1
|
Castelletti S, Gervasi S, Ballardini E, Casasco M, Cavarretta E, Colivicchi F, Contursi M, Cuccaro F, D'Ascenzi F, Gazale G, Mos L, Nistri S, Palmieri V, Patrizi G, Scorcu M, Spampinato A, Tiberi M, Zito GB, Zorzi A, Zeppilli P, Sciarra L. The athlete after COVID-19 infection: what the scientific evidence? What to do? A position statement. Panminerva Med 2024; 66:63-74. [PMID: 36178109 DOI: 10.23736/s0031-0808.22.04723-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The Coronavirus-19 disease (COVID-19) related pandemic have deeply impacted human health, economy, psychology and sociality. Possible serious cardiac involvement in the infection has been described, raising doubts about complete healing after the disease in many clinical settings. Moreover, there is the suspicion that the vaccines, especially those based on mRNA technology, can induce myopericarditis. Myocarditis or pericarditis related scars can represent the substrate for life-threatening arrhythmias, triggered by physical activity. A crucial point is how to evaluate an athlete after a COVID-19 infection ensuring a safe return to play without increasing the number of unnecessary disqualifications from sports competitions. The lack of conclusive scientific data significantly increases the difficulty to propose recommendations and guidelines on this topic. At the same time, the psychological and physical negative consequences of unnecessary sports restriction must be taken into account. The present document aims to provide an updated brief review of the current knowledge about the COVID-19 cardiac involvement and how to recognize it and to offer a roadmap for the management of the athletes after a COVID-19 infections, including subsequent impact on exercise recommendations. Our document exclusively refers to cardiovascular implications of the disease, but pulmonary consequences are also considered.
Collapse
Affiliation(s)
| | - Salvatore Gervasi
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Ballardini
- Sports Medicine Centre, Mantova Salus Group, San Pellegrino Hospital, Mantua, Italy
| | | | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | | | - Maurizio Contursi
- Unit of Sports Cardiology, Centro Polidiagnostico Check-up, Salerno, Italy
| | - Francesco Cuccaro
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giovanni Gazale
- Center of Sports Medicine and Sports Cardiology, ASL1, Sassari, Italy
| | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Stefano Nistri
- Cardiology Service-CMSR Veneto Medica, Altavilla Vicentina, Vicenza, Italy
| | - Vincenzo Palmieri
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | - Marco Scorcu
- Department of Sports Medicine and Physical Exercise, ATS Sardegna, Cagliari, Italy
| | | | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV1, Pesaro, Italy
| | | | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Paolo Zeppilli
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Luigi Sciarra
- Department of Cardiology, Casilino Polyclinic, Rome, Italy
| |
Collapse
|
2
|
Rasmusen HK, Aarøe M, Madsen CV, Gudmundsdottir HL, Mertz KH, Mikkelsen AD, Dall CH, Brushøj C, Andersen JL, Vall-Lamora MHD, Bovin A, Magnusson SP, Thune JJ, Pecini R, Pedersen L. The COVID-19 in athletes (COVA) study: a national study on cardio-pulmonary involvement of SARS-CoV-2 infection among elite athletes. Eur Clin Respir J 2023; 10:2149919. [PMCID: PMC9744211 DOI: 10.1080/20018525.2022.2149919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background COVID-19 can cause cardiopulmonary involvement. Physical activity and cardiac complications can worsen prognosis, while pulmonary complications can reduce performance. Aims To determine the prevalence and clinical implications of SARS-CoV-2 cardiopulmonary involvement in elite athletes. Methods An observational study between 1 July 2020 and 30 June 2021 with the assessment of coronary biomarkers, electrocardiogram, echocardiography, Holter-monitoring, spirometry, and chest X-ray in Danish elite athletes showed that PCR-tested positive for SARS-CoV-2. The cohort consisted of male football players screened weekly (cohort I) and elite athletes on an international level only tested if they had symptoms, were near-contact, or participated in international competitions (cohort II). All athletes were categorized into two groups based on symptoms and duration of COVID-19: Group 1 had no cardiopulmonary symptoms and duration ≤7 days, and; Group 2 had cardiopulmonary symptoms or disease duration >7 days. Results In total 121 athletes who tested positive for SARS-CoV-2 were investigated. Cardiac involvement was identified in 2/121 (2%) and pulmonary involvement in 15/121 (12%) participants. In group 1, 87 (72%), no athletes presented with signs of cardiac involvement, and 8 (7%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. In group 2, 34 (28%), two had myocarditis (6%), and 8 (24%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. Conclusions These clinically-driven data show no signs of cardiac involvement among athletes who tested positive for SARS-CoV-2 infection without cardiopulmonary symptoms and duration <7 days. Athletes with cardiopulmonary symptoms or prolonged duration of COVID-19 display, exercise-limiting cardiopulmonary involvement.
Collapse
Affiliation(s)
- Hanne Kruuse Rasmusen
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark,CONTACT Hanne Kruuse Rasmusen Clinic of Sports Cardiology, Department of Cardiology, University of Copenhagen Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Building 67, DK-2200Copenhagen, Denmark
| | - Mikkel Aarøe
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christoffer Valdorff Madsen
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Kenneth Hudlebusch Mertz
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Astrid Duus Mikkelsen
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian Have Dall
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christoffer Brushøj
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Løvind Andersen
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Ann Bovin
- Department of Cardiology, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
| | - S. Peter Magnusson
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Redi Pecini
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
3
|
Díaz-Cano Carmona I, López Lozano AM, Pérez Rastrollo FJ, Moreno Moreno AM, Barrera Chacón JM. [Functional evaluation in patient with critical SARS-CoV-2 disease: Cohort study in a third level hospital rehabilitation unit]. Rehabilitacion (Madr) 2023; 57:100779. [PMID: 36738656 PMCID: PMC9790869 DOI: 10.1016/j.rh.2022.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION SARS-COV-2 pneumonia is a highly contagious respiratory disease that causes respiratory, physical and psychological dysfunctions. We present the results of patient assessment when they were discharged from the ICU. MATERIAL AND METHOD Cohort study of patients affected by SARS-COV-2 pneumonia admitted to the intensive care unit from 01/10/2020 to 31/07/2021. We collect sociodemographic data, personal history, ICU and hospital stay, Barthel, FAC and mMRC (pre-admission/initial assessment/discharge), development of osteomuscular and/or neurological pathology and need for rehabilitation treatment. RESULTS A total of 341 patients were evaluated, of which 224 met criteria. The average age was 63 years (68.75% men). Mean ICU/hospital stay were 27/44 days. They were assessed by physiatry, after that, we provide a guide developed by physiatry, solving doubts about the disease and setting exercises of intensity and progressive difficulty, to be carried out during the admission and at home. Neurological pathology was present at 42.86% patients, of whom a 83.33% were peripheral nervous system disease. The total of the sample needed respiratory physiotherapy and a 72.32% motor physiotherapy. CONCLUSIONS In our study, a high number of patients have needed rehabilitation treatment in order to get functional recovery, highlighting the development of post-COVID neurological pathology. SARS-COV-2 generates other complications, not only respiratory, subsidiary to be assessed and treated by rehabilitation services for a comprehensive recovery that minimizes sequelae.
Collapse
Affiliation(s)
- I Díaz-Cano Carmona
- UGC Medicina Física y Rehabilitación Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - A M López Lozano
- UGC Medicina Física y Rehabilitación Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F J Pérez Rastrollo
- UGC Medicina Física y Rehabilitación Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A M Moreno Moreno
- UGC Medicina Física y Rehabilitación Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J M Barrera Chacón
- UGC Medicina Física y Rehabilitación Hospital Universitario Virgen del Rocío, Sevilla, España
| |
Collapse
|
4
|
Uddin N, Acter T, Rashid MH, Chowdhury AI, Jahan EA. Coping with the COVID-19 pandemic by strengthening immunity as a nonpharmaceutical intervention: A major public health challenge. Health Sci Rep 2023; 6:e1562. [PMID: 37720166 PMCID: PMC10500053 DOI: 10.1002/hsr2.1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Background and Aims The global Coronavirus-2 outbreak has emerged as a significant threat to majority of individuals around the world. The most effective solution for addressing this viral outbreak is through vaccination. Simultaneously, the virus's mutation capabilities pose a potential risk to the effectiveness of both vaccines and, in certain instances, newly developed drugs. Conversely, the human body's immune system exhibits a robust ability to combat viral outbreaks with substantial confidence, as evidenced by the ratio of fatalities to affected individuals worldwide. Hence, an alternative strategy to mitigate this pandemic could involve enhancing the immune system's resilience. Methods The research objective of the review is to acquire a comprehensive understanding of the role of inflammation and immunity in COVID-19. The pertinent literature concerning immune system functions, the impact of inflammation against viruses like SARS-CoV-2, and the connection between nutritional interventions, inflammation, and immunity was systematically explored. Results Enhancing immune function involves mitigating the impact of key factors that negatively influence the immune response. Strengthening the immune system against emerging diseases can be achieved through nonpharmaceutical measures such as maintaining a balanced nutrition, engaging in regular exercise, ensuring adequate sleep, and managing stress. Conclusion This review aims to convey the significance of and provide recommendations for immune-strengthening strategies amidst the ongoing COVID-19 pandemic.
Collapse
Affiliation(s)
- Nizam Uddin
- Department of Nutrition and Food Engineering, Faculty of Allied Health ScienceDaffodil International UniversityDhakaBangladesh
| | - Thamina Acter
- Department of Mathematical and Physical SciencesEast West UniversityDhakaBangladesh
| | - Md. Harun‐Ar Rashid
- Department of Nutrition and Food Engineering, Faculty of Allied Health ScienceDaffodil International UniversityDhakaBangladesh
| | - Akibul Islam Chowdhury
- Department of Nutrition and Food Engineering, Faculty of Allied Health ScienceDaffodil International UniversityDhakaBangladesh
| | - Effat Ara Jahan
- Department of Nutrition and Food Engineering, Faculty of Allied Health ScienceDaffodil International UniversityDhakaBangladesh
| |
Collapse
|
5
|
Turska-Kmieć A, Neunhaeuserer D, Mazur A, Dembiński Ł, del Torso S, Grossman Z, Barak S, Hadjipanayis A, Peregud-Pogorzelski J, Kostka T, Bugajski A, Huss G, Kowalczyk-Domagała M, Wyszyńska J. Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes. Front Pediatr 2023; 11:1125958. [PMID: 37425260 PMCID: PMC10323832 DOI: 10.3389/fped.2023.1125958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.
