
==== Front
Sports Med Health Sci
Sports Med Health Sci
Sports Medicine and Health Science
2666-3376
Chengdu Sport University

S2666-3376(24)00065-9
10.1016/j.smhs.2024.06.003
Guest Editorial
Impact of COVID-19 pandemic on cardiovascular health in sedentary and athletes: Consensus, uncertainties, and ways for mitigation
Quindry John C. PhD, FACSM, FCVS-APS John.quindry@mso.umt.edu
⁎⁎
School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT, 59812, USA
Xi Lei MD, FAHA lei.xi@vcuhealth.org
⁎
Pauley Heart Center, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298-0204, USA
⁎⁎ Corresponding author. School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT, 59812, USA. John.quindry@mso.umt.edu
⁎ Corresponding author. Pauley Heart Center, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298, USA. lei.xi@vcuhealth.org
06 6 2024
9 2024
06 6 2024
6 3 205208
28 5 2024
5 6 2024
© 2024 Chengdu Sport University. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.
2024
Chengdu Sport University
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcMore than 4 years has elapsed since the World Health Organization (WHO) officially announced the coronavirus disease 2019 (COVID-19) as a pandemic outbreak in March 11, 2020. Despite the ongoing investigations and political debates upon the origin, exacerbation, resurgence, and final control of COVID-19, medical and scientific consensus indicates that the now endemic COVID-19 virus is one of the worst public health crises in our lifetime. Almost every person on earth has been directly or indirectly impacted by the adverse effects of the highly contagious viral pathogen - SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Indeed, the population reach of the COVID-19 infection includes governmental response measures (e.g., lockdowns and social distancing, mandates for masks and face coverings, vaccines, etc.) that have restricted entrenched societal routines, personal mobility, and lifestyles. Unfortunately, the host of health problems linked to this viral infection linger to this day, with selective groups of people experiencing a higher risk for untoward medical outcomes and/or elevated levels of vulnerability to the post-acute sequelae of COVID-19 (i.e. long-COVID). For example, a 2021 study by Logue et al. provided initial evidence that 10%–30% of individuals in United States may experience prolonged symptoms following SARS-CoV-2 infection, including cardiovascular abnormalities.1 Similarly, a 2021 retrospective cohort study in England suggest that the incidence of major adverse cardiovascular events (e.g. heart failure, myocardial infarction, ischemic stroke, and arrhythmia) during 5-month follow-up period was 3 times higher in those who were hospitalized post-COVID patients as compared to demographically-matched counterparts from the general population.2 Moreover, health problems linked to COVID-19 infections are frequently sustained for many individuals as revealed by Fairbank in a recent commentary in Nature magazine.3 Based on a wide-spread survey conducted by a non-profit organization, the Patient-Led Research Collaborative (PLRC), 3 800 long-COVID patients from 56 countries were queried. Pooled information from survey outcomes indicated that individuals tended to suffer symptoms which clustered around at least ten organ systems.3 Just as important, symptomatic persistence in those who suffer from long-COVID have accumulated to produced levels of morbidity that are measurable on a global public health level, as clearly indicated by the latest version of World Health Statistics published by WHO on May 24, 2024 (https://www.who.int/news/item/24-05-2024-covid-19-eliminated-a-decade-of-progress-in-global-level-of-life-expectancy). This report painted a troubling picture showing that within two years of its emergence, the COVID-19 pandemic wiped out nearly a decade of progress in improving life expectancy. Putting this statistic in simple numbers, between 2019 and 2021 the global life expectancy dropped by 1.8 years, resulting in a mean lifespan of 71.4 years. Shockingly, this average matches the projected lifespan as calculated in 2012. Similarly, the 2021 calculations produced by the global healthy life expectancy (HALE) dropped by 1.5 years resulting in an average life expectancy of 61.9 years, a number that matches estimates from 2012.

