• Sharlene Matthieu

Sports & COVID-19: Clearance needed to exercise after an infection

Updated: Sep 6, 2021

This page has been updated on 9/6/21 to reflect the most current AAP recommendations.

It's been a tough year for us all, and seeing some classrooms and sports opportunities open up is very encouraging. While we want all of our patients to be active and have the chance to experience some of the pleasures of our pre-pandemic life, there are some precautions to be aware of.

Over the past 12 months, we have learned a lot about COVID-19:

  • It can affect multiple organs, not just the lungs. COVID-19 can damage the brain, the kidneys, and especially the heart.

  • This damage can occur even with mild or asymptomatic illness.

  • The effects can continue well past the acute illness.

  • Most children will recover from COVID-19 without ANY of these issues.

So what does this mean for your athlete? There is evidence that even for healthy student athletes with mild cases of COVID-19, some will go on to have heart problems. The most serious of these is myocarditis, which is fortunately very rare. Pericarditis, inflammation in the lining that surrounds the heart, was more commonly seen. As described by Dr. Partho Sengupta in Science News for Students (I highly recommend this article),

[Pericarditis] causes swelling and irritation of the sac surrounding your heart. It will give some people sharp chest pains. If left untreated, it can cause serious complications and perhaps permanent heart damage. That’s why sports doctors for years have warned that athletes who develop pericarditis should not return to play until it is gone.

While most children and teens who have had COVID-19 will be fine, screening to identify those with any remnant heart issues is important. That is why we will be following the American Academy of Pediatric's (AAP) recommendations for sports clearance after COVID-19 infection.

Asymptomatic or mild illness (<4 days of fever >100.4°F, <1 week of myalgia, chills, and lethargy)

  • A phone or telehealth visit is recommended to review quarantine guidelines, symptoms to monitor for, and the importance of not exercising while in quarantine.

  • Concerning symptoms include chest pain, shortness of breath, new-onset heart palpitations, or fainting.

  • If any of these symptoms occur, an in-office examination and possibly an EKG will be needed before returning to sports.

Moderate illness (≥4 days of fever >100.4°F, ≥1 week of myalgia, chills, or lethargy, or a non-ICU hospital stay and no evidence of multisystem inflammatory syndrome in children [MIS-C])

  • Office visit after symptoms have resolved and isolation is complete.

  • Physical examination and symptom screening will done.

  • An EKG will be ordered.

  • If there are any concerns, a referral to a cardiologist will be made.

  • If all the above are negative, then a gradual return to sports is started.

Severe illness (ICU stay and/or intubation) or MIS-C

  • No exercise for a minimum of 3 - 6 months

  • Clearance by cardiology before returning to sports.

Once your child has been cleared to return to physical activity and sports, and has no concerning symptoms doing daily tasks, the AAP recommends a gradual return to sports as outlined below.

What if you've already had sports clearance done? If your child has had a diagnosis of COVID-19 since then, it does mean another appointment and further screening. Call our office if you have any questions about these recommendations. Together, we can work towards a healthy future!

* 08/18/21 Update: The AAP now recommends cardiac screening for all patients with COVID-19, regardless of timing.