Collapse
Affiliation(s)
- Anna Turska-Kmieć
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Polish PaediatricSociety, Warsaw, Poland
- Working Group on Sports Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, University of Padova Department of Medicine, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Artur Mazur
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Łukasz Dembiński
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Stefano del Torso
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Childcare Worldwide, Padova, Italy
| | - Zachi Grossman
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Maccabi Health Services, Pediatric Clinic, Tel Aviv, Israel
| | - Shimon Barak
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
| | - Jarosław Peregud-Pogorzelski
- Polish PaediatricSociety, Warsaw, Poland
- Department of Paediatrics, Paediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
- The Polish Society of Sports Medicine, Wroclaw, Poland
| | - Andrzej Bugajski
- The Polish Society of Sports Medicine, Wroclaw, Poland
- Department of Physiotherapy, College of Physiotherapy, Wroclaw, Poland
| | - Gottfried Huss
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Kinder-Permanence Hospital Zollikerberg, Zollikerberg, Switzerland
| | - Monika Kowalczyk-Domagała
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Working Group on Paediatric Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| |
Collapse
|
6
|
Thirupathi A, Yong W, Oflaz O, Agascioglu E, Gu Y. Exercise and COVID-19: exercise intensity reassures immunological benefits of post-COVID-19 condition. Front Physiol 2023; 14:1036925. [PMID: 37275224 PMCID: PMC10233405 DOI: 10.3389/fphys.2023.1036925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 06/07/2023] Open
Abstract
Any form of physical activity, including exercise, has various benefits at the physiological (improving cardiac and respiratory functions, increasing skeletal muscle mass, and maintaining homeostasis) and psychological levels (improving cognitive function, reducing anxiety and depression) which help to combat any type of infection. In contrast, the infectivity ratio could reduce the physical activity of an individual, such as performing a habitual exercise. Adaptation to different exercise strategies including intensity and duration may better increase physical performance and improve the symptoms. For example, low to moderate intensity perhaps fails to induce this adaptive process, while high-intensity of exercise compromises immune health. This can aggravate the infection rate (Open window theory). However, high intensity with a shorter time produces various morphological alterations in the primary organs including the lungs and heart, which facilitate life support in COVID-19 patients. However, less information about exercise protocols failed to assure the benefits of exercise to COVID-19 patients, particularly post-COVID-19 conditions. Therefore, this review will answer how exercise intensity is crucial to reassure the exercise benefits for promoting safe participation before infection and post-COVID-19 conditions.
Collapse
Affiliation(s)
- Anand Thirupathi
- Research Academy of Medicine Combining Sports, Ningbo No 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Wang Yong
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Ofcan Oflaz
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Eda Agascioglu
- Department of Medical Biology, Faculty of Medicine, Lokman Hekim University, Ankara, Türkiye
| | - Yaodong Gu
- Research Academy of Medicine Combining Sports, Ningbo No 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
| |
Collapse
|
7
|
Bhatia RT, Malhotra A, MacLachlan H, Gati S, Marwaha S, Chatrath N, Fyyaz S, Aleixo H, Al-Turaihi S, Babu A, Basu J, Catterson P, Cooper R, Daems JJN, Dhutia H, Ferrari F, van Hattum JC, Iqbal Z, Kasiakogias A, Kenny A, Khanbhai T, Khoury S, Miles C, Oxborough D, Quazi K, Rakhit D, Sharma A, Varnava A, Tome Esteban MT, Finocchiaro G, Stein R, Jorstad HT, Papadakis M, Sharma S. Prevalence and diagnostic significance of de-novo 12-lead ECG changes after COVID-19 infection in elite soccer players. Heart 2023; 109:936-943. [PMID: 37039240 DOI: 10.1136/heartjnl-2022-322211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/21/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND AND AIM The efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection. METHODS In this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection. Athletes exhibiting de-novo ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all players (n=30) following COVID-19 infection, despite the absence of cardiac symptoms or de-novo ECG changes. RESULTS 511 soccer players (median age 21 years, IQR 18-26 years) were included. 17 (3%) athletes demonstrated de-novo ECG changes, which included reduction in T-wave amplitude in the inferior and lateral leads (n=5), inferior leads (n=4) and lateral leads (n=4); inferior T-wave inversion (n=7); and ST-segment depression (n=2). 15 (88%) athletes with de-novo ECG changes revealed evidence of inflammatory cardiac sequelae. All 30 athletes who underwent a mandatory CMR scan had normal findings. Athletes revealing de-novo ECG changes had a higher prevalence of cardiac symptoms (71% vs 12%, p<0.0001) and longer median symptom duration (5 days, IQR 3-10) compared with athletes without de-novo ECG changes (2 days, IQR 1-3, p<0.001). Among athletes without cardiac symptoms, the additional yield of de-novo ECG changes to detect cardiac inflammation was 20%. CONCLUSIONS 3% of athletes demonstrated de-novo ECG changes post COVID-19 infection, of which 88% were diagnosed with cardiac inflammation. Most affected athletes exhibited cardiac symptoms; however, de-novo ECG changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.
Collapse
Affiliation(s)
- Raghav T Bhatia
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Aneil Malhotra
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
- Manchester Academic Health Science Centre, Manchester University National Health Service Foundation Trust, Manchester, UK
| | - Hamish MacLachlan
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sabiha Gati
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Sarandeep Marwaha
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Nikhil Chatrath
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Saad Fyyaz
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Samar Al-Turaihi
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Aswin Babu
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Joyee Basu
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Paul Catterson
- Department of Medicine, Newcastle United Football Club, Newcastle, UK
| | | | - Joelle J N Daems
- Department of Cardiology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands
| | - Harshil Dhutia
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rio, Brazil
| | - Juliette C van Hattum
- Department of Cardiology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands
| | - Zafar Iqbal
- Department of Sports Medicine, Crystal Palace Football Club, London, UK
| | - Alexandros Kasiakogias
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | - Shafik Khoury
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Chris Miles
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Kashif Quazi
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Dhrubo Rakhit
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anushka Sharma
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Amanda Varnava
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Maria Teresa Tome Esteban
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Gherardo Finocchiaro
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rio, Brazil
| | - Harald T Jorstad
- Department of Cardiology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
8
|
Hilbold E, Bär C, Thum T. COVID-19: Insights into long-term manifestations and lockdown impacts. J Sport Health Sci 2023:S2095-2546(23)00019-4. [PMID: 36868374 PMCID: PMC9977467 DOI: 10.1016/j.jshs.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Coronaviruses are pathogens thought to primarily affect the respiratory tracts of humans. The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 was also marked mainly by its symptoms of respiratory illness, which were named coronavirus disease 2019 (COVID-19). Since its initial discovery, many other symptoms have been linked to acute SARS-CoV-2 infections as well as to the long-term outcomes of COVID-19 patients. Among these symptoms are different categories of cardiovascular diseases (CVDs), which continue to be the main cause of death worldwide. The World Health Organization estimates that 17.9 million people die from CVDs each year, accounting for ∼32% of all deaths globally. Physical inactivity is one of the most important behavioral risk factors for CVDs. The COVID-19 pandemic has affected CVDs as well as the physical activity in different ways. Here, we provide an overview of the current status as well as future challenges and possible solutions.
Collapse
Affiliation(s)
- Erika Hilbold
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover 30625, Germany
| | - Christian Bär
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover 30625, Germany; Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover 30625, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover 30625, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover 30625, Germany; Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover 30625, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover 30625, Germany.
| |
Collapse
|
9
|
Monosilio S, Prosperi S, Squeo MR, Spataro S, Spataro A, Maestrini V. Short and Long-Term Cardiovascular Sequelae after SARS-CoV-2 Infection: A Narrative Review Focusing on Athletes. Viruses 2023; 15. [PMID: 36851707 DOI: 10.3390/v15020493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Cardiovascular (CV) involvement after severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection was found to be frequent among the general population, especially in the pre-vaccination era, and particularly for hospitalized patients or those who experienced a more severe course of the disease. The spectrum of CV disease varies; however, acute myocarditis is particularly fearsome for the athletic population due to the possible associated risk of malignant arrhythmias during training. Alarming percentages of CV injuries, even in young and healthy athletes with a benign course of the disease, arose from a few initial studies limited to case series. Subsequent single-center studies and larger observational registries reported a lower prevalence of SARS-CoV2 CV involvement in athletes. Studies showing the occurrence of CV adverse events during follow-up periods are now available. The objective of our narrative review is to provide an updated summary of the literature on CV involvement after coronavirus disease 2019, both in the early post-infection period and over a longer period of time, with a focus on athletic populations.
Collapse
|
10
|
Peebles LA, Aman ZS, Kraeutler MJ, Mulcahey MK. Impact of the COVID-19 Pandemic on Sports Medicine Patient Care. Arthroscopy 2023; 39:161-5. [PMID: 36347417 DOI: 10.1016/j.arthro.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
The COVID-19 pandemic has necessitated new practices in sports medicine patient care. Telehealth has been validated as a reliable tool for consultations and physical examinations and increases access to care in a cost-efficient manner. Social distancing and avoiding team members who have tested positive are the most effective ways to reduce spread. For screening, daily self-reported symptom checklists and fever monitoring help identify potentially infected athletes who should be instructed to isolate and seek care. Polymerase chain-reaction (PCR) testing for the virus via nasopharyngeal swab is not recommended for screening and should be reserved for symptomatic individuals with fever, cough, or shortness of breath. Face masks and personal protective equipment (PPE) may be beneficial in high-risk settings, but there is little evidence to support use in athletic populations. Median return to play after COVID-19 in elite athletes has been reported as 18 days (range: 12 to 30), with 27% not fully available at 28 days. Chest pain at diagnosis was the only symptom associated with time loss longer than 28 days. Finally, canceled competitions or time loss results in grief, stress, and frustration for athletes, as well as loss of a social support network and routine training regimens. Mental health support services may be indicated.
Collapse
|
11
|
Barreiro-Pérez M, Pueyo PP, Roubin SR, Corominas DM, Uribarri A, Bachiller RE, Rozado Castaño J, Álvarez LGC, Fernández LS, Domínguez F, Figal DP. [Myocarditis related SARS-CoV-2 infection or vaccination: an expert consensus statement on its diagnosis and management]. Rev Esp Cardiol 2023:S0300-8932(23)00052-0. [PMID: 36743295 PMCID: PMC9884510 DOI: 10.1016/j.recesp.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revealed several cardiovascular complications, including myocarditis caused by SARS-CoV-2 infection (COVID-19) or after messenger RNA vaccines. The high prevalence of COVID-19, vaccination programs expansion, and the appearance of new information regarding myocarditis in these contexts make it necessary to condense the knowledge acquired since the pandemic began. With this aim, the Myocarditis Working Group of the Heart Failure Association of the Spanish Society of Cardiology, with the collaboration of the Spanish Agency for Medicines and Health Products (AEMPS), has written this document. It aims to address the diagnosis and treatment of cases of myocarditis-associated SARS-CoV-2 infection or messenger RNA vaccine.
