How can we ensure a safe return to play for athletes after COVID-19 infections?
There is still much to be learned about COVID-19. We know that some children and young adults have significant damage to their heart, kidneys, or lungs or chronic fatigue. Any of these could put an athlete at risk during activities. We don’t know precisely who is most at risk for complications after COVID-19 infections.
Anyone who is sick enough to require hospitalization should have a complete medical exam and clearance prior to resuming activities that use increased strength or endurance. But what about others who had less significant symptoms – or no symptoms?
I’m sure these recommendations may change as we learn more about the later effects of COVID-19, but it’s important that parents, coaches and athletes understand the potential risks of returning to strenuous activities before their body is recovered.
If you like podcasts, be sure to listen to Dr. Mike from PediaCast as he talks with Drs. Tom Pommering and Simon Lee all about COVID-19 and student athletes – the link is toward the bottom of this post under Resources and More Information.
When is it safe to resume athletic activities?
The American Academy of Pediatrics (AAP) believes that everyone who has had COVID-19, regardless of symptoms, should rest for at least 2 weeks. Those with symptoms may require rest even longer.
The AAP strongly encourages that all athletes who have had COVID-19 have sports clearance prior to return to play after this period of rest. Many states (including Kansas and Missouri) have return to play guidelines and clearance forms.
According to these pediatric cardiologists, athletes over the age of 12 years who have more than 3 days of symptoms or any fever with COVID-19 should not return to formal sports at least until they have been symptom free for 14 days due to the possibility of inflammation in their heart.
This is beyond the time of quarantine to allow for recovery prior to exertion. It is important that everyone takes the proper time to rest after COVID-19. Don’t rush back to sports or active play!
Return to Play Progression after COVID-19 infection
1. Wait until you’re symptom free for 14 days.
Rest at home and return to normal daily activities during this time.
2. Schedule with your physician for medical clearance.
Depending upon symptoms you experienced and expected intensity of the level of play, this evaluation may include cardiac testing, such as an electrocardiogram (ECG), or lung or kidney function testing as determined by the physician.
Cardiology return to play recommendations:
3. Begin phased in gradual return to play.
After medical clearance from your physician, you may begin a gradual return to play.
These phases come from Children’s Mercy recommendations.
It takes at least a week to get to full activity.
Return to Play Phases
Phase 1 (2 day minimum)
Light aerobic exercise at no more than 70% maximum heart rate for 15 minutes or less – repeat at least 24 hours later.
Phase 2 (1 day minimum)
Add simple movement activities no greater than 80% of maximum heart rate for 30 minutes or less.
Phase 3 (1 day minimum)
Advance to training at no more than 80% maximum heart rate for 45 minutes or less. May add light resistance training.
Phase 4 (2 day minimum)
Normal training activity for 60 minutes or less at no greater than 80% maximum heart rate. Repeat in 24 hours.
Return to full activity.
During return to play: monitor for
- chest pain/pressure
- difficulty breathing
- decreased exercise tolerance
If these symptoms develop: stop exercise immediately and schedule an appointment with the primary care physician before resuming activities.
If symptoms are significant, call 911 and take the athlete to the nearest ER.
Children’s Mercy has updated their information as below.