BackgroundThere are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP).ObjectiveTo determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes with other ARI.DesignCross-sectional descriptive study.SettingOnline survey.ParticipantsAthletes with confirmed/suspected COVID-19 (ARICOV) (n=45) and athletes with other ARI (ARIOTH) (n=39).MethodsParticipants recorded days to RTP and completed an online survey detailing ARI symptoms (number, type, severity and duration) in three categories: ‘nose and throat’, ‘chest and neck’ and ‘whole body’. We report the association between symptoms and RTP (% chance over 40 days) and compare the days to RTP and symptoms (number, type, duration and severity) in ARICOV versus ARIOTH subgroups.ResultsThe symptom cluster associated with more prolonged RTP (lower chance over 40 days; %) (univariate analysis) was ‘excessive fatigue’ (75%; p<0.0001), ‘chills’ (65%; p=0.004), ‘fever’ (64%; p=0.004), ‘headache’ (56%; p=0.006), ‘altered/loss sense of smell’ (51%; p=0.009), ‘Chest pain/pressure’ (48%; p=0.033), ‘difficulty in breathing’ (48%; p=0.022) and ‘loss of appetite’ (47%; p=0.022). ‘Excessive fatigue’ remained associated with prolonged RTP (p=0.0002) in a multiple model. Compared with ARIOTH, the ARICOV subgroup had more severe disease (greater number, more severe symptoms) and more days to RTP (p=0.0043).ConclusionSymptom clusters may be used by sport and exercise physicians to assist decision making for RTP in athletes with ARI (including COVID-19).

ObjectiveTo determine the days until return to sport (RTS) after acute respiratory illness (ARill), frequency of time loss after ARill resulting in >1 day lost from training/competition, and symptom duration (days) of ARill in athletes.DesignSystematic review and meta-analysis.Data sourcesPubMed, EBSCOhost, Web of Science, January 1990–July 2020.Eligibility criteriaOriginal research articles published in English on athletes/military recruits (15–65 years) with symptoms/diagnosis of an ARill and reporting any of the following: days until RTS after ARill, frequency (%) of time loss >1 day after ARill or symptom duration (days) of ARill.Results767 articles were identified; 54 were included (n=31 065 athletes). 4 studies reported days until RTS (range: 0–8.5 days). Frequency (%) of time loss >1 day after ARill was 20.4% (95% CI 15.3% to 25.4%). The mean symptom duration for all ARill was 7.1 days (95% CI 6.2 to 8.0). Results were similar between subgroups: pathological classification (acute respiratory infection (ARinf) vs undiagnosed ARill), anatomical classification (upper vs general ARill) or diagnostic method of ARinf (symptoms, physical examination, special investigations identifying pathogens).ConclusionsIn 80% of ARill in athletes, no days were lost from training/competition. The mean duration of ARill symptoms in athletes was 7 days. Outcomes were not influenced by pathological or anatomical classification of ARill, or in ARinf diagnosed by various methods. Current data are limited, and future studies with standardised approaches to definitions, diagnostic methods and classifications of ARill are needed to obtain detailed clinical, laboratory and specific pathogen data to inform RTS.PROSPERO registration numberCRD42020160479.

PurposeThis study aimed to determine factors predictive of prolonged return to training (RTT) in athletes with recent SARS-CoV-2 infection.MethodsThis is a cross-sectional descriptive study. Athletes not vaccinated against COVID-19 (n = 207) with confirmed SARS-CoV-2 infection (predominantly ancestral virus and beta-variant) completed an online survey detailing the following factors: demographics (age and sex), level of sport participation, type of sport, comorbidity history and preinfection training (training hours 7 d preinfection), SARS-CoV-2 symptoms (26 in 3 categories; “nose and throat,” “chest and neck,” and “whole body”), and days to RTT. Main outcomes were hazard ratios (HR, 95% confidence interval) for athletes with versus without a factor, explored in univariate and multiple models. HR < 1 was predictive of prolonged RTT (reduced % chance of RTT after symptom onset). Significance was P < 0.05.ResultsAge, level of sport participation, type of sport, and history of comorbidities were not predictors of prolonged RTT. Significant predictors of prolonged RTT (univariate model) were as follows (HR, 95% confidence interval): female (0.6, 0.4–0.9; P = 0.01), reduced training in the 7 d preinfection (1.03, 1.01–1.06; P = 0.003), presence of symptoms by anatomical region (any “chest and neck” [0.6, 0.4–0.8; P = 0.004] and any “whole body” [0.6, 0.4–0.9; P = 0.025]), and several specific symptoms. Multiple models show that the greater number of symptoms in each anatomical region (adjusted for training hours in the 7 d preinfection) was associated with prolonged RTT (P < 0.05).ConclusionsReduced preinfection training hours and the number of acute infection symptoms may predict prolonged RTT in athletes with recent SARS-CoV-2. These data can assist physicians as well as athletes/coaches in planning and guiding RTT. Future studies can explore whether these variables can be used to predict time to return to full performance and classify severity of acute respiratory infection in athletes.

