With Victoria’s case numbers of COVID-19 still so high, many of us will have either contracted it ourselves or know someone who has. So, what happens after you are no longer infectious and you are looking to get back into sport or your regular activity?

After spending at least a week being relatively sedentary, many of us will want to jump straight back into our regular training regimes to minimise strength and fitness losses. However, this comes with associated risk. Many athletes have reported ongoing symptoms for weeks or even months after covid. Complaints of shortness of breath, dizziness, rapid heart rates, chest pain and general fatigue are all symptoms which while often reported are serious and should not be ignored.

COVID-19 affects many of our bodies systems including cardiac (heart), pulmonary (lunges), renal (kidneys) and gastrointestinal (digestive). Even once we are no longer infectious, these systems can take some time to recover. It is therefore important that we take a graduated approach to returning to sport to reduce the risk of longer-term complications.

The amount of time to return to sport is also going to depend on the sport being participated in and the demands involved. For example, returning to a walking sport such as golf may occur sooner than return to a running sport. Any sport that naturally requires a greater workload and higher demand on the cardiorespiratory system will be more difficult to return to post-infection than lower intensity activities. Therefore, it is a good idea to start with low intensity activities such as walking, yoga or golf before recommencing higher intensity activities such as running or swimming.

Return to sport should not be attempted until you are completely symptom free. In fact, it has been recommended that you should be at least 7 days symptom free and at least 10 days after symptom onset before returning to sport. Once this milestone is reached, activity should be recommenced very slowly. The recommended starting point is 15 minutes of light activity under 70% of maximum heart rate, if no issues then progressing by adding 15 minutes at a time and slowly increasing the intensity may be attempted. Full normal training should not be attempted before day 17 at the earliest assuming you have been completely symptom free throughout the process. For a more specific program designed for athletes, see the below infographic (Elliott et al., 2020).

It has been estimated that in most athletes without comorbidities, ongoing respiratory symptoms should gradually resolve within 4 weeks of infection. If this is not the case and symptoms are not improving or are worsening, it is important to get a full medical check up to assess your lung function.

Athletes with excessive fatigue have been shown to have a 70% lower chance of return to sport within 40 days when compared to athletes without excessive fatigue following COVID-19. If you are experiencing excessive fatigue, it is worth considering that it may take you longer than you were anticipating to return to sport.

It is important to note that the safest option is to have a review with your GP before attempting to return to sport. They will be able to assess your heart and lung function and advise whether you will be safe to gradually return. Once medically cleared, physiotherapists or exercise physiologists can advise you around gradual return to sport programs. It is important to consider that you will need to ease back in not purely from a cardiorespiratory point of view but also from a muscular one. After a sustained period of illness you may be at increased risk of injury. For further information on returning to sport after a hiatus see CSSM physio Hugh Feary’s latest blog.

About the author

CSSM physio Sally Lynch enjoys all aspects of physiotherapy but has a particular interest in the musculoskeletal side of the profession. Sally studied at Charles Sturt University in Albury before moving to Melbourne to play for Collingwood in the VFLW in 2019. She loves challenging the perception that women’s bodies aren’t designed for contact sports like football and encourages women and girls to show that they are strong, athletic and capable.

References

Elliott, N., Martin, R., Heron, N., Elliott, J., Grimstead, D., & Biswas, A. (2020). Infographic. Graduated return to play guidance following COVID-19 infection. British Journal Of Sports Medicine, 54(19), 1174-1175. doi: 10.1136/bjsports-2020-102637

Löllgen, H., Bachl, N., Papadopoulou, T., Shafik, A., Holloway, G., & Vonbank, K. et al. (2020). Infographic. Clinical recommendations for return to play during the COVID-19 pandemic. British Journal Of Sports Medicine, 55(6), 344-345. doi: 10.1136/bjsports-2020-102985

Schwellnus, M., Sewry, N., Snyders, C., Kaulback, K., Wood, P., & Seocharan, I. et al. (2021). Symptom cluster is associated with prolonged return-to-play in symptomatic athletes with acute respiratory illness (including COVID-19): a cross-sectional study—AWARE study I. British Journal Of Sports Medicine, 55(20), 1144-1152. doi: 10.1136/bjsports-2020-103782

Wilson, M., Hull, J., Rogers, J., Pollock, N., Dodd, M., & Haines, J. et al. (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), 1157-1161. doi:10.1136/bjsports-2020-102710