By Adam Virgile, Sports Science Consultant

COVID-19 has taken a toll on all athletes due to abrupt, drastic changes in schedules. Athletes are being exposed to game schedules for which they are unaccustomed. At the drop of a hat, training can be ceased and games, including their locations, can be jostled around. As a result, intelligent periodization frameworks have been thrown out the window, leaving athletes underprepared for competition demands. Physical and psychological deconditioning, mental health and underperformance issues may be present as athletes emerge from quarantine restrictions. It is not a stretch to assume that athletes will emerge from quarantine and be thrust into competition. If there are a few days to spare, it is likely that those days will be filled with high-volume, high-intensity work in attempt to prepare for upcoming competition as quickly as possible, resulting in excessive fatigue and increased injury potential.

Of particular concern are athletes who have been infected with COVID-19 because they are dealing with recovery from a serious illness on top of schedule adjustments. It is important that the return to play (RTP) pathways for all athletes, but COVID-19-infected athletes in particular, are modified on an individual basis. A recent publication by Wilson et al. (2020) in the British Journal of Sports Medicine outlines an RTP pathway intended for elite athletes who place high demand on their cardiorespiratory system and are currently being required to return to train or compete; this pathway is reflected in the infographic [1].

Wilson et al. (2020) urge sport and exercise medicine physicians to consider the following: (1) a standard cardiac evaluation typically performed during preseason may be sufficient in the vast majority of athletes to allow RTP, (2) most athletes will have previous preparticipation medical evaluations that can be used for comparison, (3) athletes with significant and prolonged symptoms or those that were hospitalised from COVID-19 require a complete cardiac and respiratory workup even if now fully recovered and finally (4) in athletes that are/were infected with confirmed or suspected COVID-19, any graded RTP decision starts when athletes are symptom free at rest for 7 days and no sooner than 10 days from the onset of symptoms. The overarching goal of the paper by Wilson et al. (2020) and the coinciding infographic are to provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system [1].

1. Wilson, M.G., Hull, J.H., Rogers, J., Pollock, N., Dodd, M., Haines, J., Harris, S., Loosemore, M., Malhotra, A., Pieles, G. and Shah, A., 2020. Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. British journal of sports medicine, 54(19), pp.1157-1161.