For over two years now, the SARS-CoV (Covid) pandemic has not only affected social coexistence around the world. The world of sport, and in particular soccer as a team sport, also suffered from the exponential spread of the virus.
Empty Bundesliga stadiums, suspensions of training and gaming operations (especially in the amateur sector) and a resulting “corona hole” were the consequences. Over the summer, things have returned to normal in the German leagues and clubs — the stadiums are full and we can finally enjoy our beloved sport to the fullest again.
However, if you are one of those who have already been through a Covid infection, you've probably also experienced that the first training sessions and games can take a lot of breath.
In the weeks following the infection, many people who have recovered suffer from reduced endurance, resulting in heavy legs and in some cases even shortness of breath or cardiovascular weakness.
It's no wonder! In most cases, the ambitious soccer players are back on the pitch at the end of the quarantine and chase the round leather in full sprint.
But they not only play with the ball, but also with their health. Experts unanimously advise against starting sports again too soon after surviving the infection.
In this article, we have summarized the current state of science for you and, based on this, provide you with a Return-to-Sports guideline, i.e. a recommendation for safe return to sport.
The current symptoms and progression are relevant for returning to training and competition.
Symptoms of a mild form include no or very slight fever (<38.5°C), mild cough, sore throat, mild feeling of illness and discomfort. Mild cold ≤3 days is considered symptom-free. If it lasts longer, it is considered a mild symptom.
Symptoms include severe illness (fatigue symptoms), shortness of breath at rest, higher fever (fever > 38.5°C) as well as headache, muscle, joint and body pain, nausea or diarrhea. Prolonged cough ≥ 3 days is also considered a moderate symptom.
Severe cases are characterized by the need for hospitalization due to COVID-19 and intensive care.
In addition, it can be helpful to better quantify and assess fitness for training and competition if athletes rate their well-being according to subjective resilience, sleep quality, symptoms of fatigue and feeling ill.
Depending on the severity of the course, the return-to-sports protocol differs. Below you will find recommendations on how the comeback should be structured according to the respective course of action.
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If the SARS-CoV-2 infection is asymptomatic, a three-day break from exercise after the time of diagnosis is recommended. Loads reduced in scope and intensity are possible in individual cases.
If the course is mild, it is recommended to take a break from exercise during persistent symptoms and for three consecutive symptom-free days. After three consecutive days without specific symptoms, reduced intensity and intensity can be resumed without medical diagnosis. The further increase in stress is carried out individually and taking into account possible symptoms and the individual stress response.
If symptoms occur when returning to training under stress or even at rest, the exercise should be paused, a doctor should be consulted and, if necessary, a specific diagnosis should be carried out.
Competitions, i.e. maximum stress, are possible after a total of 10 consecutive symptom-free days, inconspicuous load buildup and subjectively symptom-free resilience. An earlier start in competition activities is only recommended after careful medical examination.
If the course of the disease is moderate or severe, medical diagnosis is recommended in any case after symptoms have subsided to make informed decisions before returning to sport. This diagnosis should include a specific medical history, physical examination, laboratory tests, and a resting ECG. After severe cases, an individual specific diagnosis is necessary.
For heart symptoms (e.g. heart stumbling or palpitations), in addition to rest, a stress ECG, echocardiography, long-term ECG and the determination of NT-pro-BNP and troponin are recommended.
Pulmonary function diagnostics should only be carried out for specific symptoms such as bronchial constriction or shortness of breath at rest and during exercise. If symptoms persist, including persistent tiredness and exercise intolerance, a more comprehensive medical examination is recommended before sports approval.
These recommendations are intended to reduce and avoid your health risk due to physical stress following a SARS-CoV-2 infection. Take care of your body, because it is your asset — not just on the soccer field.
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