Collapse
Affiliation(s)
- Manuel Barreiro-Pérez
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Pablo Pastor Pueyo
- Unidad de Cardiología Clínica y Cuidados Agudos Cardiovasculares, Hospital Universitario Arnau de Vilanova, Lleida, España
- Institut de Reserca Biomèdica Lleida (IRB-Lleida), Lleida, España
| | - Sergio Raposeiras Roubin
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Dolores Montero Corominas
- División de Farmacoepidemiología y Farmacovigilancia, Departamento de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Sanitarios, Madrid, España
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Rocío Eiros Bachiller
- Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - José Rozado Castaño
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Luis Serratosa Fernández
- Unidad de Cardiología del Deporte, Hospital Universitario Quirónsalud Madrid, Madrid, España
- Unidad de Cardiología del Deporte, Centro de Medicina Deportiva Olympia Quirónsalud, Madrid, España
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Domingo Pascual Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
| |
Collapse
|
12
|
Maestrini V, Penza M, Filomena D, Birtolo LI, Monosilio S, Lemme E, Squeo MR, Mango R, Di Gioia G, Serdoz A, Fiore R, Fedele F, Pelliccia A, Di Giacinto B. Low prevalence of cardiac abnormalities in competitive athletes at return-to-play after COVID-19. J Sci Med Sport 2023; 26:8-13. [PMID: 36372623 PMCID: PMC9622018 DOI: 10.1016/j.jsams.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE to evaluate the prevalence of cardiac involvement after COVID-19 in competitive athletes at return-to-play (RTP) evaluation, following the recommended Italian protocol including cardiopulmonary exercise test (CPET) and 24-Hour Holter monitoring. DESIGN AND METHODS this is a single centre observational, cross-sectional study. Since October 2020, all competitive athletes (age ≥ 14 years) evaluated in our Institute after COVID-19, prior RTP were enrolled. The protocol dictated by the Italian governing bodies included: 12‑lead ECG, blood test, CPET, 24-h ECG monitoring, spirometry. Cardiovascular Magnetic Resonance (CMR) was performed based on clinical indication. RESULTS 219 consecutive athletes were examined (59% male), age 23 years (IQR 19-27), 21% asymptomatic, 77% mildly symptomatic, 2% with previous pneumonia. The evaluation was performed after a median of 10 (6-17) days from negative SARS-CoV-2 swab. All athletes showed a good exercise capacity at CPET without cardiovascular and respiratory limitations. Uncommon premature ventricular contractions (PVCs) were found in 9.5% (n = 21) at CPET/Holter ECG monitoring. Two athletes (0.9%) were diagnosed with acute myocarditis (by CMR) and another one with new pericardial effusion. All the three athletes were temporally restricted from sport participation. CONCLUSIONS Myocarditis in competitive athletes screened after COVID-19 resolution was detected in a low minority of the cases (0.9%). However, a non-negligible prevalence of uncommon PVCs (9%) was observed, either at CPET and/or Holter ECG monitoring, including all athletes with COVID-19 related cardiovascular abnormalities.
Collapse
Affiliation(s)
- Viviana Maestrini
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy,Corresponding author at: Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Marco Penza
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Medical Biotechnology and Translational Medicine, University of Milan, Italy
| | - Domenico Filomena
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Lucia Ilaria Birtolo
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Sara Monosilio
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Erika Lemme
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Maria Rosaria Squeo
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Ruggiero Mango
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Giuseppe Di Gioia
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Andrea Serdoz
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Roberto Fiore
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Francesco Fedele
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Barbara Di Giacinto
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| |
Collapse
|
13
|
Cavigli L, Fusi C, Focardi M, Mandoli GE, Pastore MC, Cameli M, Valente S, Zorzi A, Bonifazi M, D’Andrea A, D’Ascenzi F. Post-Acute Sequelae of COVID-19: The Potential Role of Exercise Therapy in Treating Patients and Athletes Returning to Play. J Clin Med 2022; 12:jcm12010288. [PMID: 36615087 PMCID: PMC9821682 DOI: 10.3390/jcm12010288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Post-acute sequelae of coronavirus disease 19 (COVID-19) (PASC) describe a wide range of symptoms and signs involving multiple organ systems occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, representing a growing health problem also in the world of sport and the athletic population. Patients with PASC have new, returning, or persisting symptoms four or more weeks after the infection. Among the most frequent symptoms, patients complain of fatigue, dyspnea, exercise intolerance, and reduced functional capacity that interfere with everyday life activity. The role of exercise programs in PASC patients will be identified, and upcoming studies will establish the magnitude of their benefits. However, the benefits of exercise to counteract these symptoms are well known, and an improvement in cardiopulmonary fitness, functional status, deconditioning, and quality of life can be obtained in these patients, as demonstrated in similar settings. Based on this background, this review aims to summarise the current evidence about the PASC syndrome and the benefit of exercise in these patients and to provide a practical guide for the exercise prescription in PASC patients to help them to resume their functional status, exercise tolerance, prior activity levels, and quality of life, also considering the athletic population and their return to play and sports competitions.
Collapse
Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Chiara Fusi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, 35128 Padova, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
- Correspondence: ; Tel.: +39-0577-585377
| |
Collapse
|
14
|
Elkhatib W, Herrigel D, Harrison M, Flipse T, Speicher L. Cardiovascular Concerns from COVID-19 in Pilots. Aerosp Med Hum Perform 2022; 93:855-865. [PMID: 36757258 DOI: 10.3357/amhp.6109.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND: Cardiovascular disease, now complicated by the COVID-19 pandemic, remains a leading cause of death and risk for sudden incapacitation for pilots during flight. The capacity for aeromedically significant cardiovascular sequelae with potentially imperceptible clinical symptoms elicits concern both during and following resolution of acute COVID-19 in pilots.OBJECTIVE: We summarize the current state of knowledge regarding COVID-19 cardiovascular implications as applied to the aviation environment to better understand their significance toward flight safety and application toward a focused cardiovascular screening protocol following recovery from infection.METHODS: A narrative review of the cardiovascular implications of COVID-19 infection was performed using the PubMed literature search engine and existing organizational guidelines. In addition, to established medical aviation benchmarks, surrogate populations examined included high performance athletes (as a correlate for high G-forces), and scuba divers (as an environmental work analog). Conditions of primary concern included myocardial injury, proarrhythmic substrates, risk of sudden death, myopericarditis, pulse orthostatic lability in response to vigorous activity, cardiovagal dysfunction, and thromboembolic disease.LITERATURE REVIEW: Cardiovascular screening guideline recommendations post-infection recovery are suggested based on profile stratification: airperson flight class, tactical military, and aerobatic pilots. This provides an approach to inform aeromedical decision making.CONCLUSION: Aviation medical examiners should remain cognizant of the clinically apparent and occult manifestations of cardiovascular dysfunction associated with COVID-19 infection when applying return-to-work screening guidelines. This will ensure high flight safety standards are maintained and sudden incapacitation risk mitigated during and following the ongoing pandemic.Elkhatib W, Herrigel D, Harrison M, Flipse T, Speicher L. Cardiovascular concerns from COVID-19 in pilots. Aerosp Med Hum Perform. 2022; 93(12):855-865.
Collapse
|
15
|
Halasz G, Piepoli MF. Editorial comments: Focus on cardiovascular risk screening. Eur J Prev Cardiol 2022; 29:2073-2075. [PMID: 36378490 DOI: 10.1093/eurjpc/zwac247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza, Italy
| | - Massimo F Piepoli
- Clinical Cardiology, Policlinico San Donato IRCCS, University of Milan, Italy.,Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
16
|
Costa GP, Camacho-Cardenosa A, Brazo-Sayavera J, Viliod MCDL, Camacho-Cardenosa M, Foresti YF, de Carvalho CD, Merellano-Navarro E, Papoti M, Trapé ÁA. Effectiveness, implementation, and monitoring variables of intermittent hypoxic bicycle training in patients recovered from COVID-19: The AEROBICOVID study. Front Physiol 2022; 13:977519. [PMID: 36406995 PMCID: PMC9667939 DOI: 10.3389/fphys.2022.977519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
Hypoxic exposure is safely associated with exercise for many pathological conditions, providing additional effects on health outcomes. COVID-19 is a new disease, so the physiological repercussions caused by exercise in affected patients and the safety of exposure to hypoxia in these conditions are still unknown. Due to the effects of the disease on the respiratory system and following the sequence of AEROBICOVID research work, this study aimed to evaluate the effectiveness, tolerance and acute safety of 24 bicycle training sessions performed under intermittent hypoxic conditions through analysis of peripheral oxyhemoglobin saturation (SpO2), heart rate (HR), rate of perceived exertion (RPE), blood lactate concentration ([La-]) and symptoms of acute mountain sickness in patients recovered from COVID-19. Participants were allocated to three training groups: the normoxia group (GN) remained in normoxia (inspired fraction of O2 (FiO2) of ∼20.9%, a city with 526 m altitude) for the entire session; the recovery hypoxia group (GHR) was exposed to hypoxia (FiO2 ∼13.5%, corresponding to 3,000 m altitude) all the time except during the effort; the hypoxia group (GH) trained in hypoxia (FiO2 ∼13.5%) throughout the session. The altitude simulation effectively reduced SpO2 mean with significant differences between groups GN, GHR, and GH, being 96.9(1.6), 95.1(3.1), and 87.7(6.5), respectively. Additionally, the proposed exercise and hypoxic stimulus was well-tolerated, since 93% of participants showed no or moderate acute mountain sickness symptoms; maintained nearly 80% of sets at target heart rate; and most frequently reporting session intensity as an RPE of "3" (moderate). The internal load calculation, analyzed through training impulse (TRIMP), calculated using HR [TRIMPHR = HR * training volume (min)] and RPE [TRIMPRPE = RPE * training volume (min)], showed no significant difference between groups. The current strategy effectively promoted the altitude simulation and monitoring variables, being well-tolerated and safely acute exposure, as the low Lake Louise scores and the stable HR, SpO2, and RPE values showed during the sessions.
Collapse
Affiliation(s)
- Gabriel Peinado Costa
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Alba Camacho-Cardenosa
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Javier Brazo-Sayavera
- Department of Sports and Computer Science, Universidad Pablo de Olavide, Seville, Spain,Polo de Desarrollo Universitario EFISAL, Centro Universitario Regional Noreste, Universidad de la República, Rivera, Uruguay
| | | | - Marta Camacho-Cardenosa
- Clinical Management Unit of Endocrinology and Nutrition - GC17, Maimónides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Yan Figueiredo Foresti
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Eugenio Merellano-Navarro
- Departamento de Ciencias de la Actividad Física, Facultad de Ciencias de la Educación, Universidad Católica del Maule, Talca, Chile
| | - Marcelo Papoti
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil,Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Átila Alexandre Trapé
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil,*Correspondence: Átila Alexandre Trapé,
| |
Collapse
|
17
|
Drummond LR, Campos HO, Drummond FR, de Oliveira GM, Fernandes JGRP, Amorim RP, da Costa Monteiro M, Lara HFG, Leite LHR, Coimbra CC. Acute and chronic effects of physical exercise on IgA and IgG levels and susceptibility to upper respiratory tract infections: a systematic review and meta-analysis. Pflugers Arch 2022; 474:1221-1248. [PMID: 36251066 PMCID: PMC9574171 DOI: 10.1007/s00424-022-02760-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 10/26/2022]
Abstract
This systematic review and meta-analysis aimed at evaluating acute and chronic effects of physical exercise on IgA and IgG levels, as well as its relationship with the susceptibility to develop upper respiratory tract infections (URTI). This systematic review and meta-analysis was conducted and reported in accordance with PRISMA statement. A systematic search of PubMed, Web of Science, and EMBASE was performed in July 2020. This systematic review and meta-analysis included studies in which participants performed acute exercise or chronic physical training and were subjected to analyses of URTI incidence and concentrations of IgA and IgG. The selected studies for systematic review were divided into the following three groups: (I) trials that evaluated the effects of acute exercise in sedentary subjects, (II) trials that evaluated the effects of acute exercise in athletes/trained individuals, and (III) trials that evaluated the effects of chronic physical training on the incidence of URTI, as well as on the levels of IgA and IgG. Acute exercise increases the IgA levels in trained subjects but does not affect its levels in untrained subjects. Such increase in IgA levels induced by acute exercise is greater in trained individual that performed ultramarathon. On the other hand, chronic physical training reduces IgA levels in both trained and untrained subjects, does not change IgA levels in non-military subjects, besides from not affecting IgG levels. The present systematic review and meta-analysis indicates that acute exercise positively influences IgA levels in trained individuals, being this effect pronounced when a strenuous exercise such as ultramarathon is executed. Chronic physical training, in turn, does not affect IgG levels.
