SARS-CoV-2 infection sequelae on exercise response: persistent or reversible? A 2 year perspective.

SARS-CoV2 and the related disease COVID-19 had a dramatic impact on global healthcare system since its appearance in December 2019 [1]. The evidence of long-lasting sequelae in COVID-19 survivors have rapidly grown, leading to the current definition of "long COVID", an entity defined as the persistence or development of new symptoms 3 months after the acute infection lasting at least 2 months [2]. Nevertheless, recent literature showed how a share of patients still presented SARS-CoV2 sequelae with clinical and functional impairment even at a 2-year follow-up [3]. Cardiopulmonary exercise test (CPET), which is the gold standard for the evaluation of pathophysiological response during exercise [4], allowed to unveil mechanisms of exercise intolerance in the early post-acute phase, mainly involving deconditioning and peripheral oxygen utilisation impairment, but also alteration of the breathing pattern and possibly chronotropic incompetence [5, 6]. However, data on the long-term outcome of patients presenting altered exercise capacity as post-acute sequelae of COVID-19 are still lacking.