athletes COVID-19

Athletes guide to returning to sport post-COVID-19

2020 and 2021 have NOT been conducive to sports. If it wasn’t catching COVID-19 itself, the mandated lockdowns and travel bans were enough to throw a spanner in the works for athletes in Australia and worldwide.

It’s fair to say the ongoing absence of, or at least disruption to, sports have caused many Australian athletes to experience an unforeseen decline in physical activity. Not to mention the potential take-up of poor dietary habits, and the consequent loss of athletic performance.

Are you one of the many athletes recovering from COVID-19 and eager to make an effective return to your sport? If so, it’s important to know that your recovery and eventual return to sport will likely be different from your usual turnaround after contracting a common cold.

We spoke to Accredited Exercise Physiologist (AEP) Toby Edmanson from Queensland Sports Medicine Centre about the dos and don’ts for athletes to consider when trying to get back to their pre-COVID-19 athletic self.

 

Getting back into sport after COVID-19

There’s no easy fix to get you back to your pre-COVID-19 athletic condition. Exhausting your body’s systems whilst experiencing symptoms, or even after the absence of symptoms, may be detrimental to your health.

It is prudent to follow a scientifically guided, measured approach to the re-establishment of your athletic performance. An incremental strategy will help to maximise health outcomes for all athletes.

While an overly conservative approach to your return to sport will delay competition, an overly hasty return may result in adverse health outcomes. With both extremes in mind, let’s break down what you need to be aware of to get back to your pre-COVID-19 physical condition as an elite athlete.

 

Everyone is different. What works for some may be completely different for you

Everyone experiences COVID-19 slightly differently. However, there are common symptoms among most individuals, such as fever, cough, tiredness and loss of taste or smell. Left untreated, these symptoms may result in more severe illness and long-term complications such as chronic fatigue, myocarditis, shortness of breath and/or heart palpitations.

These factors can increase your risk of developing ‘post-exertion symptom exacerbation’. This refers to continuing symptomology for 3 – 9 months. For the most effective return to sport possible, you must be aware of your individual circumstance either asymptomatic or symptomatic.

 

Athlete running post-COVID-19

 

Identifying your level of risk post-COVID-19

The Australasian College of Sport and Exercise Physicians has released a position statement detailing a framework used to assess your return to physical activity post-COVID-19. Firstly, you should identify which level of risk you are, i.e. low, intermediate or high, to determine the appropriate course of action.

Low-Risk

    • You experience mild or no symptoms
    • You experience only upper respiratory symptoms (cough)
    • You are a younger athlete
    • You have recreational exercise goals

Recommended Actions

    1. You should have 10 days of deliberate rest from the onset of symptoms
    2. You should be at least seven days symptom-free before exercising
    3. You should no longer require any medications such as paracetamol


Intermediate-Risk

    • You experience symptoms for 7 days
    • You experience chest pain
    • You are an elite or endurance athlete
    • You have a history of asthma or chronic fatigue

Recommended Actions

    1. Visit your General Practitioner (GP) to discuss whether an ECG is needed to test for levels of Troponin and Chemokine Receptors (CKR) in your blood
    2. If the tests above are abnormal, you should take the recommended actions from the High-Risk classification


High-Risk

    • You have been hospitalised or in ICU due to COVID-19
    • You experience prolonged chest pain with rest and minimal energy exertion
    • You have a history of cardiac arrest

Recommended Actions

    1. Visit your GP to discuss whether an ECG is needed to test for levels of Troponin, Chemokine Receptors (CKR) and Brain Natriuretic Peptide (BNP) in your blood.
    2. If recommended by your GP, consult with a Cardiologist who can administer an echocardiogram and stress test
    3. If recommended by your GP, consult with a Respiratory Physician for a Pulmonary Function Test and chest CT scan
    4. Consult with an Accredited Exercise Physiologist (AEP) who can prescribe an individualised, progressive exercise program and undertake further assessment to ensure a safe return to physical activity. Click here to find an AEP near you.

*This is general advice to get you started. It is recommended to seek individualised medical advice from your General Practitioner or healthcare provider.  

Once you have identified your risk level and taken the associated actions, you’re ready to gradually return to physical activity. Although each phase has recommendations as to the intensity, duration and volume of exercise, there are no specific timeframe requirements as this will depend on your pre-COVID-19 fitness levels.

Assess your individual circumstances and how comfortable you feel through each phase and remember to be kind to your body in the recovery process!

 

Watch out for Red Flag Symptoms!

It’s important to be aware of key red flag symptoms. If you experience any of the below, take the recommended actions from the High-Risk classification above. These symptoms are:

  • Chest pain or palpitations
  • Breathlessness, out of proportion with expected recovery periods
  • Thrombosis symptoms, e.g. pain and swelling in one or both legs

 

5 Phases of the COVID-19 Recovery Process

5 Phases of the Recovery Process for athletes post-COVID-19

Phase 1: Returning to school or work

The first phase of the recovery process is returning to school or work. That is, reintroduce yourself to normal daily routines, sleep/wake cycles and normal activities of daily living, absent of exercise.

Phase 2: Returning to light activity

Then, return to “light” activity. This phase of the recovery process recommends starting with 15 minutes of light-intensity exercise (i.e. 40-55% HRMax, or RPE 1-2) on 2-3 days per week. The 15 minutes of exercise remains constant, but you may gradually increase the intensity to moderate-intensity exercise (55-70% HRMax, or RPE 3-4). The recommended modalities of exercise in this phase are walking, light jogging, or a stationary bike.

Phase 3: Introduce progressive exercise training

The next phase is the introduction of progressive exercise training. Start to increase the duration of the current exercise modality to 30 minutes. Then, introduce bodyweight resistance exercises on 1-2 days per week kept at a low volume (i.e. 4-6 repetitions by 2 sets). It’s important in this phase that you remind your muscles how they work and that you pay close attention to having adequate recovery (i.e. sleep and nutrition).

Phase 4: Increase training volume

In the next phase, you should steadily increase your training volume. It is recommended to re-introduce sport-specific training and higher intensity drills such as running and ball drills. It’s important to pay attention to the coordination and skill progression requirements of these drills. In your resistance training, increase the manageable load to the weight you are navigating. Depending on your pre-COVID-19 condition, you may exercise 3-5 days per week, with at least 1-2 resistance training sessions.

By this stage, you should regain pre-COVID-19 confidence in your skills and exercise tolerance. Again, it is important to have sufficient recovery and monitor for any symptoms.

Phase 5: Return to pre-COVID-19 exercise levels

In the final phase, you should return to all pre-COVID-19 exercise levels. In conjunction with your coach, you may progress your resistance and sport-specific training accordingly. Remember to monitor for “red flag” symptoms or concerns upon your full-scale return. An Accredited Exercise Physiologist can help guide you through an individualised, progressive training program.

Read more about exercising after having COVID-19 here.

References:

Baggish A, Drezner JA, Kim J, et al Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes British Journal of Sports Medicine 2020;54:1130-1131.

Elliott N, Martin R, Heron N, et al Infographic. Graduated return to play guidance following COVID-19 infection British Journal of Sports Medicine 2020;54:1174-1175.

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. doi: 10.31128/AJGP-COVID-40.