Returning to Sport after COVID
By: Martha Theirl, PT, DPT, Cert-CFMA
With COVID-19 cases on the rise all around us, it seems inevitable that yourself or someone you know will contract the virus. Below is a brief review of the current literature on the after effects of COVID and returning to exercise. We also discuss guidance endorsed from the American College of Cardiology Sports and Exercise Cardiology Section from Drs. Phalen and Kim.
As always, this article is meant to be educational content and not medical advice. Please consult your medical professional before starting an exercise program or for individualized guidance.
In summary: You may need to meet with a cardiologist if there is suspected heart involvement.¹ High intensity exercise done regularly looks to be correlated with a lower hospitalization rate if you contract COVID-19.² If you are an athlete or highly active adult and you are recovering from COVID-19 looking to return to sport and activity, current guidance is based on severity of symptoms.⁴ The more severe the symptoms, the slower and more monitored your return should be. Most young athletes look to be mainly asymptomatic and recover well from COVID-19. As we watch the development of COVID-19 over the next few years we will have an even better understanding of how we adapt and overcome this disease. Looking for some breathing exercises you can do to create resilience? Check out our blog post here.
High Intensity Exercise May Decrease your Chance of being Hospitalized due to COVID-19
In a recent study published by Brawner et. Al², they looked at almost 1200 patients who had been stress tested prior to the COVID-19 pandemic, and subsequently, 246 of them tested positive for COVID-19 (21%). They found that the fitter the individual, as dictated by higher metabolic equivalent of task (MET) capacity had a significantly lower risk of hospitalization than those with lower MET scores (6.7 MET in hospitalized patients vs 8.0 MET in non-hosptialized).
What is MET and how does it work?³ It’s a ratio of your working metabolic rate vs your resting metabolic rate. One MET is your resting metabolic rate. A MET of 7 means you’re using 7 times the energy you would at rest. Brisk walking is about 4 METs, jumping rope is about a MET of 12.
It’s important to note that there was no MET difference in contraction of COVID-19. This doesn’t mean that you’re less likely to get the virus if exposed. There was also no MET difference in severe vs non-severe illness. So if you get COVID, being fitter doesn’t necessarily mean you won’t get extremely sick. Those who were hospitalized tended to be older with comorbidities such as hypertension, diabetes mellitus, coronary heart disease, chronic kidney disease, and heart failure.
For every MET higher you score on the stress test, you are 13% less likely to be hospitalized, according to the study! This is exciting news for those who exercise regularly and at higher intensities.
COVID Positive: now what?
Don’t panic! Speak with your medical professionals about your symptoms, quarantine or report to the hospital as necessary, participate in any contact tracing, and monitor and report your symptoms, especially if they worsen.
COVID and heart function
In one of the first studies of its kind, a team from Frankfurt, Germany looked at 100 age and risk-factor matched patients who tested positive for COVID-19 and their heart function.¹ They found that 78% of patients with a history of a COVID positive test had cardiovascular involvement and 60% demonstrated persistent inflammation of the heart tissue. This was regardless of symptom severity and risk factors.¹
Even if you have mild symptoms, the data indicates increased stress to the heart either by inflammation or elevated stress markers for up to 3 months post infection. This impacts the way that we return to exercise and sports, and may involve other people in your care team such as a cardiologist.
It’s important to know that these are early days in the exploration of recovery from COVID-19. As we get more information, further patterns may emerge that agree or disagree with these findings. They did not look at anyone younger than 18 years old (average age was 49) nor do the findings go out beyond 3 months post positive test. We also don’t know how fit these individuals were beforehand, or if they participated in exercise 1-2 days before cardiac testing. Since exercise in general, such as 30 minutes of moderate jogging, can elevate some of the cardiac markers they examined, therefore we may not see the whole picture of heart recovery after COVID. It’s still vital to consider the impact of COVID-19 on the heart as you resume exercise.
Recommendations for Return to sport
Research is beginning to emerge regarding athletes and return to sport following a COVID-19 positive diagnosis. Phelen et Al regard athletes as a competitive athlete and highly active person (this includes masters athletes and those who exercise regularly at higher intensities).
So here’s the deal:
It’s important to pay attention to how your symptoms respond over time. Didn’t have any? Great, proceed with caution and monitor for any worsening/changing symptoms with your medical team.
Have symptoms? Monitor closely! Work with your care team to determine if cardiac testing is advised for you, and when medically cleared, the return will be slow and measured. It is not advised to jump back into high intensity exercise, but have a measured and graded plan that gradually exposes you to more intense exercise. Keeping a watchful eye on your symptoms and open communication with your care team is paramount in your return to sport.
Below is a flow chart designed by Phelen et Al⁴ to help guide you! I’ve adapted it to fit this formatting. As we learn more, we will continue to update the literature and help those affected by COVID-19 resume the normal activities as safely as possible! If you have any questions, please don’t hesitate to ask! Email martha@q4pt.com or set up a consultation or evaluation online here!
References:
Putmann VO, Carej L, Wieters I, Fahmi M, Arendt C, Hoffmann J, Shchendrygina A, Escher F, Vasa-Nicotera M, Zeiher A, Vehreschild M, Nagel E. Outcomes of Cariovascular Magnetic Resonance Imaging in Patients Recently Recovered from Coronovirus 19 (COVID-19). JAMA Cardiol. E-pub ahead of print July 27 2020. Doi: 10.1001/jamacardio.2020.3557.
Brawner CA, Ehrman JK, Bole S, Kerrigan DJ, Parikh SS, Lewis BK, Gindi RM, Keteyian C, Abdul-Nour K, Keteyian SJ, Maximal Exercise Capacity is Inversely Related to Hospitalization Secondary to Coronavirus Disease 2019, Mayo Clinic Proceedings (2020), doi: https:// doi.org/10.1016/j.mayocp.2020.10.003.
Roland J, Bubnis D. What exactly are METs, and what should you know about them?. Healthline. October 21 2019. Accessed November 1 2020. https://www.healthline.com/health/what-are-mets
Phelan D, Kim JH, Chung EH. A Game Plan for the Resumption of Sport and Exercise After Coronovirus Disease 2019 (COVID-19) Infection. JAMA Cardiology 2020; 5(10).
