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Wilson MG, Hull JH, Rogers J, Pollock N, Dodd M, Haines J, Harris S, Loosemore M, Malhotra A, Pieles G, Shah A, Taylor L, Vyas A, Haddad FS, Sharma S. Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. Br J Sports Med 2020; 54:1157-1161. [PMID: 32878870 PMCID: PMC7513247 DOI: 10.1136/bjsports-2020-102710] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.
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Affiliation(s)
- Mathew G Wilson
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK .,The Princess Grace Hospital (HCA Healthcare UK), London, United Kingdom
| | - James H Hull
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,English Institute of Sport, London, United Kingdom
| | - John Rogers
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,The Wilmslow Hospital (HCAHealthcareUK), Wilmslow, United Kingdom
| | - Noel Pollock
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,British Athletics, London, United Kingdom
| | - Miranda Dodd
- The Princess Grace Hospital (HCA Healthcare UK), London, United Kingdom
| | - Jemma Haines
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,NIHR Manchester BRC and University of Manchester, Manchester, United Kingdom
| | - Sally Harris
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,The Wilmslow Hospital (HCAHealthcareUK), Wilmslow, United Kingdom
| | - Mike Loosemore
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,English Institute of Sport, London, United Kingdom
| | - Aneil Malhotra
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Department of Cardiovascular Science, University of Manchester, Manchester, United Kingdom
| | - Guido Pieles
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
| | - Anand Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Department of Infectious Diseases Epidemiology, Imperial College London, London, United Kingdom
| | - Lesley Taylor
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,The Wilmslow Hospital (HCAHealthcareUK), Wilmslow, United Kingdom
| | - Aashish Vyas
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Lancashire Teaching Hospitals Trust, Lancashire, United Kingdom
| | - Fares S Haddad
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,The Princess Grace Hospital (HCA Healthcare UK), London, United Kingdom.,Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, London, United Kingdom
| | - Sanjay Sharma
- St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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