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Background: There are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP)., Objective: To determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes with other ARI., Design: Cross-sectional descriptive study., Setting: Online survey., Participants: Athletes with confirmed/suspected COVID-19 (ARI COV ) (n=45) and athletes with other ARI (ARI OTH ) (n=39)., Methods: Participants recorded days to RTP and completed an online survey detailing ARI symptoms (number, type, severity and duration) in three categories: 'nose and throat ', 'chest and neck ' and 'whole body '. We report the association between symptoms and RTP (% chance over 40 days) and compare the days to RTP and symptoms (number, type, duration and severity) in ARI COV versus ARI OTH subgroups., Results: The symptom cluster associated with more prolonged RTP (lower chance over 40 days; %) (univariate analysis) was 'excessive fatigue ' (75%; p<0.0001), ' chills ' (65%; p=0.004), ' fever ' (64%; p=0.004), ' headache ' (56%; p=0.006), 'altered/loss sense of smell ' (51%; p=0.009), ' Chest pain/pressure ' (48%; p=0.033), ' difficulty in breathing ' (48%; p=0.022) and ' loss of appetite ' (47%; p=0.022). ' Excessive fatigue ' remained associated with prolonged RTP (p=0.0002) in a multiple model. Compared with ARI OTH , the ARI COV subgroup had more severe disease (greater number, more severe symptoms) and more days to RTP (p=0.0043)., Conclusion: Symptom clusters may be used by sport and exercise physicians to assist decision making for RTP in athletes with ARI (including COVID-19)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

SARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported. To (1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with a recent SARS-CoV-2 infection and (2) identify factors affecting exercise responses. Cross-sectional, experimental study. Male and female athletes (age = 24.2 ± 6.3 years) with a recent (< 28 days) SARS-CoV-2 infection (n = 72). A COVID-19 Recovery Clinic for athletes. Heart rate, SBP, and RPE were measured during submaximal exercise (modified Bruce protocol) at 10 to 28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, comorbidities, preinfection training variables, and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models. Heart rate, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (P =.0001). At stage 5 (10.1 metabolic equivalents), a higher HR and a higher SBP during exercise were associated with younger age (P =.0007) and increased body mass index (BMI; P =.009), respectively. Higher RPE during exercise was significantly associated with a greater number of whole-body (P =.006) and total number (P =.004) of symptoms during the acute phase of infection. A greater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes at 10 to 28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection, as this may indicate disease severity and be valuable for tracking progress, recovery, and return to sport. [ABSTRACT FROM AUTHOR]

Higher exercise heart rate (HR) and prolonged return-to-sport in athletes with SARS-CoV-2 infection are described, but the cardiovascular response to exercise during recovery is not understood. This prospective, cohort, experimental study with repeated measures evaluated the cardiovascular response to exercise over 16 weeks in athletes recovering from SARS-CoV-2 infection. Athletes (n = 82) completed 2–5 repeat assessments at regulated intervals over 16 weeks post-SARS-CoV-2 infection. Data from 287 assessments (submaximal exercise tests; Modified Bruce protocol) are included. HR (bpm), systolic blood pressure (SBP) (mmHg) and rating of perceived exertion (RPE) (Borg scale 6–20) were measured. Rates of change in HR, SBP and RPE over time are reported. Submaximal exercise HR, SBP and RPE decreased significantly over 16 weeks (p < 0.01). There was a steeper rate of decline for HR and RPE ≤30 days compared to >30 days after SARS-CoV-2 infection: HR at Stage 3: ≤30 days −0.53 (0.01); >30 days −0.06 (0.02) and Stage 5: ≤30 days −0.77 (0.12); >30 days −0.12 (0.02); RPE at Stage 3: ≤30 days −0.09 (0.02); >30 days −0.01 (0.0002) and Stage 5: ≤30 days −0.13 (0.02); >30 days −0.02 (0.004). The findings provide clinical recommendation for exercise prescription and monitoring RPE in response to exercise post-SARS-CoV-2 infection and contribute to the clinical understanding of recovery which can help manage athlete expectations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine factors predictive of prolonged return to training (RTT) in athletes with recent SARS-CoV-2 infection. Methods: This is a cross-sectional descriptive study. Athletes not vaccinated against COVID-19 (n = 207) with confirmed SARS-CoV-2 infection (predominantly ancestral virus and beta-variant) completed an online survey detailing the following factors: demographics (age and sex), level of sport participation, type of sport, comorbidity history and preinfection training (training hours 7 d preinfection), SARS-CoV-2 symptoms (26 in 3 categories; "nose and throat," "chest and neck," and "whole body"), and days to RTT. Main outcomes were hazard ratios (HR, 95% confidence interval) for athletes with versus without a factor, explored in univariate and multiple models. HR < 1 was predictive of prolonged RTT (reduced % chance of RTT after symptom onset). Significance was P < 0.05. Results: Age, level of sport participation, type of sport, and history of comorbidities were not predictors of prolonged RTT. Significant predictors of prolonged RTT (univariate model) were as follows (HR, 95% confidence interval): female (0.6, 0.4–0.9; P = 0.01), reduced training in the 7 d preinfection (1.03, 1.01–1.06; P = 0.003), presence of symptoms by anatomical region (any "chest and neck" [0.6, 0.4–0.8; P = 0.004] and any "whole body" [0.6, 0.4–0.9; P = 0.025]), and several specific symptoms. Multiple models show that the greater number of symptoms in each anatomical region (adjusted for training hours in the 7 d preinfection) was associated with prolonged RTT (P < 0.05). Conclusions: Reduced preinfection training hours and the number of acute infection symptoms may predict prolonged RTT in athletes with recent SARS-CoV-2. These data can assist physicians as well as athletes/coaches in planning and guiding RTT. Future studies can explore whether these variables can be used to predict time to return to full performance and classify severity of acute respiratory infection in athletes. [ABSTRACT FROM AUTHOR]