Login | October 23, 2020

Athletes with COVID returning to play

PETE GLADDEN
Pete’s World

Published: October 5, 2020

COVID-19 and its ultimate impact on the sports community is still pretty much of an unknown.
And for me as a coach who provides guidance to athletes, this COVID-19 unknown had left me feeling very unsettled.
To be more precise my unsettledness had centered around the eventuality of my having to offer a “back to training” plan for athletes who had previously tested positive for the disease.
You see, other than some rather general guidelines provided in CDC publications there’s really nothing else to use as a template for instituting back to training scenarios.
Well, last week my sister - the doc - forwarded me a JAMA (Journal of the American Medical Association) article that immediately grabbed my attention.
Now first of all it’s co-written by my sports cardiologist, Dermot Phelan, a pretty brilliant young gentleman who’s worked with me since May 2016.
And second, it comes at a great time because I’ve suddenly been presented with a client, an Ironman distance athlete, who wants to safely return to her training after having testing positive for COVID-19.
What with the publication of this article and its very thorough return-to-play algorithm, I’m starting to feel a bit more confident about instituting COVID related back to training protocols.
So be you a hardcore athlete, a recreational exerciser or a coach like me, I urge you to read this piece if for only to give you some real insights into the more insidious risks associated with COVID-19 and more specifically, the risks of going back to an exercise regime too soon after contracting the disease.
The May 13, 2020 article I’m referring to, which I’ll be quoting at length, is titled “A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection,” written by by Dermont Phelan, MD, PhD, Jonathan H. Kim, MD, MSc, and Eugene H. Chung, MD, MSc. It’s from the online JAMA Network, JAMA Cardiology, Viewpoint and can be found at: https://jamanetwork.com/journals/jamacardiology/fullarticle/2766124.
Now as you already know, COVID-19 is more than just a bad flu. But did you also know that if this virus becomes deeply entrenched in the body it can cause more severe problems?
Indeed, it can attack organs that have ACE2 receptors like the heart muscle, kidneys, blood vessels, the liver and possibly even the central nervous system.
This is why it’s absolutely crucial for athletes and coaches to possess a scientifically based return-to-play protocol that spans asymptomatic to severely symptomatic individuals.
In this article Phelan et al. have stated, “For athletes who remain asymptomatic and are negative for COVID-19, return to exercise training is permissible without additional testing. However, asymptomatic athletes who test positive for COVID-19 antigen (active infection) should refrain from exercise training for at least two weeks from the date of positive test result and follow strict isolation guidelines.
“If athletes remain asymptomatic, slow resumption of activity should be guided under direction from their medical professional. For those asymptomatic individuals with detected COVID-19 antibodies in response to prior infection, we recommend similar evaluation as the asymptomatic athlete with positive COVID-19 test results, and cardiac testing should be considered if there is concern for cardiac involvement.”
Now what I found to be a real eye-opener are the recommendations for those individuals who possess(ed) more severe COVID-19 symptoms.
In this case Phelan et al. suggest, “For athletes who are positive for COVID-19 and develop mild or moderate symptoms, we recommend a minimum of two weeks’ cessation of any exercise training from symptom resolution. Whether the increased risk of myocardial injury in hospitalized patients with COVID-19 translates to mildly ill nonhospitalized patients is unknown but underscores the need to carefully consider the possibility of cardiac injury among nonhospitalized patients with COVID-19.
“For recovered individuals ready to resume training after temporal restrictions, we recommend a careful, clinical cardiovascular evaluation in combination with cardiac biomarkers and imaging. Further adjunctive testing with cardiac magnetic resonance imaging, exercise testing, or ambulatory rhythm monitoring should be based on the clinical course and initial testing. With no symptoms and no objective evidence of cardiac involvement, a return-to-exercise training with close clinical follow-up would be reasonable. If testing suggests cardiac involvement, return to play should be based on myocarditis return-to-play guidelines.”
As you can see, COVID-19 has an insidious side that we’re only beginning to understand, especially with respect to the athlete.


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