Return to Sports & Recreation after COVID-19
Updated: Apr 12, 2021
The COVID-19 pandemic has undoubtedly changed all of our lives over the past year. Thousands of people across the United States have contracted the virus. Many of these cases (estimated 80%) have been asymptomatic or mild in comparison to the approximately 15% of severe cases (requiring supplemental oxygen) and 5% critical (requiring mechanical ventilation).
The purpose of today's blog is to provide the most up-to-date information on the safe return to sports & recreation for those who have had COVID-19. Please note, guidelines will likely continue to change as further data is published and as we learn more about the effects of this virus.
Even in those who have tested positive for COVID-19, but have no symptoms, it is recommended to rest (avoid participation in moderate/vigorous exercise and sports) for 2 weeks. Should the individual continue to be asymptomatic, they may slowly return to full sport participation.
Those who develop COVID-19 and have mild to moderate symptoms (have not required hospitalization or supplemental oxygen) should refrain from activity for 2 weeks beyond their resolution of symptoms. Should there be any concern for cardiac involvement, medical testing should be performed before slowly returning to exercise.
Gradual activity resumption for either group should follow the 50/30/20/10 rule over a 4 week period (developed by the National Strength & Conditioning Association). The first week the athlete returns to activity, conditioning volume should be reduced by 50%. The second week the volume should be reduced 30% from normal exercise load, etc. This gradual return to activity is assuming that the individual is not experiencing any adverse response with the titration.
Individuals who had a severe case of COVID-19 should work closely with their medical staff before being cleared to return to competitive exercise or sports.
The reason behind the gradual return to exercise in all cases is due to the high inflammatory burden that COVID-19 carries. There have been multiple cases of myocarditis (inflammation of the heart) after COVID-19 infection, as well as DVT's (blood clots).
During the period of time that the individual is returning to exercise, they should work at or below 70% heart-rate maximum. The simple way to calculate this value is taking 220 minus your age multiplied by 0.7. For example, someone who is 30 years old would have a 70% heart rate maximum of 133 beats/minute.
It is also recommended that during the recovery period strength training should be performed between 70-80% of 1 rep max and no higher.
No matter what type of exercise the individual is participating in, constant monitoring of the cardiac system (by checking pulse rate) is encouraged. It is also recommended that the respiratory system is monitored during exercise by either checking SpO2 values and/or keeping the activity between a 3-4 on the Borg Breathlessness Scale. SpO2 values should remain above 95%, which can be checked using a finger pulse oximeter.
Direct links to the reference articles for this information include the following: