Return To Sport after having COVID-19: Part 1

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus that emerged in late 2019 and has caused a pandemic of acute respiratory disease, named ‘coronavirus disease 2019’ (COVID-19). 

The primary purpose of this blog is to provide guidance about individual return to play or strenuous activity following infection with COVID-19, with a focus on older adolescent (eg, high school) athletes, recreational and elite adult athletes.¹ Considerations for child and younger athletes are much the same, and further details can be found at The American Academy Of Pediatrics website.

With increased risk of cardiological, renal, respiratory, and haematological complications, it is best practice to follow a steady resumption of training, paying attention to physical and psychological factors after COVID-19 infection.³ While there are no set evidence-based guidelines to assist decision-making about return to play of the athlete recovering from COVID-19, several authorities recommend: 

• Refraining from any exercise until at least 10 days of rest from symptom onset, including a minimum of seven days from resolution of all symptoms.  As loss of taste or smell may persist beyond 10 days, they do not consider these symptoms when making return to play decisions.¹
• Before considering a Graduated Return To Play/participation protocol (GRTP), the athlete must be able to complete activities of daily living and walk 500 m on the flat without excessive fatigue or breathlessness.²
• Less aerobically intense sports like golf may progress quicker. Experience suggests that some athletes take over 3 weeks to recover.²

Figure 1 Adapted from Elliot et al 2020 https://bjsm.bmj.com/content/bjsports/54/19/1174/F1.large.jpg

References

1. O’Connor F, Franzos M, 2021. COVID-19: Return to play or strenuous activity following infection. [online] Uptodate.com. [Accessed 19 January 2022] https://www.uptodate.com/contents/covid-19-return-to-play-or-strenuous-activity-following-infection#H2153716845
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] https://www1.racgp.org.au/getattachment/1a21815f-4e61-475b-ab65-740083ecfae9/Life-after-COVID-19.aspx 
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]  https://bjsm.bmj.com/content/54/19/1174