The ongoing COVID-19 pandemic has wrought havoc in all of our lives. Sporting teams and competitions have not been immune to this, as the sight of empty stands and endlessly changing fixtures will attest.

As we all get more used to ‘living with COVID-19’, most sporting competitions have been able to recommence in one form or another. At a community level this is vital for all the benefits that social sport brings: keeping people active and connected in an otherwise difficult time. But as things open up and more of us are exposed to the virus, care needs to be taken with returning to sport after COVID-19.

Anyone with a positive diagnosis of COVID-19 should follow the relevant local rules with regards to isolation, follow-up testing and notification of authorities. If they are unwell they should seek advice from their usual doctor or from emergency services as required. Once the person has recovered and completed the required period of isolation, there are some guidelines for a safe return to exercise.

1. If the person had very mild symptoms, such as less than 2 days of mild fever and common cold symptoms only, they should still rest from exercise for 7-10 days after testing positive. After that, they should recommence exercise gradually, and watch for any new or unusual symptoms with exercise. In this case, no special tests are recommended.
2. With more severe symptoms e.g. shortness of breath, chest pains, palpitations or more than 2 days of fevers or chills, more significant assessment is required. This also holds for people with pre-existing asthma or chronic fatigue. In this case, being seen by a doctor is strongly recommended. Depending on the symptoms, some tests may be suggested, such as blood tests for heart muscle inflammation, an ECG (heart rhythm trace) or echocardiograph (heart ultrasound). If these are normal and all symptoms have resolved, then a safe return to sport can be expected. People in this situation should still take it easy when restarting exercise. If any of these tests come back abnormal, further assessment and testing may be needed. A return to exercise should only be undertaken in consultation with appropriately qualified medical advice, such as a Sports Physician or a cardiologist (heart specialist).
3. Any new symptoms with exercise, especially chest pain, shortness of breath or palpitations, need to be assessed with blood tests and ECG or echo.
4. People with severe COVID-19 (i.e. needing hospitalisation) will also need a careful medical checkup before returning to activity. The return to exercise will need to be overseen by appropriate specialists

Coming back after a couple of weeks off can be enough to increase the risk of injury because of a loss of strength and fitness. Getting back into exercise will be great for the mental recovery from illness, but taking it easy will help the process go smoothly.