Effects of COVID-19 infection on maximal oxygen consumption, gas exchange, and substrate oxidation in young adults who are overweight or obese
DOI:
https://doi.org/10.47197/retos.v77.118324Keywords:
Overweight, COVID-19, Fat oxidation, Carbohydrate oxidation, V̇O2maxAbstract
Introduction: The impact of COVID-19 on maximal oxygen consumption (V̇O2max), gas exchange, and substrate oxidation in individuals who are overweight or obese remains uncertain and warrants investigation.
Objective: To investigate the effects of prior COVID-19 infection on V̇O2max, gas exchange, and substrate oxidation in overweight and obese young adults.
Methodology: Ninety young men and women who were overweight or obese were enrolled in the study and divided into two groups: those previously infected with COVID-19 (COVID) and those with no history of COVID-19 infection (NCOVID). Anthropometry, resting heart rate (RHR), blood pressure, and health questionnaire data were collected. V̇O2max, oxygen consumption (V̇O2), estimated fat oxidation (FO), carbohydrate oxidation (CHO), respiratory exchange ratio (RER), and minute ventilation (V̇E) were assessed during an incremental treadmill V̇O2max test. Differences between the groups were assessed using paired and independent sample t-tests. Associations between the parameters were examined using the Pearson product-moment correlation coefficient.
Results: Among the women, the V̇O2, V̇CO2, CHO, FO, and RER peaks were significantly different in the COVID group compared with the NCOVID group (all, p < .05). There was no statistically significant difference in V̇O2max between the COVID and NCOVID groups. However, in both groups V̇O2max differed significantly by sex, with higher values in the men than women. In the men, V̇O2max, V̇O2, and V̇CO2 were correlated with the participants’ body mass, BMI, and exercise frequency. In the NCOVID group, RHR was found to be moderately correlated with V̇O2max, V̇O2, V̇CO2, and V̇E in the men, while in the NCOVID women, V̇CO2 was associated with the RHR, exercise frequency, and exercise duration.
Conclusion: Women who were overweight or obese and who had a history of COVID-19 infection exhibited altered gas exchange and substrate oxidation responses during maximal exercise compared with their never-infected peers, despite showing no difference in V̇O2max.
References
Albashir, A. A. D. (2020). The potential impacts of obesity on COVID-19. Clinical Medicine, 20(4), e109-113. https://doi.org/10.7861/clinmed.2020-0239
Alsharif, W., & Qurashi, A. (2021). Effectiveness of COVID-19 diagnosis and management tools: a review. Radiography, 27(2), 682-687. https://doi.org/10.1016/j.radi.2020.09.010
Alvaro, C. E., Levers, K. S., Barberio, M. D., Jin, Y., Stranieri, A. M., & Sacheck, J. M. (2024). COVID-19 incidence and cardiorespiratory fitness among first-year college students. Front Public Health, 12, 1468300. https://doi.org/10.3389/fpubh.2024.1468300
Berg, O. K., Aagård, N., Helgerud, J., Brobakken, M. F., Hoff, J., & Wang, E. (2025). Maximal oxygen uptake, pulmonary function and walking economy are not impaired in patients diagnosed with long COVID. European Journal of Applied Physiology, 125(4), 1157-1166. https://doi.org/10.1007/s00421-024-05652-7
Borg, G. (1998). Borg’s perceived exertion and pain scales. Human Kinetics.
