Post-COVID Return to Sports Assessment

Some children with COVID-19 develop issues with their heart that can make exercise dangerous. Therefore, the American Academy of Pediatrics (AAP) recommends that they refrain from exercise and athletics entirely until they are seen for a follow up evaluation with their physician. Your child cannot be cleared for sports until at least 10 days after their positive test. Their symptoms should be resolved or significantly improved prior to the appointment. During the post-infection evaluation, the physician will determine whether they are ready to return to play based on AAP guidelines. It is important to resume exercise GRADUALLY, watching carefully for symptoms of possible heart problems such as excessive fatigue, fainting, dizziness, shortness of breath, chest pain, palpitations or skipped beats. Should any such symptoms arise, the athlete should discontinue all exercise and contact their physician. The recommended sequence for returning to play is provided below.

The following progression was adapted from Elliott N, et al, infographic, British Journal of Sports Medicine, 2020:

Stage 1: 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.

Stage 2: 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.

Stage 3: 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.

Stage 4: Day 5 and Day 6 – (2 Days Minimum) – 60 minutes: Normal training activity – intensity no greater than 80% maximum heart rate.

Stage 5: Day 7 – Return to full activity/participation (i.e. contests/competitions).