In response to these landmark outcomes, the current Special Issue of Sports Medicine and Health Science (SMHS) was planned to provide a forum for high quality original research and review articles that showcase the recent advances in translational research and clinical practices. As summarized in Table 1, a total of 11 papers, authored by 52 contributors from Brazil, China, South Africa, and United States, have been accepted for this issue. Collectively, these papers represent an international effort for quantifying and tackling the unsolved issues raised by the emergence of COVID-19. A variety of scientific approaches featured in this special issue surround the central theme of CVOID-19 and its viral pathogen – SARS-CoV-2 (Fig. 1). Topics include original manuscripts about spike protein-driven pathogenesis of COVID-19, and associated links to cardiovascular complications (https://doi.org/10.1016/j.smhs.2023.03.004), heart and blood vessel abnormalities in Long-COVID Syndrome (https://doi.org/10.1016/j.smhs.2024.03.009), and myocarditis caused by viral or non-viral pathogens (https://doi.org/10.1016/j.smhs.2024.03.003). Other contributions include new evidence on the impact of prolonged sedentary behavior and post-infection outcomes. Tragically, this evidence suggests that initially lifesaving stay-home lockdowns, and similar social distancing mandates, appear to have amplified individual psychological stress during the COVID-19 pandemic. In addition, sleep quality among university students, as well as general population, (https://doi.org/10.1016/j.smhs.2024.04.003; https://doi.org/10.1016/j.smhs.2024.04.005) appear to have been negatively altered by the pandemic. The cardiovascular impacts of COVID-19 infection appear to be diffuse, including new findings featured in this issue which examine the impact of the illness on cerebral blood circulation measurable via functional near-infrared spectroscopy (fNIRS) technology (https://doi.org/10.1016/j.smhs.2024.06.002). Several other studies were focused on various cardiac rehabilitation measures (https://doi.org/10.1016/j.smhs.2023.09.004) and telehealth strategies (https://doi.org/10.1016/j.smhs.2023.03.002), finding that conventional cardiac rehabilitation achieved a superior effect on clinical improvement (e.g. blood pressure stabilization) and quality of life. These findings are notable in that the observations occurred in patients with cardiovascular diseases during the period of COVID-19-associated social isolation. In addition, a separate study Patient Health Questionnaire-9 surveys from more than 27 000 cardiac rehabilitation patients indicated that screening metrics that are sensitive to both major and minor depressive disorder were improved both following a standard course of cardiac rehabilitation (https://doi.org/10.1016/j.smhs.2023.09.004). A separate set of researchers also investigated complicating issues related to contact team sports such as rugby (https://doi.org/10.1016/j.smhs.2024.03.005) and highlighted the influence incidental physical contact that occurs during rugby training and competition as a stimulus for the spread of the SARS-CoV-2 virus. Another study in female volleyball players demonstrated the effects of biological maturation on cardiac autonomic recovery following repeated sprints training, a health outcome that likely informs the incidence and severity of illnesses, including viral infections (https://doi.org/10.1016/j.smhs.2023.10.002). Finally, a group of physician-scientists used the Mendelian randomization approach to analyze the European-based open access “big data” sets via the IEU Open GWAS online platform,4,5 in order to establish a possible causal link between COVID-19 and cardiovascular diseases (https://doi.org/10.1016/j.smhs.2024.06.001). Findings from this innovative approach suggest that use of the Mendelian randomization approach to evaluate exposure-associated genetic variants was instrumental in the identification of variables that may be associated with risk factors (e.g. COVID-19 infection) and disease outcomes (e.g. cardiovascular diseases). In this investigation, the meiosis-based random classification of genetic variants forms suggests that the basis of molecular recognition provides reasonable predictive power as an epidemiological strategy for tracking future illness.Table 1 List of articles included in the 2024 Special Issue of Sports Medicine and Health Science on COVID-19 and Cardiovascular Health.

