Infographic. Graduated return to play guidance following COVID-19 infection.

COVID-19 and sport

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

Scope of this infographic

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.

COVID-19 clinical guidance

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.

Graduated return to play (GRTP) protocol

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 with comorbidities

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.

Further assessments

Athletes who have a complicated or prolonged COVID-19 illness may need further investigations, including

Blood testing for markers of inflammation (high sensitivity-Troponin, Brain Natriuretic Peptide and C reactive protein).3 4

Cardiac monitoring (12-lead ECG, echocardiogram, exercise tolerance test and cardiac MRI).3 4

Respiratory function assessment (spirometry).

Renal and haematological monitoring.