Physical activities

AAP updates guidelines for returning to sports and physical activity

As pandemic restrictions loosen and young athletes return to the fields, courts, tracks and rinks, medics are sharing ways to help them return to sport safely.

This means taking action to prevent COVID-19.

It also means trying to avoid sports-related injuries, which may be more likely if young athletes weren’t moving as much during the pandemic.

For eligible teens, getting the COVID-19 vaccine may be the most important thing they can do, according to the American Academy of Pediatrics (AAP).

“The AAP encourages everyone who is eligible to receive the COVID-19 vaccine as soon as it becomes available,” the organization wrote in updated guidelines on returning to sport and physical activity.

“I don’t think one can overstate the importance of these vaccines, both for the individual and at the community level,” says Aaron L. Baggish, MD, associate professor of medicine at Harvard Medical School and director of the Cardiovascular Performance Program at Massachusetts General Hospital in Boston.

Baggish, a cardiologist for the New England Patriots, Boston Bruins, New England Revolution, American men’s and women’s football, and US rowing, as well as the medical director of the Boston Marathon, has studied the effects of COVID- 19 on Heart in College Athletes and written return-to-play recommendations for school-aged and older athletes.

“Millions of people have received these vaccines from the age of 12,” Baggish said. “The efficacy continues to seem very long-lasting and almost complete, and the risk associated with vaccination is incredibly low, to the point that the risk-benefit ratio across the age spectrum, whether you are athletic or not, strongly favors the vaccination. There really is no reason to wait at this point. “

While outdoor activities pose a lower risk of the spread of COVID-19 and many people have been vaccinated, masks should still be worn in some settings, notes the AAP.

“Overcrowded indoor spaces still pose a high risk of COVID-19 transmission. And we recognize that not everyone in these settings may be vaccinated, ”says Susannah Briskin, MD, lead author of the AAP Guide.

“So for sporting events indoors with spectators, in locker rooms or other small spaces such as a training hall, and when traveling by shared car or school transport to and from the events, the individuals must continue to mask themselves, ”adds Briskin, a pediatrician in the division. of Sports Medicine and Fellowship Director for the Primary Care Sports Medicine Program at Rainbow Babies & Children’s Hospital Teaching Hospitals.

For outdoor sports, athletes who are not fully immunized should be encouraged to wear masks on the sidelines and during group practice and competition when within 3 feet of others for an extended period of time. , according to the AAP.

Resume exercise gradually

In general, athletes who haven’t been active for more than a month should resume exercise gradually, says Briskin. Starting at 25% of normal volume and increasing slowly over time – with increases of 10% each week – is a rule of thumb.

“Those who have taken an extended break from sport are at a higher risk of injury upon return,” she notes. “Families should also be aware of the increased risk of heat-related illness if they are not acclimatized. “

Caitlyn Mooney, MD, team physician at the University of Texas at San Antonio, has heard reports of doctors seeing more injuries as stress fractures. Some cases may involve people who go from “months of doing nothing to suddenly returning to sport,” says Mooney, who is also a clinical assistant professor of pediatrics and orthopedics at UT Health San Antonio.

“Coaches, parents and the athletes themselves really have to keep in mind that this isn’t like a regular season,” Mooney said. She suggests gradually increasing activity and paying attention to any pain. “It’s a good indicator that you may be going too fast,” she adds.

Athletes should also be on the lookout for other symptoms when they resume exercise, especially after illness.

It is “very important that any athlete who has recently contracted COVID-19 watch for new symptoms when they return to exercise,” says Jonathan Drezner, MD, professor of family medicine at the University of Washington in Seattle. “You can expect some fatigue from de-training, but chest pain on exertion warrants further evaluation.”

Drezner – editor-in-chief of British Journal of Sports Medicine and Seattle Seahawks team doctor – along with Baggish and colleagues found a low prevalence of cardiac involvement in a study of more than 3,000 college athletes who had previously been infected with SARS-CoV-2.

“Any athlete, despite the initial course of their symptoms, who exhibits cardiopulmonary symptoms upon return from exercise, especially chest pain, should see their doctor for a complete cardiac evaluation,” Drezner said. “Cardiac MRI should be reserved for athletes with abnormal tests or when clinical suspicion of myocardial involvement is high.”

If an athlete had COVID-19 with moderate symptoms (like fever, chills, or flu-like syndrome) or cardiopulmonary symptoms (like chest pain or shortness of breath), heart tests should be considered, note he does.

These symptoms “were associated with a higher prevalence of heart damage,” Drezner said in an email. “Tests may include an ECG, echocardiogram (ultrasound), and troponin (blood test).”

For children who test positive for SARS-CoV-2 but have no symptoms, or whose symptoms last less than 4 days, a phone call or telemedicine visit with their doctor may be enough to clear them to play, says Briskin , who is also an assistant professor of pediatrics at Case Western Reserve University School of Medicine.

“This will allow the doctor to screen for any worrying cardiac signs or symptoms, update the electronic medical record of the patient with the recent COVID-19 infection and provide appropriate advice to resume exercise,” she adds. .

Baggish, Briskin, Mooney and Drezner had no relevant financial disclosure.

For more news, follow Medscape on Facebook, Twitter, Instagram and YouTube.