Standardised lung function metrics in healthy athletes

The objective of the current review was to identify whether clinically established lung function metrics of ventilatory and diffusion capacity obtained by standardised methodology are consistent with superior lung function in athletes, and whether this is related to maximal oxygen uptake (V̇O_2max). Three independent reviewers performed a literature search in PubMed, Scopus, and reference screening. Data was extracted and analysed according to a predefined strategy. Studies published between 1970 and 2023 on athletes reporting V̇O_₂max and at least one of the following lung function metrics: predicted forced expiratory volume in the first second of a forced vital capacity manoeuvre (FEV₁%pred); predicted forced vital capacity (FVC%pred); predicted total lung capacity (TLC%pred); predicted pulmonary diffusion capacity for carbon monoxide (D_L,CO%pred). Data on population size, age, sex, type of sports, as well as FEV₁%pred, FVC%pred, TLC%pred, D_L,CO%pred, and V̇O_2max were extracted. Standardised mean, differences, and 95% CI were calculated when data were sufficient. In total, 13 original studies encompassing 193 individuals across various sports disciplines met the inclusion criteria. Pooled FEV₁%pred was 111% (108-113%; 13 studies; n=193), FVC%pred 112% (108-116 %; 7 studies; n=118), TLC%pred 106% (103-108 %; 4 studies; n=60), and D_L,CO%pred 121% (120-122 %; 2 studies; n=23). None of the studies provided sufficient data to evaluate the relationship between any of the lung function metrics and V̇O_2max. In conclusion, athletes consistently exhibit high ventilatory and diffusing capacity metrics, but it is still unknown whether this is related to V̇O_2max.