How can athletes safely return to exercise after a COVID-19 infection? New evidence has shown that athletes should be screened after infection before they return to training, even they had a mild/moderate or non-symptomatic infection.
COVID-19 produces a wide range of systemic and organ complications after infection that athletes and other COVID patients can experience.
Some complications observed in athletes up to 6-8 weeks after a viral infection are:
A significant decrease in aerobic capacity.
Subjective symptoms such as asthenia, fatigue, persistent sore muscles, headaches, dyspnea, chest pain, or chest tightness on exertion.
Myocarditis is one of the more serious and silent complications of COVID-19. Up to 7% of the COVID-19-related deaths could be attributable to myocarditis.
Myocarditis is the inflammation of the heart muscle. The condition can affect the muscles in your heart and the "electrical" system, causing a decreased ability to pump blood.
Viral COVID-19 myocarditis has the potential to produce sudden death and other cardiac conditions in athletes (even those with no history of heart conditions). The Coronavirus produces myocarditis by direct cell damage. As the body fights the virus, it causes inflammation and cell damage.
The concern about myocarditis led researchers to investigate myocarditis in athletes and they found that up to 15-30% of athletes have evidence of myocarditis after the viral infection. There is also report of the sudden death of a college football player.
This new evidence led some college sports conferences to evaluate their student-athletes’ heart condition before they resume training and sport participation.
Some institutions have developed guidelines and recommendations for the evaluation of athletes before they can safely resume exercise and training.
The first and most important thing is rest! A two-week break from exercise is important because it can help the body heal. It helps medical professionals accurately evaluate the athlete’s recovery from any residual symptoms that can be confused with symptoms produced by returning to exercise.
Blood work to evaluate cardiac enzymes and by-products of viral infection.
Electrocardiogram to rule out myocarditis related arrhythmia, and other cardiac conditions.
If it is possible a cardiac MRI, the gold standard in the myocarditis evaluation.
If unfortunately, the evaluation is positive for myocarditis, athletes should pursue further evaluation, cardiac rehabilitation, and follow up. It’s possible that an athlete will need to completely rest from sports and taxing exercise for 3 to 6 months to allow the heart and body to fully recover.
Athletes who have been cleared of any myocarditis should get medical clearance from their doctors before returning to training and exercise. They should also return slowly and cautiously, instead of jumping back in where they left off before their COVID-19 diagnosis.
A good rule of thumb for athletes returning to training is to begin with 30-45 minutes of low-intensity aerobic work and progress slowly to moderate aerobic activity over a 2-3 week period. Your certified coach should be able to prescribe you the best training according to your background and actual physical status in a safe manner.
Manuel Delgado Gaona is a USAT Level II and Youth & Junior Coach, FMTri Level II Certified Coach, an ACSM Exercise Physiologist, and a Physician specializing in Anatomic Pathology. His coaching philosophy is based on exercise efficiency. Coach Manuel can be reached at manuel@teammpi.com.