Christensen, R. A. G., Arneja, J., St Cyr, K., Sturrock, S. L., & Brooks, J. D. (2021). The association of estimated cardiorespiratory fitness with COVID-19 incidence and mortality: a cohort study. PLoS One, 16(5), e0250508. https://doi.org/10.1371/journal.pone.0250508
Crameri, G. A. G., Bielecki, M., Züst, R., Buehrer, T. W., Stanga, Z., & Deuel, J. W. (2020). Reduced maximal aerobic capacity after COVID-19 in young adult recruits, Switzerland, May 2020. Euro Surveillance, 25(36), 2001542. https://doi.org/10.2807/1560-7917.ES.2020.25.36.2001542
de Boer, E., Petrache, I., Goldstein, N. M., Olin, J. T., Keith, R. C., Modena, B., Mohning, M. P., Yunt, Z. X., San-Millan, I., & Swigris, J. J. (2022). Decreased fatty acid oxidation and altered lactate production during exercise in patients with post-acute COVID-19 syndrome. American Journal of Respiratory and Critical Care Medicine, 205(1), 126-129. https://doi.org/10.1164/rccm.202108-1903LE
Dourado, V. Z., Morais Pereira Simoes, M. D. S., Lauria, V. T., Gulayin, P., Gutierrez, L., Pena-Silva, R., Pereyra-Gonzalez, I., Ortiz, A., Lopez-Arana, S., Widyahening, I. S., Al-Shaar, L., Danaei, G., Poggio, R., On behalf of Lown Scholars in Physical, A., & Fitness, N. (2025). Long-term impact of the COVID-19 pandemic on physical activity and estimated cardiorespiratory fitness in south American adults: a multi-country cross-sectional online survey. Archives of Public Health, 83(1), 203. https://doi.org/10.1186/s13690-025-01664-7
Ekblom-Bak, E., Vaisanen, D., Ekblom, B., Blom, V., Kallings, L. V., Hemmingsson, E., Andersson, G., Wallin, P., Salier Eriksson, J., Holmlund, T., Lindwall, M., Stenling, A., & Lonn, A. (2021). Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case control study. The International Journal of Behavioral Nutrition and Physical Activity, 18(1), 135. https://doi.org/10.1186/s12966-021-01198-5
Frayn, K. N. (1983). Calculation of substrate oxidation rates in vivo from gaseous exchange. Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology, 55(2), 628-634. https://doi.org/10.1152/jappl.1983.55.2.628
Ganesan, B., Al-Jumaily, A., Fong, K. N. K., Prasad, P., Meena, S. K., & Tong, R. K. (2021). Impact of coronavirus disease 2019 (COVID-19) outbreak quarantine, isolation, and lockdown policies on mental health and suicide. Frontiers in Psychiatry, 12, 565190. https://doi.org/10.3389/fpsyt.2021.565190
Garbsch, R., Schafer, H., Mooren, F. C., & Schmitz, B. (2024). Analysis of fat oxidation capacity during cardiopulmonary exercise testing indicates long-lasting metabolic disturbance in patients with post-covid-19 syndrome. Clinical Nutrition, 43(12), 26-35. https://doi.org/10.1016/j.clnu.2024.10.010
Guntur, V. P., Nemkov, T., de Boer, E., Mohning, M. P., Baraghoshi, D., Cendali, F. I., San-Millan, I., Petrache, I., & D'Alessandro, A. (2022). Signatures of mitochondrial dysfunction and impaired fatty acid metabolism in plasma of patients with post-acute sequelae of COVID-19 (PASC). Metabolites, 12(11), 1026. https://doi.org/10.3390/metabo12111026
Guo, L., Jiang, L., & Huang, H. (2025). A longitudinal study of four-year changes in physical fitness among university students before and after COVID-19: 2019-2022. PLoS One, 20(10), e0334088. https://doi.org/10.1371/journal.pone.0334088
Held, C., Hadziosmanovic, N., Aylward, P. E., Hagström, E., Hochman, J. S., Stewart, R. A. H., White, H. D., & Wallentin, L. (2022). Body mass index and association with cardiovascular outcomes in patients with stable coronary heart disease – A STABILITY substudy. Journal of the American Heart Association, 11(3), e023667. https://doi.org/10.1161/JAHA.121.023667
Heyward, H. V., & Gibson, L. A. (2014). Advanced fitness assessment and exercise prescription (Seventh ed.). Human Kinetics.