Table 1Type of article	Article title	Author name	Authors' primary institutions	DOI number	
Review	More than a key –the pathological roles of SARS-CoV-2 spike protein in COVID-19 related cardiac injury.	Zhiqiang Lin	Masonic Medical Research Institute, Utica, NY, USA	https://doi.org/10.1016/j.smhs.2023.03.004	
Review	Cardiovascular abnormalities of Long-COVID Syndrome: Pathogenic basis and potential strategies for treatment and rehabilitation.	Kainuo Wu, Jonathan Van Name, Lei Xi	Virginia Commonwealth University, Richmond, VA, USA	https://doi.org/10.1016/j.smhs.2024.03.009	
Review	Myocarditis – a silent killer in athletes: Comparative analysis on the evidence before and after COVID-19 pandemic.	Jonathan Van Name, Kainuo Wu, Lei Xi	Virginia Commonwealth University, Richmond, VA, USA	https://doi.org/10.1016/j.smhs.2024.03.003	
Original Article	Assessment of clinical depression metrics in cardiac patients using the patient health Questionnaire-9 before and after phase-II cardiac rehabilitation.	John C. Quindry, Michael McNamara, Carrie Oser, Crystelle Fogle	University of Montana, Missoula, MT, USA	https://doi.org/10.1016/j.smhs.2023.09.004	
Original Article	Changes in physical activity and sleep following the COVID-19 pandemic on a university campus: Perception versus Reality.	Bryce T. Daniels, Samantha Robinson, Ivan Vargas, Jamie I. Baum, Erin K. Howie	University of Arkansas, Fayetteville, AR, USA	https://doi.org/10.1016/j.smhs.2024.04.003	
Original Article	Incidence of respiratory infections and SARS-CoV-2 is higher during contact phases in student rugby players – lessons learnt from COVID-19 risk mitigation strategies - AWARE V.	Carolette Snyders, Nicola Sewry, Wayne Derman, Maaike Eken, Esme Jordaan, Sonja Swanevelder, Martin Schwellnus	University of Pretoria;
IOC Research Centre of South Africa;
Stellenbosch University;
South African Medical Research Council;
University of the Western Cape, South Africa	https://doi.org/10.1016/j.smhs.2024.03.005	
Original Article	Relationship between infection, physical and mental health and exercise habits of some Chinese residents after recovery from COVID-19.	Aiyi Zhou, Yuncan Xia, Peng Pi, Zhengzhen Wang, Hongmei Huang, Yan Wang	Beijing Sport University, Beijing, China	https://doi.org/10.1016/j.smhs.2024.04.005	
Original Article	Effects of COVID-19 on the cardiovascular system: A Mendelian randomization study.	Qingzhi Ran, Aoshuang Li, Rui Li, Yuyang Dong, Xue Xiao, Kun Wang, Jingjing, Chen, Hengwen Chen, Benxiang He	China Academy of Traditional Chinese Medicine;
Beijing University of Traditional Chinese Medicine;
Capital Medical University, Beijing, China
Chengdu Sport University, Chengdu, China	https://doi.org/10.1016/j.smhs.2024.06.001	
Original Article	Effect of a cardiac telerehabilitation program during COVID-19 associated social isolation.	João Paulo Prado, Giovane Galdino	Federal University of Alfenas, Alfenas, Minas Gerais, Brazil	https://doi.org/10.1016/j.smhs.2023.03.002	
Original Article	Influence of biological maturation on cardiac autonomic recovery in female volleyball players during & after repeated sprints training: An experimental trial.	Paulo Francisco de Almeida-Neto, Fernanda Cristina Silva de Oliveira, José Marcondes de Oliveira-Júnior, Júlio César Medeiros Alves, Matheus de Lima Rocha, Iago Medeiros da Silva, Roberto Felipe Câmara Rocha, Paulo Moreira Silva Dantas, Breno Guilherme de Araújo Tinôco Cabral	Federal University of Rio Grande do Norte, Natal, Brazil	https://doi.org/10.1016/j.smhs.2023.10.002	
Original Article	The effects of prolonged sitting behavior on resting-state brain functional connectivity in college students post-COVID-19 rehabilitation: A study based on fNIRS technology.	Xiaocong Yan, Ying Qin, Haifeng Yu, Zhenghao Xue, Desheng Jiang, Limin Huang	Harbin Sport University, Harbin, China	https://doi.org/10.1016/j.smhs.2024.06.002	

Fig. 1 A graphical summary of the main topics covered by this Special Issue of Sports Medicine and Health Science on COVID-19 and Cardiovascular Health in sedentary population and athletes.

Fig. 1

In summary, we are confident that studies assembled for this special issue will bring in-depth analyses of what the COVID-19 pandemic has wrought during the past 4 years. Foundational evidence now indicates that in many individuals, COVID-19 exerts a lingering and deleterious impact on our cardiovascular system. These and other sobering realities in the post-pandemic world serve as a reminder for us to seek more effective ways to mitigate the detrimental outcomes and to better prepare for future similar public health crisis or pandemic through health lifestyle approaches including the participation in regular physical activity and structured exercise. We, the Guest Editors of the Special Issue of SMHS, would like to express our gratitude to all of our participating authors, the unsounding expert peer-reviewers, the Editors-in-Chief (Dr. J. Larry Durstine and Dr. Quansheng Su), Deputy Editor-in-Chief (Dr. Li Li Ji), and the handling Editors (Dr. Junzhi Sun, Ms. Liz Anderson, Dr. Yu Wang), for their sustained support and patience, which made this publication endeavor possible throughout the long process of the past 2+ years.

Authors' contributions

John C. Quindry: Conceptualization, Writing – review & editing.

Lei Xi: Conceptualization, Writing – original draft, Writing – review & editing.
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References

1 Logue J.K. Franko N.M. McCulloch D.J. Sequelae in adults at 6 months after COVID-19 infection JAMA Netw Open 4 2021 e210830 10.1001/jamanetworkopen.2021.0830
2 Ayoubkhani D. Khunti K. Nafilyan V. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study BMJ 372 2021 n693 10.1136/bmj.n693
3 Fairbank R. Long COVID still has no cure - so these patients are turning to research Nature 628 8006 2024 26 28 10.1038/d41586-024-00901-3 38565658
4 COVID-19 Host Genetics Initiative The COVID-19 host genetics initiative, a global initiative to elucidate the role of host genetic factors in susceptibility and severity of the SARS-CoV-2 virus pandemic Eur J Hum Genet 28 6 2020 715 718 10.1038/s41431-020-0636-6 32404885
5 Sakaue S. Kanai M. Tanigawa Y. A cross-population atlas of genetic associations for 220 human phenotypes Nat Genet 53 10 2021 1415 1424 10.1038/s41588-021-00931-x 34594039