Collapse
Affiliation(s)
- Lucas Rios Drummond
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. .,Departamento de Educação Física, Universidade do Estado de Minas Gerais - Unidade Divinópolis, Av. Paraná, 3001 - Jardim Belvedere I, Divinópolis, MG, Brazil.
| | - Helton Oliveira Campos
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Departamento de Ciências Biológicas, Universidade do Estado de Minas Gerais - Unidade Carangola, Carangola, MG, Brazil
| | - Filipe Rios Drummond
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gabriel Moraes de Oliveira
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - João Guilhermo Rios Pimenta Fernandes
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo Prates Amorim
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mateus da Costa Monteiro
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Henrique Fernandes Gerspacher Lara
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Laura Hora Rios Leite
- Departamento de Fisiologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Cândido Celso Coimbra
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
18
|
D’Ascenzi F, Castelletti S, Adami PE, Cavarretta E, Sanz-de la Garza M, Maestrini V, Biffi A, Kantor P, Pieles G, Verhagen E, Tiberi M, Hanssen H, Papadakis M, Niebauer J, Halle M. Cardiac screening prior to return to play after SARS-CoV-2 infection: focus on the child and adolescent athlete: A Clinical Consensus Statement of the Task Force for Childhood Health of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:2120-2124. [PMID: 36059208 PMCID: PMC9494331 DOI: 10.1093/eurjpc/zwac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Cardiac sequelae after COVID-19 have been described in athletes, prompting the need to establish a return-to-play (RTP) protocol to guarantee a safe return to sports practice. Sports participation is strongly associated with multiple short- and long-term health benefits in children and adolescents and plays a crucial role in counteracting the psychological and physical effects of the current pandemic. Therefore, RTP protocols should be balanced to promote safe sports practice, particularly after an asymptomatic SARS-CoV-2 infection that represents the common manifestation in children. The present consensus document aims to summarize the current evidence on the cardiac sequelae of COVID-19 in children and young athletes, providing key messages for conducting the RTP protocol in paediatric athletes to promote a safe sports practice during the COVID-19 era.
Collapse
Affiliation(s)
| | - Silvia Castelletti
- IRCCS Istituto Auxologico Italiano, Cardiomyopathy Unit and Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco, Principality of Monaco
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Mediterranea Cardiocentro, Naples, Italy
| | - María Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Paul Kantor
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Guido Pieles
- Sports Medicine Department, Aspetar, Orthopaedic and Sports Medicine Hospital, Doh, Qatar,Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Monica Tiberi
- Sport Medicine, Department of Prevention, ASUR Marche Area Vasta 1, Pesaro, Italy
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George’s, University of London, London, UK
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | |
Collapse
|
19
|
Maestrini V, Filomena D, Birtolo LI, Serdoz A, Fiore R, Tatangelo M, Lemme E, Squeo MR, Mango R, Di Gioia G, Fedele F, Gualdi G, Spataro A, Pelliccia A, Di Giacinto B. Systematic Cardiovascular Screening in Olympic Athletes before and after SARS-CoV-2 Infection. J Clin Med 2022; 11:3499. [PMID: 35743567 DOI: 10.3390/jcm11123499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 12/10/2022] Open
Abstract
Conflicting results on the cardiovascular involvement after SARS-CoV-2 infection generated concerns on the safety of return-to-play (RTP) in athletes. The aim of this study was to evaluate the prevalence of cardiac involvement after COVID-19 in Olympic athletes, who had previously been screened in our pre-participation program. Since November 2020, all consecutive Olympic athletes presented to our Institute after COVID-19 prior to RTP were enrolled. The protocol was dictated by the Italian governing bodies and comprised: 12-lead ECG, blood test, cardiopulmonary exercise test (CPET), 24-h ECG monitoring, and spirometry. Cardiovascular Magnetic Resonance (CMR) was also performed. All Athletes were previously screened in our Institute as part of their periodical pre-participation evaluation. Forty-seven Italian Olympic athletes were enrolled: 83% asymptomatic, 13% mildly asymptomatic, and 4% had pneumonia. Uncommon premature ventricular contractions (PVCs) were found in 13% athletes; however, only 6% (n = 3) were newly detected. All newly diagnosed uncommon PVCs were detected by CPET. One of these three athletes had evidence for acute myocarditis by CMR, along with Troponin raise; another had pericardial effusion. No one of the remaining athletes had abnormalities detected by CMR. Cardiac abnormalities in Olympic athletes screened after COVID-19 resolution were detected in a minority, and were associated with new ventricular arrhythmias. Only one had evidence for acute myocarditis (in the presence of symptoms and elevated biomarkers). Our data support the efficacy of the clinical assessment including exercise-ECG to raise suspicion for cardiovascular abnormalities after COVID-19. Instead, the routine use of CMR as a screening tool appears unjustified.
Collapse
|
20
|
Cicchella A. Recommendations for Resuming PA after Prolonged Rest in Children and Adolescents: A Systematic Integrative Review of Relevance for Immunity. J Funct Morphol Kinesiol 2022; 7. [PMID: 35736018 DOI: 10.3390/jfmk7020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
This systematic integrative review aims to summarize the protective effect of PA on children and adolescents, with special reference to the immune system. Periods of prolonged inactivity in children and adolescents are rare and due to exceptional events, such as illness or environmental circumstances, e.g., natural disasters, wars, or epidemics. The recent COVID-19 pandemic forced billions of children in developmental ages into inactivity. This exceptional event was the reason for studying the compensational behavioral strategies adopted by children and adolescents to counteract physical inactivity. Several studies showed the rise of spontaneous physical activity (PA) among children and adolescents to compensate for sedentarism. However, for some children, sedentarism could in turn foster other sedentarism. With the restart of "normal daily life" worldwide, a question is posed on both how to resume PA without causing damage and how to improve the immune response. Some key points emerged from the literature. Children must resume PA gradually using different methods, considering age, sex, health status, and the presence of overweight conditions. Immunity can be stimulated with PA by aerobic exercise, resistance training, flexibility exercise, relaxation, and coordinative exercises.
Collapse
|
21
|
Romagnoli S, Sbrollini A, Marcantoni I, Morettini M, Burattini L. Review on Cardiorespiratory Complications after SARS-CoV-2 Infection in Young Adult Healthy Athletes. Int J Environ Res Public Health 2022; 19:ijerph19095680. [PMID: 35565074 PMCID: PMC9101647 DOI: 10.3390/ijerph19095680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023]
Abstract
This review analyzes scientific data published in the first two years of the COVID-19 pandemic with the aim to report the cardiorespiratory complications observed after SARS-CoV-2 infection in young adult healthy athletes. Fifteen studies were selected using PRISMA guidelines. A total of 4725 athletes (3438 males and 1287 females) practicing 19 sports categories were included in the study. Information about symptoms was released by 4379 (93%) athletes; of them, 1433 (33%) declared to be asymptomatic, whereas the remaining 2946 (67%) reported the occurrence of symptoms with mild (1315; 45%), moderate (821; 28%), severe (1; 0%) and unknown (809; 27%) severity. The most common symptoms were anosmia (33%), ageusia (32%) and headache (30%). Cardiac magnetic resonance identified the largest number of cardiorespiratory abnormalities (15.7%). Among the confirmed inflammations, myocarditis was the most common (0.5%). In conclusion, the low degree of symptom severity and the low rate of cardiac abnormalities suggest that the risk of significant cardiorespiratory involvement after SARS-CoV-2 infection in young adult athletes is likely low; however, the long-term physiologic effects of SARS-CoV-2 infection are not established yet. Extensive cardiorespiratory screening seems excessive in most cases, and classical pre-participation cardiovascular screening may be sufficient.
Collapse
|
22
|
Abstract
OBJECTIVE To determine the utility of screening electrocardiograms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children in detecting myocarditis related to coronavirus disease 2019 (COVID-19). STUDY DESIGN A retrospective chart review was performed at a large paediatric academic institution to identify patients with prior SARS-CoV-2 infection who received a screening electrocardiogram by their primary care providers and were subsequently referred for outpatient cardiology consultation due to an abnormal electrocardiogram. The outcomes were the results from their cardiology evaluations, including testing and final diagnoses. RESULTS Among 46 patients, during their preceding COVID-19 illness, the majority had mild symptoms, 4 were asymptomatic, and 1 had moderate symptoms. The median length of time from positive SARS-CoV-2 test to screening electrocardiogram was 22 days, and many electrocardiogram findings that prompted cardiology consultation were normal variants in asymptomatic adolescent athletes. Patients underwent frequent additional testing at their cardiology appointments: repeat electrocardiogram (72%), echocardiogram (59%), Holter monitor (11%), exercise stress test (7%), and cardiac MRI (2%). Five patients were incidentally diagnosed with CHD or structural cardiac abnormalities, and three patients had conduction abnormalities (pre-mature atrial contractions, pre-mature ventricular contractions, borderline prolonged QTc), although potentially incidental to COVID-19. No patients were diagnosed with myocarditis or ventricular dysfunction. CONCLUSION In a small cohort of children with prior COVID-19, who were primarily either asymptomatic or mildly symptomatic, subsequent screening electrocardiograms identified various potential abnormalities prompting cardiology consultation, but no patient was diagnosed with myocarditis. Larger multi-centre studies are necessary to confirm these results and to evaluate those with more severe disease.
Collapse
|
23
|
Alosaimi B, AlFayyad I, Alshuaibi S, Almutairi G, Alshaebi N, Alayyaf A, Alturaiki W, Shah MA. Cardiovascular complications and outcomes among athletes with COVID-19 disease: a systematic review. BMC Sports Sci Med Rehabil 2022; 14:74. [PMID: 35443680 PMCID: PMC9020555 DOI: 10.1186/s13102-022-00464-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Abstract
Background Current evidence still emerging regarding the risk of cardiovascular (CV) sequel associated with coronavirus disease 2019 (COVID-19) infection, and considerable replicated studies are needed to ensure safe return-to-play. Therefore, we aimed in this systematic review to measure the prevalence of CV complications suffered by COVID-19 athletic patients, explore the outcomes, optimal approaches to diagnoses, and safe return-to-play considerations. Methods A systematic search on post COVID-19 infection quantitative studies among athletes was conducted following MeSH terms in Medline, Cochrane Library, Ovid, Embase and Scopus (through 15 January 2022). We included peer-reviewed studies reported athletes’ CV complications and the outcomes post COVID-19 infection. Editorials, letters, commentaries, and clinical guidelines, as well as duplicate studies were excluded. Studies involving non-athletic patients were also excluded. Quality assessment was performed using Newcastle–Ottawa Scale. Results We included 15 eligible articles with a total of 6229 athletes, of whom 1023 were elite or professional athletes. The prevalence of myocarditis ranged between 0.4% and 15.4%, pericarditis 0.06% and 2.2%, and pericardial effusion between 0.27% and 58%. Five studies reported elevated troponin levels (0.9-6.9%). Conclusions This study provides a low prevalence of CV complications secondary to COVID-19 infection in short-term follow-up. Early recognition and continuous assessment of cardiac abnormality in competitive athletes are imperative to prevent cardiac complications. Establishing a stepwise evaluation approach is critical with an emphasis on imaging techniques for proper diagnosis and risk assessment for a safe return to play.
