletes to maintain peak performance following infection with SARS-CoV-2 may be their favourable body composition. Even the athletes who have higher body fat stores, exhibit a healthier fat distribution compared to people who are not physically active. Athletes store their fat mostly intramuscularly and within the superficial compartment of the subcutaneous adipose tissue, both of which are healthier reserves than the visceral and the deep subcutaneous tissue stores, where inactive people tend to store their fat. 14 Therefore, even the athletes with higher body fat do not in general manifest the chronic inflammation and insulin resistance that characterises a plethora of inactive people with obesity, and thus their immune system is not affected in the same manner by the extra adipose tissue as it is in people with the same adiposity that are not active. 15 The resistance of elite athletes to serious adverse outcomes with SARS-CoV-2, and their ability to sustain peak performance both in the short-and long-term post infection, further emphasises the importance of performing regular physical activity and maintaining a favourable body composition and overall fitness for health and wellbeing. 15, 16 COVID-19 has exposed how unhealthy we have become as a species, with most adverse outcomes seen in people with obesity and its associated comorbidities of diabetes and hypertension. 13 Overweight and obesity affect more than 2 billion people around the world, and they are largely results of modern lifestyles. In the quest for convenience, consumption of processed foods and calorie-dense nutrientpoor foods, such as most take-away foods, keeps increasing. Physical activity rates drop and the decline is predicted to accelerate. From the homo erectus walking on two legs, to the Botai people riding horses, to the first commercial cars being deployed at the beginning of the last century that required muscular strength to change a gear, and soon to travelling in driverless cars that don't even require us to use a steering wheel, we are embracing a life that minimises movement and activity. "Alexa" can now turn on the lights at home on demand, and soon there will be an infinitesimal need for incidental activity. Technological advancements are great and have improved many aspects of life, however health does not come at the press of a button. The UK government is now planning to offer incentives for leading a healthy lifestyle, in an effort to reduce obesity and to promote healthy eating and participating in physical activity. 17 Governments throughout the world must invest in public health initiatives and actions that promote leading a healthy lifestyle on a population level. Given that SARS-CoV-2, with its mutations, is here to stay for a long time, preventive medicine measures such as advocacy and incentives to be active and to eat healthy are warranted as another shield, along with vaccines, in the arsenal against SARS-CoV-2, but also to reduce the chronic burden from noncommunicable diseases, for which the rising obesity pandemic is a major risk factor in addition to being the strongest risk factor for adverse outcomes from COVID-19. 13 The author declares no receipt of funding. The author declares no conflicts of interest. Cardiorespiratory considerations for return-toplay in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians Prevalence of inflammatory heart disease among professional athletes with prior COVID-19 infection who received systematic return-to-play cardiac screening Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: results from the big ten COVID-19 cardiac registry From Hamilton to Ronaldo: athletes who tested positive for COVID-19 in 2020 Donovan Mitchell's 57 points rank third in NBA single-game playoff history Kevin Durant turns in all-timer, leads nets over bucks in game 5 Jayson Tatum scores 60 points and amazes the NBA world Phoenix suns follow Chris Paul's lead in game 1 NBA finals win: when it's going like that Reduced maximal aerobic capacity after COVID-19 in young adult recruits COVID-19 and the nervous system Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients Fitness, strength and severity of COVID-19: a prospective register study of 1 559 187 Swedish conscripts Underlying medical conditions and severe illness among 540,667 adults hospitalized with COVID-19 Causes, consequences, and treatment of metabolically unhealthy fat distribution The case for promoting physical activity amidst the COVID-19 pandemic The case for promoting physical activity amidst the COVID-19 pandemic. An update The Telegraph. Families could get rewards for healthy living in new war on obesity