Return to Sport after COVID-19: part 2


To determine the appropriate return to physical activity, the relative risk of the individual returning to physical activity will be considered by the doctor, in particular the risk of cardiovascular, respiratory, and chronic fatigue complications. Following a thorough clinical assessment they will stratify patients into three categories:

Low risk – includes:

  • Mild or no symptoms resolved within 7 days
  • Upper respiratory infection only
  • Younger patients (aged <50 years)
  • Recreational exercise goals.
  • High risk 

Intermediate risk – any or more than 1 of:

  • Patients who experienced prolonged symptoms or fatigue (>7 days)
  • Ongoing shortness of breath or chest pain, which did not require hospitalisation.
  • Dyspnoea (breathlessness)/chest pain with illness 
  • Elite and/or endurance athletes
  • Older patients (aged >50 years)
  • Those with pre-existing comorbidities that may affect recovery eg asthma, chronic fatigue.

High risk:

  • Individuals who required hospitalization / ICU
  • Patients with any evidence of system involvement outside the respiratory tract
  • Prolonged shortness of breath or chest pain at rest or with activities of daily living
  • Significant cardiac comorbidities, history of cardiac disease, or abnormal electrocardiogram (ECG) or blood test findings during the illness.

Low-risk patients should be able to enter a graded return to physical activity without further investigations.2

Intermediate- and high-risk patients should be considered by the doctor for an ECG and baseline pathology.  High-risk patients should be considered for a team approach to management including a cardiologist, respiratory physician and a sport and exercise physician to help with individualised exercise prescription.2

It is important to note that in this statement from the Australian College of Sport and Exercise Physicians it states that any athlete of elite and endurance athletes are considered moderate risk and it is recommended they seek medical clearance for return to training and competition.

Once cleared for activity and training, a gradual return to exercise is utilised and supervised by a medical professional as shown below.


Figure 2 Adapted from Elliot et al 2020

Monitoring your return to activity

There are several simple ways to help monitor and track your progress that may add value, which could include

  • Resting heart rate – mornings.
  • Duration of session in minutes and Rate of Perceived Exertion (RPE) scale (below).  Score /10 
  • Monitor Symptoms
  • Breathlessness
  • Sleep quality
  • Stress
  • Fatigue
  • Muscle soreness.

If any symptoms occur (including excessive fatigue) while going through GRTP, the athlete must return to the previous stage and progress again after a minimum of 24 hours’ period of rest without symptoms.

So, see your GP and/or one of the many great Sports and Exercise Physicians in your local area.  And then see your friendly RHP Sports physiotherapist for strategies to prevent musculoskeletal injuries and maximise your performance as you return to training after COVID-19 infection or prolonged time off training. 


  1. O’Connor F, Franzos M, 2021. COVID-19: Return to play or strenuous activity following infection. [online] [Accessed 19 January 2022]
  2. Jewson J, McNamara A, Fitzpatrick J. Life after COVID-19: The importance of a safe return to physical activity. Aust J Gen Pract 2020; 49 Suppl 40. [Accessed 19 January 2022] 
  3. Elliott N, Martin R, Heron N, et al. Infographic. Graduated return to play guidance following COVID-19 infection. BJSM 2020; 54:1174-1175. [Accessed 19 January 2022]
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