Collapse
Affiliation(s)
- Bandar Alosaimi
- Research Center, King Fahad Medical City, Riyadh, 11525, Saudi Arabia. .,Research Center, King Fahad Medical City, Riyadh, 11525, Saudi Arabia.
| | - Isamme AlFayyad
- Research Center, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Salman Alshuaibi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, 13317, Saudi Arabia
| | | | - Nawaf Alshaebi
- Faculty of Medicine, King AbdulAziz University, Jeddah, 21589, Saudi Arabia
| | - Abdulaziz Alayyaf
- Faculty of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, Riyadh, 11942, Saudi Arabia
| | - Wael Alturaiki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia
| | - Muhammad Azam Shah
- Adult Cardiology Department, King Salman Heart Center, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| |
Collapse
|
24
|
Modica G, Bianco M, Sollazzo F, Di Murro E, Monti R, Cammarano M, Morra L, Nifosì FM, Gervasi SF, Manes Gravina E, Zeppilli P, Palmieri V. Myocarditis in Athletes Recovering from COVID-19: A Systematic Review and Meta-Analysis. IJERPH 2022; 19:4279. [PMID: 35409960 PMCID: PMC8998516 DOI: 10.3390/ijerph19074279] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 12/31/2022]
Abstract
Background: To assess the event rates of myocarditis detected by Cardiac Magnetic Resonance (CMR) in athletes who recovered from COVID-19. Methods: A systematic literature search was performed to identify studies reporting abnormal CMR findings in athletes who recovered from COVID-19. Secondary analyses were performed considering increased serum high sensitivity troponin (hs-Tn) levels and electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities. Results: In total, 7988 athletes from 15 studies were included in the analysis. The pooled event rate of myocarditis was 1% (CI 1–2%), reaching 4% in the sub-group analysis. In addition, heterogeneity was observed (I2 43.8%). The pooled event rates of elevated serum hs-Tn levels, abnormal ECG and ECHO findings were 2% (CI 1–5%), 3% (CI 1–10%) and 2% (CI 1–6%), respectively. ECG, ECHO and serum hs-Tn level abnormalities did not show any correlation with myocarditis. Conclusions: The prevalence of COVID-19-related myocarditis in the athletic population ranges from 1 to 4%. Even if the event rate is quite low, current screening protocols are helpful tools for a safe return to play to properly address CMR studies. Trial registration: the study protocol was registered in the PROSPERO database (registration number: CRD42022300819).
Collapse
|
25
|
Calcaterra G, Fanos V, Cataldi L, Cugusi L, Crisafulli A, Bassareo PP. Need for resuming sports and physical activity for children and adolescents following COVID-19 infection. Sport Sci Health 2022; 18:1179-1185. [PMID: 35378898 PMCID: PMC8966858 DOI: 10.1007/s11332-022-00930-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/10/2022] [Indexed: 12/22/2022]
Abstract
Introduction Evidence acquisition Evidence synthesis Conclusions
Collapse
Affiliation(s)
- Giuseppe Calcaterra
- Postgraduate Medical School of Cardiology, Department of Cardiology, University of Palermo, Palermo, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, AOU Cagliari Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Luigi Cataldi
- Department of Paediatrics, Sacred Heart Catholic University of Rome, Rome, Italy
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Antonio Crisafulli
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Pier Paolo Bassareo
- Department of Cardiology, University College of Dublin, School of Medicine, Mater Misericordiae University Hospital and Children’s Health Ireland at Crumlin, Eccles St, Inns Quay, Dublin, D07 R2WY Ireland
| |
Collapse
|
26
|
Schmidt T, Bjarnason-Wehrens B, Zacher J, Predel G, Reiss N. Sports, Myocarditis and COVID-19: Diagnostics, Prevention and Return-to-Play Strategies. Int J Sports Med 2022; 43:1097-1105. [PMID: 35345017 DOI: 10.1055/a-1810-5314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Myocarditis is an umbrella term for non-ischemic myocardial inflammation and remains a leading cause of sudden cardiac death in active individuals and athletes. Accurate diagnosing is challenging and diseases could often remain undetected. In the majority of cases, acute myocarditis resolves favourably. However, a relevant proportion of patients may have an increased risk of prognostically relevant cardiac arrhythmias and/or the development and progression of maladaptive myocardial remodelling (dilated cardiomyopathy). This review provides current knowledge on myocarditis and sports with special regard to the COVID-19 pandemic. Possible causes, common symptoms and proposed diagnostics are summarized. The relevance of temporary avoidance of intensive sports activities for both the prevention and therapy of acute myocarditis is discussed. Risk stratification, specific return-to-play recommendations and proposed follow-up diagnostics (also after COVID-19 infection) are presented.
Collapse
Affiliation(s)
- Thomas Schmidt
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany.,Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Jonas Zacher
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Georg Predel
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| |
Collapse
|
27
|
Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J 2022; 43:1157-1172. [PMID: 35176758 PMCID: PMC8903393 DOI: 10.1093/eurheartj/ehac031] [Citation(s) in RCA: 245] [Impact Index Per Article: 122.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Emerging as a new epidemic, long COVID or post-acute sequelae of coronavirus disease 2019 (COVID-19), a condition characterized by the persistence of COVID-19 symptoms beyond 3 months, is anticipated to substantially alter the lives of millions of people globally. Cardiopulmonary symptoms including chest pain, shortness of breath, fatigue, and autonomic manifestations such as postural orthostatic tachycardia are common and associated with significant disability, heightened anxiety, and public awareness. A range of cardiovascular (CV) abnormalities has been reported among patients beyond the acute phase and include myocardial inflammation, myocardial infarction, right ventricular dysfunction, and arrhythmias. Pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiac diseases which are abundant in those at risk of severe disease. In this review, we discuss the definition of long COVID and its epidemiology, with an emphasis on cardiopulmonary symptoms. We further review the pathophysiological mechanisms underlying acute and chronic CV injury, the range of post-acute CV sequelae, and impact of COVID-19 on multiorgan health. We propose a possible model for referral of post-COVID-19 patients to cardiac services and discuss future directions including research priorities and clinical trials that are currently underway to evaluate the efficacy of treatment strategies for long COVID and associated CV sequelae.
Collapse
Affiliation(s)
- Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
| | - Thomas F. Lüscher
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| |
Collapse
|
28
|
Gluckman TJ, Bhave NM, Allen LA, Chung EH, Spatz ES, Ammirati E, Baggish AL, Bozkurt B, Cornwell WK, Harmon KG, Kim JH, Lala A, Levine BD, Martinez MW, Onuma O, Phelan D, Puntmann VO, Rajpal S, Taub PR, Verma AK. 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play. J Am Coll Cardiol 2022; 79:1717-1756. [PMID: 35307156 PMCID: PMC8926109 DOI: 10.1016/j.jacc.2022.02.003] [Citation(s) in RCA: 171] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
29
|
Abstract
Medical surveillance and risk mitigation protocols to reduce viral transmission have underpinned the return of elite football during the COVID-19 pandemic. This article describes the evidence-informed approach and surveillance findings from the English Football League across a 9-week period at the end of the 2019-20 season. Protocols were devised by the lead EFL Medical Advisor with specialist occupational medicine input. Isolation requirements for cases and contacts were in-line with UK Government regulations, with external contact tracing conducted by local public health authorities. Quantitative PCR testing was conducted twice weekly and within 72 hours of fixtures. Forty-three individuals, including 18 players returned positive tests. No positive results were returned after week 5 (round 10). Our findings support those from other leagues that with appropriate compliance, elite football can continue safely during this pandemic. We recommend that protocols and compliance should be revised as necessary according to community prevalence and changes in viral transmission dynamics.
Collapse
Affiliation(s)
- Subhashis Basu
- English Football League (EFL) Occupational Medicine Advisor, Sheffield United Football Club, Sheffield, England
| | - Richard Higgins
- Lead Sports Physician for the North and English Football League (EFL) Medical Advisor, English Institute of Sport, Sheffield, England
| | - Aneil Malhotra
- Division of Cardiovascular Science, University of Manchester, Manchester University NHS Foundation Trust, Manchester, England
| | - Imtiaz Ahmad
- Head of Medical Services, Queens Park Rangers Football and Athletic Club, Shepherd's Bush, London, England
| |
Collapse
|
30
|
Barbara C, Clavario P, De Marzo V, Lotti R, Guglielmi G, Porcile A, Russo C, Griffo R, Mäkikallio T, Hautala AJ, Porto I. Effects of exercise rehabilitation in patients with long COVID-19. Eur J Prev Cardiol 2022; 29:e258-e260. [PMID: 35078233 PMCID: PMC8807301 DOI: 10.1093/eurjpc/zwac019] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Cristina Barbara
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Piero Clavario
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Vincenzo De Marzo
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| | - Roberta Lotti
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| | - Giulia Guglielmi
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| | - Annalisa Porcile
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Carmelo Russo
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Raffaele Griffo
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Timo Mäkikallio
- Faculty of Sports and Health Sciences, University of Jyväskylä, Finland
| | - Arto Jorma Hautala
- Cardiovascular Research Group, Division of Cardiology, Oulu University Hospital,University of Oulu, Finland
| | - Italo Porto
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| |
Collapse
|
31
|
Guevarra CC, Murray N, Cipriani D, Mailland K, Char A, Coffman K, Davis C, Truong F, Danielian A, Barnes G, Gaal W. Cardiovascular involvement among collegiate athletes following COVID-19 infection. J Clin Transl Res 2022; 8:1-5. [PMID: 35097235 PMCID: PMC8791243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent studies suggest that the prevalence of cardiac involvement in young competitive athletes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears to be low. AIM This study aimed to determine the prevalence of cardiovascular involvement in young competitive athletes. METHODS In this single-center retrospective cohort study from one Division I university; we assessed the prevalence of cardiovascular involvement among collegiate athletes who tested positive for SARS-CoV-2 by polymerase chain reaction testing. Data were collected from June 25, 2020, to May 15, 2021. The primary outcome was the prevalence of cardiac involvement based on a comparison of pre- and post-infection electrocardiogram (ECGs). The secondary outcome was to evaluate for any association between ethnicity and the presence or absence of symptoms. RESULTS Among 99 athletes who tested positive for the SARS-CoV-2 virus (mean age 19.9 years [standard deviation 1.7 years]; 31% female), baseline ECG changes suggestive of cardiovascular involvement post-infection were detected in two athletes (2/99; 2%). There was a statistically significant association between ethnicity and the presence or absence of symptoms, χ 2 (3, n = 99) = 10.61, P = 0.01. CONCLUSIONS The prevalence of cardiovascular involvement among collegiate athletes following SARS-CoV-2 infection in this cohort is low. Afro-American and Caucasian athletes are more likely to experience symptoms following SARS-CoV-2 infection in comparison to Hispanic and Pacific Islander athletes; however, there is no association between ethnicity and symptom severity. RELEVANCE FOR PATIENTS These data add to the growing body of the literature and agree with larger cohorts that the risk of cardiac involvement post-infection appears to be low among elite athletic and semi-professional athletic populations.