Kang, H. (2021). Sample size determination and power analysis using the G*Power software. Journal of Educational Evaluation for Health Professions, 18, 17. https://doi.org/10.3352/jeehp.2021.18.17
Kang, S. J., & Ko, K. J. (2019). Association between resting heart rate, VO(2)max and carotid intima-media thickness in middle-aged men. International Journal of Cardiology. Heart & Vasculature, 23, 100347. https://doi.org/10.1016/j.ijcha.2019.100347
Keller, K., Friedrich, O., Treiber, J., Quermann, A., & Friedmann-Bette, B. (2023). Former SARS-CoV-2 infection was related to decreased VO(2) peak and exercise hypertension in athletes. Diagnostics (Basel), 13(10), 1792. https://doi.org/10.3390/diagnostics13101792
Kumar, S., Gogoi, H., Singh, S., Verma, M. K., Nara, K., Choudhary, S., & Govindasamy, K. (2025). Impact of gender, urbanization, and food preference on university students' body composition post-COVID-19. Retos, 69, 166-182. https://doi.org/10.47197/retos.v69.113972
Lemos, M. M., Cavalini, G. R., Pugliese Henrique, C. R., Perli, V. A. S., de Moraes Marchiori, G., Marchiori, L. L. M., Sordi, A. F., Franzoi de Moraes, S. M., de Paula Ramos, S., Valdes-Badilla, P., Mota, J., & Magnani Branco, B. H. (2022). Body composition and cardiorespiratory fitness in overweight or obese people post COVID-19: a comparative study. Frontiers in Physiology, 13, 949351. https://doi.org/10.3389/fphys.2022.949351
Meloni, A., Codella, R., Gotti, D., Di Gennaro, S., Luzi, L., & Filipas, L. (2023). Fat oxidation rates and cardiorespiratory responses during exercise in different subject populations with post-acute sequelae of SARS-CoV-2 infection: a comparison with normative percentile values. Frontiers in Physiology, 14, 1310319. https://doi.org/10.3389/fphys.2023.1310319
Mihalick, V. L., Canada, J. M., Arena, R., Abbate, A., & Kirkman, D. L. (2021). Cardiopulmonary exercise testing during the COVID-19 pandemic. Progress in Cardiovascular Diseases, 67, 35-39. https://doi.org/10.1016/j.pcad.2021.04.005
Mondal, H., & Mishra, S. P. (2017). Effect of BMI, body fat percentage and fat free mass on maximal oxygen consumption in healthy young adults. Journal of Clinical and Diagnostic Research, 11(6), CC17-20. https://doi.org/10.7860/jcdr/2017/25465.10039
Musa, S., Al-Dahshan, A., & Singh, R. (2023). Prevalence of obesity and lifestyle risk factors following two years' COVID-19 related service closure at wellness center, primary health care. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 16, 3851-3868. https://doi.org/10.2147/DMSO.S433978
Namprai, S., Hongratanaworakit, T., & Silalertdetkul, S. (2019). Effects of aromatherapy massage on pain perception, range of motion, and physical performance in soccer players. Journal of Faculty of Physical Education, 22(2), 12-23.
Paneroni, M., Simonelli, C., Saleri, M., Bertacchini, L., Venturelli, M., Troosters, T., Ambrosino, N., & Vitacca, M. (2021). Muscle strength and physical performance in patients without previous disabilities recovering from COVID-19 pneumonia. American Journal of Physical Medicine & Rehabilitation, 100(2), 105-109. https://doi.org/10.1097/phm.0000000000001641
Parpa, K., & Michaelides, M. (2022). Aerobic capacity of professional soccer players before and after COVID-19 infection. Scientific Reports, 12(1), 11850-11850. https://doi.org/10.1038/s41598-022-16031-7
Pleguezuelos, E., Del Carmen, A., Moreno, E., Ortega, P., Robles, A., Serra-Prat, M., Miravitlles, M., Yebenes, J. C., & Garnacho-Castaño, M. V. (2022). Impaired pulmonary and muscle function during moderate exercise in female patients recovered from SARS-CoV-2. Scientific Reports, 12(1), 20943. https://doi.org/10.1038/s41598-022-24941-9
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J. P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M. P. (2021). Obesity and cardiovascular disease: a scientific statement from the american heart association. Circulation, 143(21), e984-1010. https://doi.org/10.1161/cir.0000000000000973
