How to return to playing after Covid

The Covid-19 pandemic has had an unprecedented impact on physical activity and sport, distressing professional, elite, collegiate, strategic, work-related and recreational athletes at all levels. We look into some important aspects to be aware of from the athletes’ point of view in return to play if they had tested positive.

Illness from Covid-19 can cause a range of medical complications with potential intermediate and long-term consequences. For athletes preparing to return to play, the residual effects of illness can complicate medical clearance, protocols for returning to play or activity, and monitoring.

ALSO READ | Training domain: sport-specific or athlete-defined?

While our understanding of Covid-19-related illness continues to evolve, for both athletes and non-athletes, recovery varies widely depending on the extent and severity of the acute illness, pre-morbid conditions and other factors. Here are some problem areas to look into:

Effect on detraining

A common concern among amateur and elite athletes is the impact of detraining on their bodies. Several studies account that public lockdowns to prevent viral spread have had antagonistic effects on physical fitness. Detraining is an important reflection for clinicians to address when providing guidance about return to play post-Covid effect.

ALSO READ | Run faster and further — Part II

Cardiovascular complications

The cardiovascular sequela of Covid-19 illness presents challenges for doctors caring for athletes preparing to return to play. In particular, myocarditis may develop without symptoms and can be exacerbated by exercise during recovery. The cause of asymptomatic and other athletes with mild or moderate disease remains unclear.

Facilitating return to play/activity

Coronavirus-related illness poses special challenges for determining how athletes can return to intense exercise and full play safely once they are medically cleared to begin exercising. The process can be complex and requires that medical professionals consider the following:

Safety of the athlete first with proper data in place.
Potential risks to the safety of other participants or team members.
Practical competencies of the athlete.
Functional specific demands of the athletes’ sport or skill.
Sporting bodies requirements from the athletes.

ALSO READ | Run faster and further

Numerous specialists recommend refraining from any exercise until at least 10-12 days of rest from the onset of symptoms, including a minimum of seven days from the resolution of all symptoms. In addition, the athlete should be off all symptom-related treatment before beginning a structured return to action.

The period of inactivity before an athlete can begin exercising causes a degree of detraining and increases the risk for potential injury, particularly if the athlete resumes exercise too aggressively. While monitoring athlete progress, the doctors and support staff should focus professionally on training intensity and workload management, making modifications as and when required according to each athlete.

Medical clearance

Athletes who suffered greater severe illness or have major underlying syndromes will likely require medical screening, additional testing and specialist consultation on all parameters on a regular interval before embarking on a return to play.

Several scientists have raised concerns about the impact of neurologic and neuromuscular complications on return to play. Athletes recovering from illness may suffer from fatigue, impaired neuromuscular function and reduced muscle strength, leading to poor performance.

Return to activity progression

Each professional team has its own system in place to safeguard the athletes’ return to play. Foolproof monitoring protocols for each and every athlete are of utmost importance.

Monitoring is the key

Watch for signs of potentially dangerous complications of Covid-19-related illness such as myocarditis and pulmonary embolism. Regularly monitor the assessments of how the athlete is responding to increases in activity and progression. Data collection at every stage is critical for a safe return and to point out any red flags at the earliest possible time.

Red flags

Clinicians and athletes should remain alert for the following symptoms and signs, particularly early during the return to play process.

Chest pain or palpitations.
Breathlessness out of proportion to that expected during recovery from exercise.
Judgements associated with thrombosis or pulmonary embolism.

At every stage, doctors should maintain close communication with athletes as they move from one stage to the next. The pace at which an athlete progresses within and between stages will diverge widely; individuals must complete each stage comfortably prior to progressing to the next stage.

Other protocols to monitor

Monitor symptoms throughout all stages of return to play.

Keep adequate focus and data on fatigue, quality of sleep, muscle soreness and psychological stress.

Checking early-morning resting heart rate is a simple, useful gauge of recovery. An increase in the morning resting heart rate of more than 10 beats per minute is normally considered a sign of overtraining and accumulated fatigue.

RPE, or the rate of perceived exertion, scales can also be used to assess athlete recovery and readiness to progress on a daily basis.

Athletes should step back one level if there is too much fatigue or other symptoms are prolonged or concerning. Renewed progression to the next stage should not begin until after a minimum of 24 hours’ rest without symptoms.

Dietary regime should be updated and at every stage of illness, based on energy requirement and activity. Progression into a specialised regime would be advisable before return to play.

Psychological readiness in returning to sport or exercise should be monitored through the IPRSS (psychological readiness to return to sport) scale, which is a useful tool on every level.

This is the first of a two-part series. Read the second part in the July 10 issue of Sportstar .