Collapse
Affiliation(s)
- Christle C. Guevarra
- 1Department of Family and Community Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States,
Corresponding author: Christle C. Guevarra Department of Family and Community Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States.
| | - Nicholas Murray
- 2School of Community Health Sciences, University of Nevada Reno, Reno, NV, United States
| | - Daniel Cipriani
- 3Center for Graduate Studies, West Coast University, Los Angeles, CA, United States
| | - Kevin Mailland
- 1Department of Family and Community Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Amber Char
- 4Crozer Health Family Medicine Residency, Springfield, PA, United States
| | - Kyle Coffman
- 5Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Cameron Davis
- 1Department of Family and Community Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Frank Truong
- 1Department of Family and Community Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Alfred Danielian
- 6Director of Sports Cardiology and Echocardiography, Las Vegas Heart Associates, Las Vegas, NV, United States
| | - Glenn Barnes
- 1Department of Family and Community Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Wade Gaal
- 1Department of Family and Community Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States
| |
Collapse
|
32
|
Hodgson L, Phillips G, Saggers RT, Sharma S, Papadakis M, Readhead C, Cowie CM, Massey A, Weiler R, Mathema P, Larkin J, Gordon J, Maclean J, Rossiter M, Elliott N, Hanson J, Spencer S, Jaques R, Patricios J. Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic. Br J Sports Med 2022; 56:68-79. [PMID: 33619127 PMCID: PMC7902323 DOI: 10.1136/bjsports-2020-103622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/03/2022]
Abstract
The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.
Collapse
Affiliation(s)
- Lisa Hodgson
- The Football Association, Burton-Upon-Trent, UK
- Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - Gemma Phillips
- Rugby Football League Ltd, Leeds, UK
- Hull Kingston Rovers RLFC, Hull, UK
- Carnegie Applied Rugby Research Centre, Leeds Beckett University, Leeds, UK
| | - Robin Terence Saggers
- Wits Sport and Health (WiSH), School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Department of Paediatrics and Child Health, The University of Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | | | | | | | - Michael Rossiter
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
- Premiership Rugby, London, UK
| | | | - Jonathan Hanson
- Scottish Football Association, Glasgow, UK
- Sport Scotland Institute of Sport, Glasgow, UK
- Glasgow Warriors, Glasgow, UK
| | | | - Rod Jaques
- English Institute of Sport, Manchester, UK
| | - Jon Patricios
- Wits Sport and Health (WiSH), School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| |
Collapse
|
33
|
Moncion K, Rodrigues L, MacKay-Lyons M, Eng JJ, Billinger SA, Ploughman M, Bailey DM, Trivino M, Bayley M, Thiel A, Roig M, Tang A. Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic. Neurorehabil Neural Repair 2022; 36:3-16. [PMID: 34711094 PMCID: PMC8721549 DOI: 10.1177/15459683211054175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.
Collapse
Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lynden Rodrigues
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columba and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, BC, Canada
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer’s Disease Center, Fairway, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Ploughman
- Recovery and Performance Laboratory, BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Damian M. Bailey
- Neurovascular Research Laboratory, University of South Wales Faculty of Life Sciences and Education, Pontypridd, UK
| | - Michael Trivino
- Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Alexander Thiel
- Jewish General Hospital Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
34
|
Akay M, Subramaniam S, Brennan C, Bonato P, Waits CMK, Wheeler BC, Fotiadis DI. Healthcare Innovations to Address the Challenges of the COVID-19 Pandemic. IEEE J Biomed Health Inform 2022; 26:3294-3302. [PMID: 35077374 PMCID: PMC9423029 DOI: 10.1109/jbhi.2022.3144941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We have been faced with an unprecedented challenge in combating the COVID-19/SARS-CoV2 outbreak that is threatening the fabric of our civilization, causing catastrophic human losses and a tremendous economic burden globally. During this difficult time, there has been an urgent need for biomedical engineers, clinicians, and healthcare industry leaders to work together to develop novel diagnostics and treatments to fight the pandemic including the development of portable, rapidly deployable, and affordable diagnostic testing kits, personal protective equipment, mechanical ventilators, vaccines, and data analysis and modeling tools. In this position paper, we address the urgent need to bring these inventions into clinical practices. This paper highlights and summarizes the discussions and new technologies in COVID-19 healthcare, screening, tracing, and treatment-related presentations made at the IEEE EMBS Public Forum on COVID-19. The paper also provides recent studies, statistics and data and new perspectives on ongoing and future challenges pertaining to the COVID-19 pandemic.
Collapse
|
35
|
Colombo C. Exercise Is Medicine! How to Safely Return to Sports after COVID-19? A Meta-Analysis and a Practical Flowchart for Cardiovascular Risk Assessment may Help you. International Journal of Cardiovascular Sciences 2021. [DOI: 10.36660/ijcs.20210202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
36
|
Cavigli L, Cillis M, Mochi V, Frascaro F, Mochi N, Hajdarevic A, Roselli A, Capitani M, Alvino F, Giovani S, Lisi C, Cappellini MT, Colloca RA, Mandoli GE, Valente S, Focardi M, Cameli M, Bonifazi M, D'Ascenzi F. SARS-CoV-2 infection and return to play in junior competitive athletes: is systematic cardiac screening needed? Br J Sports Med 2021; 56:264-270. [PMID: 34844952 DOI: 10.1136/bjsports-2021-104764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND SARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents who are less susceptible to adverse clinical outcomes and are often asymptomatic. OBJECTIVES We conducted this prospective multicentre study to describe the incidence of cardiovascular complications following SARS-CoV-2 infection in a large cohort of junior athletes and to examine the effectiveness of a screening protocol for a safe return to play. METHODS Junior competitive athletes suffering from asymptomatic or mildly symptomatic SARS-CoV-2 infection underwent cardiac screening, including physical examination, 12-lead resting ECG, echocardiogram and exercise ECG testing. Further investigations were performed in cases of abnormal findings. RESULTS A total of 571 competitive junior athletes (14.3±2.5 years) were evaluated. About half of the population (50.3%) was mildly symptomatic during SARS-CoV-2 infection, and the average duration of symptoms was 4±1 days. Pericardial involvement was found in 3.2% of junior athletes: small pericardial effusion (2.6%), moderate pericardial effusion (0.2%) and pericarditis (0.4%). No relevant arrhythmias or myocardial inflammation was found in subjects with pericardial involvement. Athletes with pericarditis or moderate pericardial effusion were temporarily disqualified, and a gradual return to play was achieved after complete clinical resolution. CONCLUSIONS The prevalence of cardiac involvement was low in junior athletes after asymptomatic or mild SARS-CoV-2 infection. A screening strategy primarily driven by cardiac symptoms should detect cardiac involvement from SARS-CoV-2 infection in most junior athletes. Systematic echocardiographic screening is not recommended in junior athletes.
Collapse
Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Michele Cillis
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Veronica Mochi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Federica Frascaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Mochi
- Sports Medicine Unit, USL Toscana Centro, Italy, Firenze, Italy
| | - Arnel Hajdarevic
- Medical Lab, Center for Sports Medicine and Rehabilitation, Asti, Italy.,Turin E. R. G. E. Center for Sports Medicine, Turin, Italy
| | - Alessandra Roselli
- Institute of Sports Medicine, Firenze, Italy.,Center for Sports Medicine, Sam Miniato, Italy
| | - Massimo Capitani
- Center for Sports Medicine, National Health Service, Siena, Italy
| | - Federico Alvino
- Center for Sports Medicine, National Health Service, Siena, Italy
| | - Silvia Giovani
- Center for Sports Medicine, National Health Service, Siena, Italy
| | - Corrado Lisi
- Sports Medicine Unit, USL Toscana Centro, Italy, Firenze, Italy
| | | | | | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Clinical and Surgical Cardiology Uniti, Cardiothoracic and Vascular Department, University Hospital Le Scotte, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| |
Collapse
|
37
|
Savicevic AJ, Nincevic J, Versic S, Cuschieri S, Bandalovic A, Turic A, Becir B, Modric T, Sekulic D. Performance of Professional Soccer Players before and after COVID-19 Infection; Observational Study with an Emphasis on Graduated Return to Play. Int J Environ Res Public Health 2021; 18:11688. [PMID: 34770203 DOI: 10.3390/ijerph182111688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
The impact of the COVID-19 pandemic in sport has been the subject of numerous studies over the past two years. However, knowledge about the direct impact of COVID-19 infection on the performance of athletes is limited, and the importance of studies on this topic is crucial during the current pandemic era. This study aimed to evaluate the changes in the match running performance (MRP) of professional soccer players that occurred as a result of COVID-19 infection after fulfilling all of the prerequisites for a safe return to play (RTP). The participants were 47 professional soccer players from a team which competed in first Croatian division (21.6 years old on average) during the 2020/21 season. The total sample was divided into two subgroups based on the results of a PCR test for COVID-19, where 31 players tested positive (infected) and 16 tested negative. We observed the PCR test results (positive vs. negative PCR), the number of days needed to return to the team, number of days needed to RTP after quarantine and isolation, and MRP (10 variables measured by a global positioning system). The number of days where the infected players were not included in the team ranged from 7 to 51 (Median: 12). Significant pre- to post-COVID differences in MRP for infected players were only found for high-intensity accelerations and high-intensity decelerations (t-test = 2.11 and 2.13, respectively; p < 0.05, moderate effect size differences), with poorer performance in the post-COVID period. Since a decrease of the MRP as a result of COVID-19 infection was only noted in two variables, we can highlight appropriateness of the applied RTP. However, further adaptations and improvements of the RTP are needed with regard to high-intensity activities.
Collapse
|
38
|
Nurek M, Rayner C, Freyer A, Taylor S, Järte L, MacDermott N, Delaney BC. Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study. Br J Gen Pract 2021; 71:e815-e825. [PMID: 34607799 PMCID: PMC8510689 DOI: 10.3399/bjgp.2021.0265] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed. AIM To provide a rapid expert guide for GPs and long COVID clinical services. DESIGN AND SETTING A Delphi study was conducted with a panel of primary and secondary care doctors. METHOD Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of 'strongly agree', 'agree', or 'neither agree nor disagree' from 90% or more of responders were taken as showing consensus. RESULTS Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support. CONCLUSION Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.