Ramirez-Velez, R., Oscoz-Ochandorena, S., Garcia-Alonso, Y., Garcia-Alonso, N., Legarra-Gorgonon, G., Oteiza, J., Lorea, A. E., Izquierdo, M., & Correa-Rodriguez, M. (2023). Maximal oxidative capacity during exercise is associated with muscle power output in patients with long coronavirus disease 2019 (COVID-19) syndrome. a moderation analysis. Clinical Nutrition ESPEN, 58, 253-262. https://doi.org/10.1016/j.clnesp.2023.10.009
Rubio Herrera, M. A., & Breton Lesmes, I. (2021). Obesity in the COVID era: a global health challenge. Endocrinology, Diabetes and Nutrition EDN, 68(2), 123-129. https://doi.org/10.1016/j.endinu.2020.10.001
Sawekchan, N., & Silalertdetkul, S. (2024). Effects of COVID-19 infection on eating behaviors, appetite perceptions, and exercise behaviors. Journal of Sports Science and Technology, 24(1), 52-64. https://he01.tci-thaijo.org/index.php/JSST/article/view/269743
Shin, J. Y., & Ha, C. H. (2016). Relationships between blood pressure and health and fitness-related variables in obese women. Journal of Physical Therapy Science, 28(10), 2933-2937. https://doi.org/10.1589/jpts.28.2933
Silalertdetkul, S. (2023). The consumption of riceberry rice combined with exercise enhances the production of circulating glucagon-like peptide-1 and inhibits creatine kinase compared to that with white rice. Journal of Physical Education and Sport, 23(6), 1473-1480. https://doi.org/10.7752/jpes.2023.06180
Silalertdetkul, S. (2024). Estimating the total and regional body fat of physically active men is not appropriate for sedentary men. Physical Education Theory and Methodology, 24(3), 388-395. https://doi.org/10.17309/tmfv.2024.3.06
Śliż, D., Wiecha, S., Ulaszewska, K., Gąsior, J. S., Lewandowski, M., Kasiak, P. S., & Mamcarz, A. (2022). COVID-19 and athletes: endurance sport and activity resilience study-CAESAR study. Frontiers in Physiology, 13, 1078763. https://doi.org/10.3389/fphys.2022.1078763
Sova, M., Sovova, E., Ozana, J., Moravcova, K., Sovova, M., Jelinek, L., Mizera, J., & Genzor, S. (2023). Post-COVID syndrome and cardiorespiratory fitness-26-month experience of single center. Life (Basel), 13(3), 684. https://doi.org/10.3390/life13030684
Stepanek, L., Nakladalova, M., Sovova, E., Stepanek, L., Borikova, A., Sovova, M., Moravcova, K., Ozana, J., & Jelinek, L. (2023). COVID-19 reduces cardiorespiratory fitness even months after a mild to moderate acute phase: a retrospective cohort study. Infectious Diseases, 55(10), 684-693. https://doi.org/10.1080/23744235.2023.2228408
Venkataraman, A., Hong, I. Z., Ho, L. C., Teo, T. L., & Ang, S. H. (2024). Public perceptions on the use of the physical activity readiness questionnaire. Healthcare, 12(17). https://doi.org/10.3390/healthcare12171686
Wells, C. R., Townsend, J. P., Pandey, A., Moghadas, S. M., Krieger, G., Singer, B., McDonald, R. H., Fitzpatrick, M. C., & Galvani, A. P. (2021). Optimal COVID-19 quarantine and testing strategies. Nature Communications, 12(1), 356. https://doi.org/10.1038/s41467-020-20742-8
Wu, X., Liu, X., Zhou, Y., Yu, H., Li, R., Zhan, Q., Ni, F., Fang, S., Lu, Y., Ding, X., Liu, H., Ewing, R. M., Jones, M. G., Hu, Y., Nie, H., & Wang, Y. (2021). 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. The Lancet Respiratory Medicine, 9(7), 747-754. https://doi.org/10.1016/s2213-2600(21)00174-0
Yaiyong, C., Mitranun, W., Anek, A., Sriramatr, S., & Silalertdetkul, S. (2026). Differences in quality of life, pulmonary function, and exercise behaviour in young overweight individuals with and without COVID-19. Retos, 76, 198-210. https://doi.org/10.47197/retos.v76.117630
Zavala Crichton, J. P., Titus-Cabrera, A., Navarro-Henríquez, F., Álvarez-Opazo, J. J., Yáñez-Sepúlveda, R., Ortiz-Marholz, P., Hinojosa-Torres, C., Cristi-Montero, C., Solís-Urra, P., & López-Gil, J. F. (2025). Associations between physical fitness, body composition, and health related quality of life among inactive university students. Retos, 73, 757-769. https://doi.org/10.47197/retos.v73.117510
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Nattaphon Dachakoon, Sonthaya Sriramatr, Witid Mitranun, Achariya Anek, Supaporn Silalertdetkul

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.