How to return to play 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.

The five stages of return to play and their duration

Stage I: Recovery and rest

Stage II: Light activity

Stage III: Moderate activity

Stage IV: Intense activity

Stage V: Normal training and full play

There is no clear consensus about the appropriate duration of each stage in an athlete’s progression to full play. Multiple authors and organisations recommend that Stage I be at least 10 days in duration. Before proceeding to Stage II, the athlete must remain symptom-free for seven days, be able to perform all activities of daily living, and be off all medications directed at controlling symptoms.

READ PART I | How to return to play after Covid

At every stage, the 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 one.

Children and adolescents

Medical professional and support staff should assist in the management of return to sport for children and adolescents recovering from COVID-19. The Association of American Physicians advises that children younger than 12 may progress back to sports and physical education classes according to their own tolerance. For children and adolescents 12 years and older, return to play may begin once the child has been examined and cleared by an appropriate clinician, a minimum of seven days has passed without symptoms, and the child exhibits no cardiorespiratory symptoms when performing normal activities of daily living. Return to sport should progress gradually over at least seven days, but may take longer too.

Parents and coaches should closely monitor for concerning symptoms such as shortness of breath, chest pain and respiratory tract infections. If any of these symptoms are obvious, stop the activity at once and reassess the child with the medical professionals at once.

The basic (FITT) exercise prescription

F – Frequency: Number of days each week

I – Intensity: Low, moderate or greater

T – Time: Minutes per session for exercise

T – Type: Endurance, strength, stability, mobility or another permutation

This process ought to be used at each stage of the return-to-play progression from Stage 1 through Stage V.

Each parameter should be augmented gradually. As a general rule of thumb for patients recovering from related illness, we suggest increasing training intensity or volume no more than 8-10 percent per week or every three to five training sessions. As with all aspects of the return-to-play protocol, this general approach should be adapted based on the athlete’s age, severity of illness and comorbidities.

Appropriate monitoring is needed throughout the process.

The application of the above principle is a no-brainer in charting out a progression for each athlete depending on individual needs.

Wearing face masks during combative sports such as wrestling is generally not recommended because of the risk of blocking the athlete’s vision and thereby placing them at risk.

Mental health considerations

Mental health issues are rarely addressed among athletes returning to play. Mindful intervention from the experts is needed at every stage to alleviate the trauma caused by loads of factors (depression, missed opportunities, anxiety, et cetera). A very detailed review is a must as an important protocol for every athlete.

Masking with exercise

Various experts assert that wearing a face mask had no effect on performance or peak power, and no significant differences were found for arterial oxygen saturation, tissue oxygenation index, rate of perceived exertion or heart rate at any time during the exercise tests. Wearing face masks during combative sports (wrestling, boxing, mixed martial arts) is generally not recommended because of the risk of blocking the athlete’s vision and thereby placing them at risk.

Vaccination and return to play

Athletes should follow the standard operating procedure and consult a medical professional along with support staff on return to exercising or play.

This is the second in a two-part series.