Collapse
Affiliation(s)
- Martine Nurek
- Department of Surgery and Cancer, Imperial College London, London
| | - Clare Rayner
- Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham
| | - Anette Freyer
- Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham
| | - Sharon Taylor
- Central and North West London NHS Foundation Trust and honorary senior clinical lecturer, Imperial College School of Medicine, London
| | - Linn Järte
- Anaesthetics Department, Morriston Hospital, Swansea Bay University Health Board, Swansea
| | | | - Brendan C Delaney
- Department of Surgery and Cancer, Imperial College London, London, and principal in general practice, Albion Street Group Practice, London
| |
Collapse
|
39
|
Costello BT, Climie RE, Wright L, Janssens K, Mitchell A, Wallace I, Lindqvist A, Foulkes S, Paratz ED, Flannery MD, Saner N, Griffin D, Green DJ, Cowie B, Howden EH, Garnham A, La Gerche A. Athletes with mild COVID-19 illness demonstrate subtle imaging abnormalities without exercise impairment or arrhythmias. Eur J Prev Cardiol 2021; 29:e220-e223. [PMID: 34669943 PMCID: PMC8574300 DOI: 10.1093/eurjpc/zwab166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Ben T Costello
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Rachel E Climie
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia
| | - Leah Wright
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Kristel Janssens
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Amy Mitchell
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Imogen Wallace
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Anniina Lindqvist
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Steve Foulkes
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Elizabeth D Paratz
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Michael D Flannery
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Nicholas Saner
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - David Griffin
- Infectious Disease Department, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Danny J Green
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Perth 6009, Australia
| | - Brian Cowie
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Erin H Howden
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Andrew Garnham
- Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Andre La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, VIC 3065, VIC, Australia
| |
Collapse
|
40
|
Davey MS, Davey MG, Hurley R, Hurley ET, Pauzenberger L. Return to Play Following COVID-19 Infection-A Systematic Review of Current Evidence. J Sport Rehabil 2021;:1-6. [PMID: 34564071 DOI: 10.1123/jsr.2021-0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT The COVID-19 pandemic has had catastrophic impact on a global scale, affecting people from all walks of life including elite athletes. OBJECTIVES The purpose of this study was to evaluate the reported rates of return to play (RTP) in conjunction with the expert-derived guidelines previously recommended to enable safe RTP post COVID-19 infection. EVIDENCE ACQUISITION Two independent reviewers searched the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing the MEDLINE, Embase, and Scopus databases. Only studies that reported rates of RTP and/or recommended guidelines for safe RTP were included. EVIDENCE SYNTHESIS Overall, 17 studies (3 level III and 14 level V) were included. A total of 3 studies reported rates of RTP in a total of 1255 athletes and 623 officials; 72 (30 symptomatic) were infected with COVID-19, 100% of whom were able to RTP post COVID-19 infection. Of the 14 studies recommending guidelines for safe RTP, 3 and 9 studies recommended 7 and 14 days of rest in isolation respectively for asymptomatic patients with COVID-19 infection, prior to safe RTP. In contrast, 7 studies recommended 3 to 6 months of rest (following 14 d isolation) in cases of COVID-19-induced myocarditis as a safe timeframe for safe RTP. Of the 11 studies reporting on whether blanket testing prior to RTP was recommended, only 7 studies recommended a negative test result as mandatory prior to RTP for athletes previously infected with COVID-19. CONCLUSIONS Although excellent rates of RTP have been reported for elite athletes post COVID-19 infection, discrepancies in recommended rest periods, requirement for mandatory negative test results, and the magnitude of screening investigations required continue to exist in the literature, with a need for further standardized international guidelines required in future. LEVEL OF EVIDENCE Level V; systematic review of all forms of evidence.
Collapse
|
41
|
Kim SY, Yoo DM, Min C, Choi HG. Changes in Dietary Habits and Exercise Pattern of Korean Adolescents from Prior to during the COVID-19 Pandemic. Nutrients 2021; 13:3314. [PMID: 34684315 DOI: 10.3390/nu13103314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 01/24/2023] Open
Abstract
This study aimed to investigate changes in the exercise pattern and dietary habits in adolescents during the COVID-19 pandemic. The 12–18-year-old population in the Korea Youth Risk Behavior Web-Based Survey data of 2019 and 2020 was enrolled. The exercise pattern and dietary habits of 105,600 participants (53,461 in the 2019 group and 52,139 in the 2020 group) were compared. The odds ratios (ORs) for the dietary habits and exercise pattern of the 2020 group compared to the 2019 group were analyzed using multiple logistic regression analysis with complex sampling. The odds of eating fruit, drinking soda, drinking sweet drinks, and consuming fast food were lower in the 2020 group than in the 2019 group (all p < 0.001). The odds of eating breakfast were higher in the 2020 group than in the 2019 group (all p < 0.001). The 2020 group showed lower odds of frequent vigorous and moderate aerobic exercise and higher odds of frequent anaerobic exercise than the 2019 group (all p < 0.001). During the COVID-19 pandemic, adolescents consumed less fruit, soda, and sweet drinks, while they had more breakfast. The frequency of aerobic exercise was lower, while the frequency of anaerobic exercise were higher during the COVID-19 pandemic period.
Collapse
|
42
|
Abstract
The Covid-19 pandemic has disrupted organised sport in the community as authorities cancelled, greatly modified or postponed sporting participation as part of a strategy to reduce transmission of the virus. This had a significant impact on young athletes and their families in relation to their psycho-social, physical and career progression considerations. The disruption is likely to continue for some years, considering the constraints of lockdowns, the need to overcome dysfunctional national logistics for delivery of medical care, fund and implement an efficacious vaccine programme locally, nationally and worldwide, develop sufficient herd immunity and create an environment of confidence in the safety of returning to sports for participants, coaches, umpires, administrators and observers. This article will consider the interim challenges regarding the physical and psychosocial importance of maintaining an active sporting programme for young athletes, reflect on safety measures for modifying sporting equipment and environmental protections to allow safest participation in training and competition and provide advice on protocols for a gradual return to sport for the young athlete after infection with Covid-19.
Collapse
Affiliation(s)
- Hugh T Fitzgerald
- Exercise Physiology, School of Medical Sciences, University of New South Wales, Kensington, NSW 2052, Australia
| | - Sam T Rubin
- Biomedical Engineering, Clemson University, Clemson, SC, USA
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital at Westmead Clinical School, Faculty of Health Sciences, University of Sydney, Westmead 2145, Australia
| | - Bruce K Rubin
- Jessie Ball duPont Distinguished Professor, Dept. of Pediatrics Professor of Biomedical Engineering Virginia Commonwealth University School of Medicine Virginia Eminent Scholar in Pediatrics 1000 East Broad St.Richmond, VA 23298 USA.
| |
Collapse
|
43
|
Foged F, Rasmussen IE, Bjørn Budde J, Rasmussen RS, Rasmussen V, Lyngbæk M, Jønck S, Krogh-Madsen R, Lindegaard B, Ried-Larsen M, Berg RMG, Christensen RH. Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: a randomised cross-over trial. BMJ Open Sport Exerc Med 2021; 7:e001156. [PMID: 34493958 PMCID: PMC8413475 DOI: 10.1136/bmjsem-2021-001156] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Many patients with COVID-19 suffer from persistent symptoms, many of which may potentially be reversed by high-intensity interval training (HIIT). Yet, the safety and tolerability of HIIT after COVID-19 is controversial. This study aimed to investigate the fidelity, tolerability and safety of three different HIIT protocols in individuals that had recently been hospitalised due to COVID-19. METHODS The study was a randomised cross-over trial. We compared three supervised HIIT protocols (4×4, 6×1, 10-20-30) in 10 individuals recently discharged after hospitalisation for severe COVID-19. Each HIIT protocol had a duration of 38 min and was performed with a 1-week washout between them. Outcomes included adverse events, exercise training intensity and tolerability assessed by the Likert scale (1-10). RESULTS All 10 participants aged 61 (mean, SD 8) years (5 males) completed all three HIIT protocols with no adverse events. High intensities were achieved in all three protocols, although they differed in terms of time spent with a heart rate ≥85% of maximum (mean (SD); 4×4: 13.7 (6.4) min; 10-20-30: 12.1 (3.8) min; 6×1: 6.1 (5.6) min; p=0.03). The three protocols were all well tolerated with similar Likert scale scores (mean (SD); 4×4: 8 (2), 10-20-30: 8 (2), 6×1: 9 (2), p=0.72). CONCLUSION Our findings indicate that recently hospitalised individuals for severe COVID-19 may safely tolerate acute bouts of supervised HIIT as per protocol. This warrants future studies testing the potential of regular HIIT as a rehabilitation strategy in this context.
Collapse
Affiliation(s)
- Frederik Foged
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | | | - Josephine Bjørn Budde
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Villads Rasmussen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Mark Lyngbæk
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Simon Jønck
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Pulmonary Medicine and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ronan Martin Griffin Berg
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Regitse Højgaard Christensen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
44
|
Khan Z, Na JS, Jerome S. Review of COVID-19 Myocarditis in Competitive Athletes: Legitimate Concern or Fake News? Front Cardiovasc Med 2021; 8:684780. [PMID: 34336948 PMCID: PMC8318064 DOI: 10.3389/fcvm.2021.684780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/09/2021] [Indexed: 01/15/2023] Open
Abstract
Since the first reported case of COVID-19 in December 2019, the global landscape has shifted toward an unrecognizable paradigm. The sports world has not been immune to these ramifications; all major sports leagues have had abbreviated seasons, fan attendance has been eradicated, and athletes have opted out of entire seasons. For these athletes, cardiovascular complications of COVID-19 are particularly concerning, as myocarditis has been implicated in a significant portion of sudden cardiac death (SCD) in athletes (up to 22%). Multiple studies have attempted to evaluate post-COVID myocarditis and develop consensus return-to-play (RTP) guidelines, which has led to conflicting information for internists and primary care doctors advising these athletes. We aim to review the pathophysiology and diagnosis of viral myocarditis, discuss the heterogeneity regarding incidence of COVID myocarditis among athletes, and summarize the current expert recommendations for RTP. The goal is to provide guidance for practitioners who will be managing and advising athletes in the COVID era.
Collapse
Affiliation(s)
- Zulqarnain Khan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jonathan S Na
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Scott Jerome
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
45
|
Filomena D, Birtolo LI, Penza M, Gualdi G, DI Giacinto B, Maestrini V. The role of cardiovascular magnetic resonance in the screening before the return-to-play of elite athletes after COVID-19: utility o futility? J Sports Med Phys Fitness 2021; 61:1137-1143. [PMID: 34256540 DOI: 10.23736/s0022-4707.21.12764-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Recent reports based on cardiovascular magnetic resonance (CMR) showed a wide range of prevalence of inflammatory heart diseases in COVID-19 convalescent athletes ranging from 0.4 up to 15%. These observations had an important impact in the field of sport cardiology opening an intense debate around the best possible screening strategy before the return-to-play. The diagnostic yield of CMR for detecting acute inflammatory disease is undebatable. However, the opportunity to use it in the screening protocol after COVID-19 has been questioned. Current evidence does not seem to support the routine use of CMR and the prescription of CMR should be based upon clinical indication.
Collapse
Affiliation(s)
- Domenico Filomena
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy.,Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Rome, Italy
| | - Lucia I Birtolo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy.,Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Rome, Italy
| | - Marco Penza
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Rome, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Gianfranco Gualdi
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Rome, Italy
| | - Barbara DI Giacinto
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy - .,Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Rome, Italy
| |
Collapse
|
46
|
Buckley BJR, Harrison SL, Fazio-Eynullayeva E, Underhill P, Jones ID, Williams N, Lip GYH. Exercise rehabilitation associates with lower mortality and hospitalisation in cardiovascular disease patients with COVID-19. Eur J Prev Cardiol 2021; 29:e32-e34. [PMID: 34219154 PMCID: PMC8344427 DOI: 10.1093/eurjpc/zwaa135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/09/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK
| | | | | | - Ian D Jones
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, University of Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.,Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
47
|
Burtscher J, Burtscher M, Millet GP. The central role of mitochondrial fitness on antiviral defenses: An advocacy for physical activity during the COVID-19 pandemic. Redox Biol 2021; 43:101976. [PMID: 33932869 PMCID: PMC8062414 DOI: 10.1016/j.redox.2021.101976] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
Mitochondria are central regulators of cellular metabolism, most known for their role in energy production. They can be "enhanced" by physical activity (including exercise), which increases their integrity, efficiency and dynamic adaptation to stressors, in short "mitochondrial fitness". Mitochondrial fitness is closely associated with cardiorespiratory fitness and physical activity. Given the importance of mitochondria in immune functions, it is thus not surprising that cardiorespiratory fitness is also an integral determinant of the antiviral host defense and vulnerability to infection. Here, we first briefly review the role of physical activity in viral infections. We then summarize mitochondrial functions that are relevant for the antiviral immune response with a particular focus on the current Coronavirus Disease (COVID-19) pandemic and on innate immune function. Finally, the modulation of mitochondrial and cardiorespiratory fitness by physical activity, aging and the chronic diseases that represent the most common comorbidities of COVID-19 is discussed. We conclude that a high mitochondrial - and related cardiorespiratory - fitness should be considered as protective factors for viral infections, including COVID-19. This assumption is corroborated by reduced mitochondrial fitness in many established risk factors of COVID-19, like age, various chronic diseases or obesity. We argue for regular analysis of the cardiorespiratory fitness of COVID-19 patients and the promotion of physical activity - with all its associated health benefits - as preventive measures against viral infection.
