Return to sports after COVID-19 illness – UPDATED

COVID-19 continues to affect our lives and the lives of our children and teens. Thankfully, in children, the illness typically continues to be mild, without long term complications. One very rare complication of the COVID-19 virus is myocarditis (inflammation of the heart muscle). Though this only occurs in 0.5% to 3% of the pediatric population after a COVID-19 illness, it is still important not to miss. Most of the children diagnosed with myocarditis were either asymptomatic or mildly ill. For these reasons, it is important to do a physical exam in office where we can assess the heart and discuss possible symptoms of heart complications before returning to sports participation after COVID-19 illness.

Key points before your child/teen returns to physical activity/sports participation:

Before exercising, make sure it’s been 10 days since testing positive for COVID AND 10 days since symptoms have resolved
Come to the office for a physical exam 10 days or more after symptoms have resolved. During this visit we will discuss whether or not an EKG (heart exam) is needed before being allowed to exercise.
Once cleared in the office, start exercise gradually (see number 4 below) and watch for the following symptoms:

chest pain
shortness of breath more so than with a typical cold
new-onset heart palpitations (feeling like the heart is “beating funny”)
passing out (or feeling like he/she is about to pass out)

If any symptoms occur, stop exercise immediately and call our office

4. Follow a gradual return-to-play exercise progression

11 and younger: progress back to sports/PE according to his/her own tolerance, gradually playing/exercising a little more each day
12 years and older: follow the protocol or one similar below

Day 1 and Day 2 – (2 Days Minimum) – 15 minutes or less: Light activity (walking, jogging, stationary bike), intensity no greater than 70% of maximum heart rate. NO resistance training.

Day 3 – (1 Day Minimum) – 30 minutes or less: Add simple movement activities (eg. running drills) – intensity no greater than 80% of maximum heart rate.

Day 4 – (1 Day Minimum) – 45 minutes or less- Progress to more complex training – intensity no greater than 80% maximum heart rate. May add light resistance training.

Day 5 and Day 6 – (2 Days Minimum) – 60 minutes – Normal training activity – intensity no greater than 80% maximum heart rate.

Day 7 – Return to full activity/participation

REFERENCES

https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/