Recommendations for return to sport during the SARS-CoV-2 pandemic

Abstract

In this viewpoint we make specific recommendations that can assist and make the return to sport/exercise as safe as possible for all those impacted – from the recreational athlete to the elite athlete. We acknowledge that there are varying rules and regulations around the world, not to mention the varying philosophies and numerous schools of thought as it relates to return to sport/exercise and we have been cognisant of this in our recommendations. Despite the varying rules and circumstances around the world, we believe it is essential to provide some helpful and consistent guidance for return to training and sport for sport and exercise physicians around the world at this most difficult time. The present viewpoint provides practical and medical recommendations on the resumption to sport process.

Returning to physical activity after covid-19

“…Without evidence from robust studies to inform practice, all current guidance to date is based on consensus or expert opinion. A consensus statement from sports clinicians of the European Federation of Sports Medicine Associations from July 2020 recommends a review with a sports and exercise medicine physician after mild symptomatic infection, and investigations including echocardiography and lung function testing where cardiopulmonary symptoms were present 24. Guidance from the Netherlands Society of Cardiology states that, for those with systemic features including fever, electrocardiography testing should be considered before resumption of activity 25.…”

“…In the natural course of covid-19, deterioration signifying severe infection often occurs at around a week from symptom onset. Therefore, consensus agreement is that a return to exercise or sporting activity should only occur after an asymptomatic period of at least seven days,21242627 and it would be pragmatic to apply this to any strenuous physical activity (fig 1). English and Scottish Institute of Sport guidance suggests that, before re-initiation of sport for athletes, activities of daily living should be easily achievable and the person able to walk 500 m on the flat without feeling excessive fatigue or breathlessness 27.…”

“…People who had more severe covid-19 illness, such as those who were hospitalised, are thought to be at higher risk of cardiac complications121321242527 and thromboembolic events 1520. We recommend that their graduated rehabilitation be managed in conjunction, or after discussion and liaison, with local post-covid-19 services.…”

Infographic. COVID-19 RT-PCR testing for elite athletes

“…Following infection, there should be a graduated return to sport, guided by professional advice which may vary based on the severity of the illness, the demands of the sport and logistical factors. [8][9][10] Additional cardiac testing should be considered based on the severity of illness. 11 1 Sports Medicine, SportNI Sports Institute, Newtownabbey, UK…”

Společné odborné stanovisko Sekce sportovní kardiologie České asociace preventivní kardiologie ČKS a Sekce sportovní kardiologie České společnosti tělovýchovného lékařství

“…7 Tělovýchovní lékaři, praktičtí lékaři i kardiologové můžou být dotazováni na uschopnění sportovce po prodělaném onemocnění COVID-19. Celosvětově vzniklo několik doporučených postupů, 5,[8][9][10][11][12][13][14][15] které vesměs zaujímají opatrnější postoj k znovuzahájení tréninků a intenzivní pohybové aktivity.…”