How professional athletes return after COVID

How professional athletes return after COVID

 

Many of us have now had or know someone who had the COVID-19 virus over the summer break, experiencing varying levels of symptoms. I look after professional rugby players, and the most common symptoms that I found were fatigue, cough, sore throat, headache, muscle aches and joint pains. These symptoms varied in severity and how long they lasted.

 

Those who had no symptoms but were in isolation because they tested positive or were family contacts were able to exercise within their home without any restriction. This meant that training loads could be maintained as much as possible which in turn meant quicker return to higher training loads with the team when they were free from isolation. Those with mild to moderate symptoms were advised to rest until symptom free for 72 hours. The usual viral management was advised including regular paracetamol or anti-inflammatories as required if no allergies, regular fluids, try to maintain their regular diet to minimise weight loss and obviously rest.

 

Most of the time athletes were able to resume exercise again while in isolation but there were about 10-20% that had prolonged symptoms, even longer than the 7 days isolation period. For athletes to return to training with the team they had to be absolutely symptom free to avoid any further transmission to teammates.

 

At Super Rugby, Team Doctors together with the Rugby Australia Chief Medical Officer developed a graduated return to play schedule similar to that we use after concussion. This involved progressive, stepped-up levels of exercise.

 

 

Return to exercise program

 

Each stage is a minimum of 24 hours.

 

Stage 1: Initial rest (must be symptom free for 72 hours)
Stage 2: Light activity (<70% of Max HR, < 15 mins eg. light walk /jog /stationary cycle, no weights)
Stage 3: Moderate activity (<80% Max HR, < 45 mins, increase running, skills, begin resistance training at about 50% of normal weight lifted)
Stage 4: Advanced activity (<80% Max HR, < 60 mins, more intense aerobic activity, increase skills training, increase to 70% of normal weight lifted)
Stage 5: Return to normal training

 

We asked the athletes to monitor their resting HR in the morning and if it was less than 20%  different from their normal resting HR, they could continue with training progressions. (HR is heart rate, maximal heart rate is 220 less your age as beats per minute)

 

If any symptoms worsened, were not improving or new symptoms developed these were reported to me as the Team Doctor and appropriate investigations were done.

 

 

Common symptoms on returning to sport

 

      • ongoing fatigue
      • shortness of breath (more than expected with exercise)
      • chest pain with exercise
      • dizziness with exercise
      • chest pain with exercise
      • elevated HR during or after exercise
      • cough with exercise.

 

There was a small percentage that required assessment by a sports cardiologist to ensure that the rare complication of pericarditis/myocarditis or lung injury had not occurred.

 

One of the most common symptoms I have seen after COVID-19 infection is a reduced exercise tolerance, especially with aerobic exercise.  My advice would be to go slow in this space (work within symptoms) and focus more on skills and strength development while you feel this way. Recovery can take as little as few days or as long as few weeks.

 

Most people do not require medical supervision of their return to exercise following COVID-19. A progressive exercise strategy to increase the amount, length, and intensity is all that is required, and will usually take around 1-2 weeks.

 

If you have any persisting symptoms of fatigue, or shortness of breath, chest pain or cough with exercise then you should be reviewed by a doctor.

 

 

Written by Dr Sam Pomroy
Recent Waratahs Rugby Team Doctor

 

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