key: cord-1053536-pqpssqr7
authors: Elliott, Niall; Martin, Rhodri; Heron, Neil; Elliott, Jonathan; Grimstead, Dan; Biswas, Anita
title: Infographic. Graduated return to play guidance following COVID-19 infection
date: 2020-06-22
journal: Br J Sports Med
DOI: 10.1136/bjsports-2020-102637
sha: f7454e430b20ad36a097a80c2d56dab0f5dc638c
doc_id: 1053536
cord_uid: pqpssqr7

nan

Niall Elliott , 1,2 Rhodri Martin, 3, 4 Neil Heron, 5, 6 Jonathan Elliott , 7 Dan Grimstead, 3 Anita Biswas 8

With risk of cardiological, renal, respiratory and haematological complications, [1] [2] [3] [4] [5] it is best practice to follow steady resumption of training, paying attention to physical and psychological factors after COVID-19 infection.

This guidance takes into account public health guidelines in the UK (although we hope its content is relevant more widely) and available expert opinion at time of publication and is for use by healthcare practitioners. It is applicable to performance athletes who have had mild to moderate illness. Those requiring hospital admission merit further assessment.

If an athlete develops an illness with symptoms of COVID-19, they should follow national guidance, speak to their sports medicine doctor, and undertake appropriate quarantine, testing and tracing.

They should maintain good hydration, a balanced diet and, if symptoms worsen or persist beyond 7 days, seek further medical review.

Quarantine when living with others includes practical aspects such as isolating within rooms not accessed by other persons, maintaining supplies of food and water, use of a different toilet and washing dirty linen and clothes regularly.

A GRTP is a progressive programme that introduces physical activity and sport in a stepwise fashion.

Key considerations ► Before considering GRTP, the athlete must be able to complete activities of daily living and walk 500 m on the flat without excessive fatigue or breathlessness. ► They should have at least 10 days' rest and be 7 days symptom-free before starting. ► Less aerobically intense sports like golf may progress quicker. Experience suggests that some athletes take over 3 weeks to recover. Some monitoring may add value, which could includes ► Resting heart rate. ► Rated perceived exertion. ► Sleep, stress, fatigue and muscle soreness. ► Injury-Psychological Readiness to Return to Sport. If any symptoms occur (including excessive fatigue) while going through GRTP, the athlete must return to the previous stage and progress again after a minimum of 24 hours' period of rest without symptoms.

Athletes diagnosed with COVID-19 and who have medical conditions such as diabetes, cardiovascular disease or renal disease should have a medical assessment before commencing GRTP.

Athletes who have a complicated or prolonged COVID-19 illness may need further investigations, including Infographic ► Blood testing for markers of inflammation (high sensitivity-Troponin, Brain Natriuretic Peptide and C reactive protein). 3 

British thoracic Society guidance on venous thromboembolic disease in patients with COVID-19 British thoracic Society pulmonary vascular specialist Advisory

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Exercise in the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) era: A Question and Answer session with the experts Endorsed by the section of Sports Cardiology & Exercise of the European Association of Preventive Cardiology (EAPC)

The resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes

Respiratory health in athletes; facing the COVID-19 challenge. The Lancet