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How Long Covid affects athletic performance, featuring Dr. Nader Ayub

The impact of a COVID-19 infection has been well documented – as of publication of this article, there have been more than 233 million recorded COVID-19 cases and 4 million people have died from the virus. What is less known are the longer symptoms of COVID-19 that may be experienced after recovering from the initial infection, known as Long Covid.

The reality is that we still don’t have a full grip on what Long COVID is and how it manifests in the body, but the scientific community is continuing to investigate this phenomenon. That being said, what we at OTandP do know currently is that Long Covid experiences are widespread. We are committed to learning from and sharing these experiences with the greater OTandP community to exchange information and possibly fill any knowledge gaps.

We are pleased to introduce the launch of our latest blog series, The Long Covid Diaries. In this new series, you’ll hear from people like you who have either personally experienced or have cared for those who feel the effects of Long Covid. These anecdotes intend to complement the ongoing investigations researchers from around the world are conducting to better understand Long Covid. You can also learn more about Long Covid by visiting our Long COVID Resource Centre, where we provide ongoing updates on Long Covid research.


For our first post in The Long Covid Diaries series, we spoke with Dr Nader Ayub, a Primary Care Sports Medicine Physician based in Houston, Texas. Dr Ayub has seen first-hand how Long Covid can change individuals’ quality of life long after they have fully recovered from a COVID-19 infection. From professional athletes who are at the peak of their athletic career to middle-aged individuals looking to improve their general mobility, Dr Ayub’s patients range in terms of physical fitness. But one thing many of them have in common is the debilitating effects of Long Covid.

First, let’s quickly recap the basics of what we know about Long Covid symptoms so far. The symptom patterns of Long Covid are wide-ranging and can currently be categorized into three broad groups: impaired cognition of brain function; upset of the automatic or autonomic nervous system; and poor exercise tolerance. The World Health Organization estimates that there have been more than 200 symptoms reported in patients, and understanding of the condition is ongoing.

Among Dr Ayub’s patients who are currently living with Long Covid symptoms, many of them are experiencing symptoms related to poor exercise tolerance.

“Among the athletes I see, including collegiate professional athletes in the NCAA who had have recovered from a COVID-19 infection, their athletic performance has taken a huge toll,” says Dr Ayub. “Shortness of breath and fatigue are symptoms that particularly affect their athletic performance, but at the end of the day, this also affects their overall quality of life, too.”

This can be a hard reality for these young athletes to accept – they are aged between 16-22 and pre-pandemic were considered some of the best athletes in their sport. Additionally, Dr Ayub has seen decreased appetite in these “long haulers.” Proper nutrition is important for all people – and for athletes, proper nutrition is an essential part of their athletic performance. With a decreased appetite and thus lower caloric intake, athletes are not getting enough of the macronutrients that they need. This lack of proper nutrition exacerbates the fatigue symptoms already experienced from Long Covid, and further affects their physical fitness.

“Long Covid really affects people’s overall quality of life.”

“It’s a vicious cycle,” explains Dr Ayub. “Athletes don’t feel like they are at peak performance if they’re short of breath or fatigued, which can affect them psychologically since their change in athletic performance can be dramatic. And the psychological effects – such as depression or ‘brain fog’ – further affect their physical performance.”

And it’s not just top athletes who are facing Long Covid challenges. Besides the athletes Dr Ayub sees, among his middle-aged patients who now live with Long Covid, many of them now cannot manage to walk a few steps without getting short of breath.

“Long Covid is very disruptive to people’s lifestyles, especially if their line of work involves a lot of movement. Long Covid really affects people’s overall quality of life.”

Unfortunately, there still aren’t any approved treatments available specifically for managing Long Covid. Rather, individuals may be given medications to manage the specific symptoms, such as inflammation in the lungs.

“For example, for those experiencing shortness of breath or fatigue, inhaled corticosteroids [which reduces inflammation] may be prescribed. In other situations, these steroids would be given to those who have chronic obstructive pulmonary disease (COPD). There hasn’t been a great success rate with the corticosteroids, but Long Covid is a new experience for both patients and practitioners and we’re trying to find the best, and safest, possible treatments.”

When asked how Long Covid may affect individuals in the long run, Dr Ayub is refreshingly frank: “Honestly, we just don’t know. What I know about Long Covid and what I’ve seen among my patients is that it just sucks. It’s hard to tell my patients that you don’t know what it’s in store for them in the future, but as a healthcare provider it’s important for me to be honest and transparent with my patients.”

Are you experiencing Long Covid symptoms? We are interested in hearing about your experience. Reach out to us at

Topics: Long COVID

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OT&P Healthcare

OT&P Healthcare is a Premium Private Healthcare Practice in Hong Kong. Our priority is to help individuals to enhance and optimise their health by providing easy access to a wide range of excellent practitioners and information, supported by management systems and technology that ensure quality of service and value. Our Mission is to provide pre-eminent private healthcare in Hong Kong. We aim to be the best in class fully integrated healthcare service, providing a circle of care for all our patients' needs.