Acute respiratory infections (ARinf) are common in athletes, but their effects on exercise and sports performance remain unclear. This systematic review aimed to determine the acute (short-term) and longer-term effects of ARinf, including SARS-CoV-2 infection, on exercise and sports performance outcomes in athletes. Data sources searched included PubMed, Web of Science and EBSCOhost, from January 1990 to 31 December 2021. Eligibility criteria included original research studies published in English, measuring exercise and/or sports performance outcomes in athletes/physically active/military aged 15-65 years with ARinf. Information regarding the study cohort, diagnostic criteria, illness classification and quantitative data on the effect on exercise/sports performance were extracted. Database searches identified 1707 studies. After full-text screening, 17 studies were included (n = 7793). Outcomes were acute or longer-term effects on exercise (cardiovascular or pulmonary responses), or sports performance (training modifications, change in standardised point scoring systems, running biomechanics, match performance or ability to start/finish an event). There was substantial methodological heterogeneity between studies. ARinf was associated with acute decrements in sports performance outcomes (four studies) and pulmonary function (three studies), but minimal effects on cardiorespiratory endurance (seven studies in mild ARinf). Longer-term detrimental effects of ARinf on sports performance (six studies) were divided. Training mileage, overall training load, standardised sports performance-dependent points and match play can be affected over time. Despite few studies, there is a trend towards impairment in acute and longerterm exercise and sports outcomes after ARinf in athletes. Future research should consider a uniform approach to explore relationships between ARinf and exercise/sports performance.PROSPERO (CRD42020159259) Highlights. Cardiorespiratory endurance is largely unaffected by recent mild SARS-CoV-2 infection and upper ARinf (rhinovirus) infection, however more severe ARinf is associated with a negative impact on exercise and sports performance. . An upper ARinf (rhinovirus) and SARS-CoV-2 infection caused marked reductions in pulmonary function tests (FEV 1.0 /FVC), with greater reductions observed in more severe ARinf. However, the results remained within normal ranges. . Self-reported training ability and training capacity can be reduced during an upper ARinf, and an ARinf with fever could alter running kinematics. . Training mileage and overall training load can be impaired over time post-ARinf. Analysis of initial studies indicates a trend for a reduction in standardised sports performance-dependent points in athletes with respiratory infection.

Complete echocardiogram-No structural abnormalities and normal systolic function Cardiac CTA-4 cm long myocardial bridge in the mid LAD with 30% reduction in diameter as compared to the LAD distal to the bridge-Large diagonal system arises proximal to the bridge and supplies the majority of the anterolateral wall-No evidence of anomalous coronary origins or atherosclerotic plaque Cardiac MRI-No myocarditis, normal biventricular function, no late gadolinium enhancement or scar Exercise stress test-Chest pain reproduced at peak exercise level-No EKG evidence of ischemia-Otherwise normal stress test FINAL/WORKING DIAGNOSIS:Long LAD myocardial bridge, presumed etiology of ischemia TREATMENT AND OUTCOMES:1. Medical management with metoprolol, dose titrated to 75mg daily. 2. Repeat exercise stress test and stress echo normal. Chest pain not reproduced at peak exercise level. 3. Thorough discussion of potential risks associated with strenuous physical activity. Through shared decision making, the patient opted to continue playing basketball. Has returned to his previous level of play and has not had recurrence of symptoms to date.