Collapse
Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland; Department of Biomedical Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland.
| | | | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland
| |
Collapse
|
48
|
Colombo CSSDS, Leitão MB, Avanza AC, Borges SF, da Silveira AD, Braga F, Camarozano AC, Kopiler DA, Lazzoli JK, de Freitas OGA, Grossman GB, Milani M, Nunes MB, Ritt LEF, Sellera CAC, Ghorayeb N. Position Statement on Post-COVID-19 Cardiovascular Preparticipation Screening: Guidance for Returning to Physical Exercise and Sports - 2020. Arq Bras Cardiol 2021; 116:1213-1226. [PMID: 34133609 PMCID: PMC8288531 DOI: 10.36660/abc.20210368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Cléa Simone Sabino de Souza Colombo
- Faculdade de Medicina São Leopoldo MandicCampinasSPBrasilFaculdade de Medicina São Leopoldo Mandic – Campinas, SP – Brasil
- Sportscardio Clínica CardiológicaValinhosSPBrasilSportscardio Clínica Cardiológica – Valinhos, SP – Brasil
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (HCor), São Paulo, SP – Brasil
| | - Marcelo Bichels Leitão
- CEFIT – Centro de Estudos de Fisiologia do Exercício e TreinamentoCuritibaPRBrasilCEFIT – Centro de Estudos de Fisiologia do Exercício e Treinamento, Curitiba, PR – Brasil
- Conselho Federal de MedicinaCâmara técnica de Medicina DesportivaRio de JaneiroRJBrasilConselho Federal de Medicina, Câmara técnica de Medicina Desportiva, Rio de Janeiro, RJ – Brasil
- Comissão de Autorização para Uso Terapêutico (CAUT) da Autoridade Brasileira de Controle de DopagemBrasilComissão de Autorização para Uso Terapêutico (CAUT) da Autoridade Brasileira de Controle de Dopagem (ABCD)
| | - Antônio Carlos Avanza
- Universidade Vila VelhaESBrasilUniversidade Vila Velha, ES – Brasil
- Clínica CentrocorVitóriaESBrasilClínica Centrocor, Vitória, ES – Brasil
| | - Serafim Ferreira Borges
- Clube de Regatas do FlamengoRio de JaneiroRJBrasilClube de Regatas do Flamengo, Rio de Janeiro, RJ – Brasil
- Instituto Estadual de Cardiologia Aloysio de CastroRio de JaneiroRJBrasilInstituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, RJ – Brasil
- Imagecor Medicina Diagnóstica e do ExercícioRio de JaneiroRJBrasilImagecor Medicina Diagnóstica e do Exercício, Rio de Janeiro, RJ – Brasil
- Conselho Federal de MedicinaCâmara técnica de Medicina DesportivaRio de JaneiroRJBrasilConselho Federal de Medicina, Câmara técnica de Medicina Desportiva, Rio de Janeiro, RJ – Brasil
| | - Anderson Donelli da Silveira
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Fabrício Braga
- Laboratório de Performance HumanaRio de JaneiroRJBrasilLaboratório de Performance Humana, Rio de Janeiro, RJ – Brasil
- Casa de Saúde São JoséRio de JaneiroRJBrasilCasa de Saúde São José, Rio de Janeiro, RJ – Brasil
- Confederação Brasileira de TriathlonRio de JaneiroRJBrasilConfederação Brasileira de Triathlon, Rio de Janeiro, RJ – Brasil
| | - Ana Cristina Camarozano
- Universidade Federal do ParanáCuritibaPRBrasilUniversidade Federal do Paraná, Curitiba, PR – Brasil
| | - Daniel Arkader Kopiler
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ – Brasil
- Confederação Pan-Americana de Medicina do EsporteBrasilConfederação Pan-Americana de Medicina do Esporte
| | - José Kawazoe Lazzoli
- Instituto Biomédico da Universidade Federal FluminenseNiteróiRJBrasilInstituto Biomédico da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil
- Hospital Santa Teresa/ACSCPetrópolisRJBrasilHospital Santa Teresa/ACSC, Petrópolis, RJ – Brasil
- Confederação Pan-Americana de Medicina do EsporteBrasilConfederação Pan-Americana de Medicina do Esporte (COPAMEDE)
- Federação Internacional de Medicina do EsporteBrasilFederação Internacional de Medicina do Esporte (FIMS)
- Comissão de Autorização para Uso Terapêutico (CAUT) da Autoridade Brasileira de Controle de DopagemBrasilComissão de Autorização para Uso Terapêutico (CAUT) da Autoridade Brasileira de Controle de Dopagem (ABCD)
| | | | - Gabriel Blacher Grossman
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento, Porto Alegre, RS – Brasil
- Clínica CardionuclearPorto AlegreRSBrasilClínica Cardionuclear, Porto Alegre, RS – Brasil
| | - Mauricio Milani
- Fitcordis Medicina do ExercícioBrasíliaDFBrasilFitcordis Medicina do Exercício, Brasília, DF – Brasil
| | - Mauricio B. Nunes
- Hospital PortuguêsSalvadorBABrasilHospital Português, Salvador, BA – Brasil
| | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio PulmonarSalvadorBABrasilHospital Cárdio Pulmonar, Salvador, BA – Brasil
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBABrasilEscola Bahiana de Medicina e Saúde Pública, – Salvador, BA – Brasil
| | - Carlos Alberto Cyrillo Sellera
- Santa Casa de SantosSantosSPBrasilSanta Casa de Santos, Santos, SP – Brasil
- Universidade Metropolitana de SantosSantosSPBrasilUniversidade Metropolitana de Santos, Santos, SP – Brasil
| | - Nabil Ghorayeb
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (HCor), São Paulo, SP – Brasil
| |
Collapse
|
49
|
Cavigli L, Frascaro F, Turchini F, Mochi N, Sarto P, Bianchi S, Parri A, Carraro N, Valente S, Focardi M, Cameli M, Bonifazi M, D'Ascenzi F. A prospective study on the consequences of SARS-CoV-2 infection on the heart of young adult competitive athletes: Implications for a safe return-to-play. Int J Cardiol 2021; 336:130-136. [PMID: 34082008 PMCID: PMC8166156 DOI: 10.1016/j.ijcard.2021.05.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 01/30/2023]
Abstract
Objectives The COVID-19 pandemic has shocked the sports world because of the suspension of competitions and the spread of SARS-CoV-2 among athletes. After SARS-CoV-2 infection, cardio-pulmonary complications can occur and, before the resumption of sports competitions, a screening has been recommended. However, few data are available and discrepancies exist in the screening modalities. We conducted this prospective study to investigate the incidence of cardiovascular consequences following SARS-CoV-2 infection in young adult competitive athletes and the appropriate screening strategies for a safe return-to-play. Methods Ninety competitive athletes (24 ± 10 years) after asymptomatic or mildly symptomatic SARS-CoV-2 infection were screened by physical examination, blood testing, spirometry, 12‑lead resting ECG, 24-h ambulatory ECG monitoring, echocardiogram, and cardiopulmonary exercise testing (CPET). Results Sixty-four athletes (71.1%) were male, and most (76.7%) were mildly symptomatic. After SARS-CoV-2 infection, spirometry and resting ECG were normal in all athletes. Ambulatory ECG monitoring demonstrated <50/24 h supraventricular and ventricular premature beats in 53.3% and 52.2% of athletes, respectively, in the absence of malignant arrhythmias. CPET did not demonstrate cardiopulmonary limitations. Echocardiography showed pericardial effusion in 3 athletes (all females) with symptomatic SARS-CoV-2 infection (3.3%; 4.4% in the symptomatic group) with a definitive diagnosis of myopericarditis in 1 athlete (1.1%) and pericarditis in 2 athletes (2.2%). Conclusions Cardiac consequences of SARS-CoV-2 infection were found in 3.3% of competitive athletes. An appropriate screening primarily based on the detection of uncommon arrhythmias and cardiac symptoms should be recommended in competitive athletes after SARS-CoV-2 infection to detect a cardiac involvement and guarantee a safe return-to-play.
Collapse
Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Federica Frascaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Turchini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Patrizio Sarto
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | | | | | - Nicolò Carraro
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| |
Collapse
|
50
|
Halle M, Bloch W, Niess AM, Predel HG, Reinsberger C, Scharhag J, Steinacker J, Wolfarth B, Scherr J, Niebauer J. Exercise and sports after COVID-19-Guidance from a clinical perspective. Transl Sports Med 2021; 4:310-318. [PMID: 34230908 PMCID: PMC8250714 DOI: 10.1002/tsm2.247] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022]
Abstract
SARS‐CoV‐2 infection has emerged as not only a pulmonary but also potentially multi‐organ disease, which may cause long‐term structural damage of different organ systems including the lung, heart, vasculature, brain, liver, kidney, or intestine. As a result, the current SARS‐CoV‐2/COVID‐19 pandemic will eventually yield substantially increased numbers of chronically diseased patients worldwide, particularly suffering from pulmonary fibrosis, post‐myocarditis, chronic heart failure, or chronic kidney disease. Exercise recommendations for rehabilitation are complex in these patients and should follow current guidelines including standards for pre‐exercise medical examinations and individually tailored exercise prescription. It is of utmost importance to start exercise training at an early stage after COVID‐19 infection, but at the same time paying attention to the physical barriers to ensure safe return to exercise. For exercise recommendations beyond rehabilitation programs particularly for leisure time and elite athletes, more precise advice is required including assessment of sports eligibility and specific return‐to‐sports exercise programs. Because of the current uncertainty of long‐term course of SARS‐CoV‐2 infection or COVID disease, long‐term follow‐up seems to be necessary.
Collapse
Affiliation(s)
- Martin Halle
- Department of Prevention and Sports Medicine Technical University of Munich Munich Germany.,DZHK (German Center for Cardiovascular Research) partner site Munich Heart Alliance Munich Germany
| | - Wilhelm Bloch
- Institute of Cardiovascular Research, Molecular and Cellular Sport Medicine German Sport University Cologne Germany
| | - Andreas M Niess
- Department of Sports Medicine University Hospital of Tübingen Tübingen Germany
| | - Hans-Georg Predel
- Department of Prevention and Rehabilitation Institute of Cardiovascular Research and Sports Medicine German Sport University Cologne Germany
| | | | - Jürgen Scharhag
- Sports Medicine, Exercise Physiology and Prevention Department of Sport Science University of Vienna Vienna Austria
| | - Jürgen Steinacker
- Division of Sports and Rehabilitation Medicine University Ulm Hospital Ulm Germany
| | - Bernd Wolfarth
- Department of Sports Medicine Humboldt University and Charité University School of Medicine Berlin Germany
| | - Johannes Scherr
- Department of Prevention and Sports Medicine Technical University of Munich Munich Germany.,University Center for Prevention and Sports Medicine University Hospital Balgrist University of Zurich Zurich Switzerland
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation Paracelsus Medical University Salzburg Salzburg Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention Salzburg Austria
| |
Collapse
|