Important information about returning to sports and exercise after having COVID-19

While recovering from COVID-19 it’s important to take it easy, even if you’ve had a light case of the disease. While most children, adolescents, and young adults recover from COVID-19 uneventfully, a very small percentage of young people develop cardiovascular complications that could make returning to sports and exercise dangerous. It’s impossible to predict during the acute infection who will develop late complications.

The AAP (American Academy of Pediatrics) recommends that all children, adolescents, and young adults consult their physician for a clearance after their isolation period is over, prior to returning to exercise and sports.

An exercise and sports clearance exam should be scheduled after the fever has been gone for over 24 hours (while NOT taking fever-reducing medication), AND at least 10 days after  COVID-19 was diagnosed.*

A physician cannot clear anyone for return to exercise and sports until after he or she is free of COVID-19 symptoms like cough, shortness of breath, and extreme fatigue.

It is vitally important that you let your doctor know if you are experiencing any symptoms of chest pain, shortness of breath, new or worsening heart palpitations (racing or irregular heartbeat), fainting, or any other new and persisting symptoms. 

Your return to Exercise and sports exam will include a thorough exam and history with a focus on the heart and lungs, measurement of key vital signs, and in some cases, an Electrocardiogram (ECG). Those who have had a severe case of COVID-19 or have new or persisting symptoms may need to be referred to a Cardiologist to get clearance.

Sports Clearance Questionnaire

When you come in for your exercise and sports clearance exam, please answer the following questions and bring this questionnaire with you:

In the past week, have you had any of the following?:

  • Chest Pain
  • Palpitations (Irregular Heartbeat or heart racing without exercising)
  • More than usual fatigue while doing activities of normal daily living
  • Shortness of breath out of proportion to your activity
  • Awakening with shortness of breath or trouble breathing (other than mild nasal symptoms due to nasal congestion)
  • Fainting or near-fainting
  • Worsening or unresolved COVID-19 symptoms, or new symptoms since having COVID-19

*If you had a very mild case of COVID-19, you currently have no symptoms, and you’ve had a sports clearance exam within a year, you may only need a telemedicine visit or phone interview. If you are symptom-free and you have already returned to sports no further action is required, but we would like to know you’re doing OK. Please let us know!

Protocol for gradual return to play after COVID-19

After you have been cleared by a physician to return to exercise and sports, make sure that you and your coaches and teammates monitor for chest pain, shortness of breath out of proportion to activity, heart palpitations (irregular heartbeat or racing heart not due to exercise), or fainting when returning to exercise. If any of these signs and/or symptoms occur, stop exercising and see a doctor. The AAP recommends another evaluation by a physician if these symptoms occur. Sports clearance is not a guarantee that symptoms won’t develop after return to exercise. While long-term complications of COVID-19 are very rare in young people, it is wise to be cautious but not worried.

An example of a gradual return to exercise and sports after clearance plan:

Day 1 and Day 2 – 15 minutes or less of light activity like walking, slow-paced jogging, stationary bike. NO resistance training.

Day 3 – 30 minutes or less: Faster-paced walking or running or cycling. Can add running drills. No resistance training.

Day 4 – 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 -60 minutes – Normal training activity – intensity no greater than 80% maximum heart rate.

Day 7 – Return to full activity/participation including contests or competition.

If symptoms of shortness of breath, chest pain, heart palpitations, fainting, or severe fatigue develop at any point during your return to exercise, stop the activity and see a doctor. While most people recovering from COVID-19 are back to their usual fitness level in several weeks, taking it slow is the right move, even if it means missing a competition or event.

Keep in mind that long-term heart and lung complications are not common in healthy young people, so don’t worry about developing them! If you feel preoccupied or overly worried about having complications from COVID-19, see your doctor or therapist.