344 LöllgenH, e al. B J Spo s Med Ma ch 2021 Vol 55 No 6
In og aphic. Clinical ecommenda ions o e u n o play
du ing he COVID-19pandemic
He be Löllgen,1,2 No be Bachl,1,3,4,5 Theodo a Papadopoulou,1,3,6,7 And ew Sha ik,7 G aham Holloway,7
Ka in Vonbank,8 Nigel Edwa d Jones,7,9 Xa ie Biga d,1,10 Da id Niede see ,11 Joachim Meye ,12,13
Bo ja Muniz- Pa dos,14 And e Deb uyne,1,3 Pe a Zupe ,1,15 Jü gen M S einacke ,1,3,16 Be nd Wol a h,3,17
James Lee John Bilzon ,3,7,18 Anca Ionescu,1,19 Michiko Dohi ,3,20 Je oen Swa ,3,21
Vic o iya Bad ie a,3,22,23 I ina Zelenko a,14,22 Mau izio Casasco,1,3,24 Michael Geis linge ,3,25 Luigi Di Luigi,3,26
Nick Webbo n,27 Pa ick Single on,28 Mike Mille ,28 Fabio Pigozzi,1,3,29,30 Yannis P Pi siladis 1,3,31
In og aphic
COVID-19 AND RETURN TO PLAY
The wo ld o spo has ecen ly e u ned
o aining and compe i ion ollowing
suspension due o he COVID-19
pandemic. I is conce ning ha a numbe
o a hle es ha e es ed posi i e o
COVID-19 a e e u ning o compe i-
ion.1 Nume ous au ho s ha e a emp ed
o add ess e u n o play gi en he impo -
ance and complexi y o he issue, wi h
no able a en ion on possible ca diac
implica ions.2–6
SCOPE OF THE INFOGRAPHIC
The speci ic ecommenda ions shown in
he p esen in og aphic ( igu e 1) ha e
been gene a ed by a panel o in e na-
ional expe s and ep esen a compila-
ion o he nume ous app oaches used
o in o m esump ion o egula spo s
du ing he COVID-19 pandemic. Despi e
he di e en egula ions a ound he wo ld
and he pa icula cha ac e is ics o each
spo , i is essen ial o p o ide in o ma-
i e, consis en and speci ic guidance o
sa e e u n o aining and compe i ion a
his mos di icul ime.
RECOMMENDATIONS
COVID-19 is a sys emic disease a ec ing
he endo helium and all o gans, especially
he hea and lungs wi h mo e se e i y
and clinical signi icance. The e o e, ou
ecommenda ions o sa e e u n o spo
a e based on a comp ehensi e clinical
e alua ion (ie, ca diac and espi a o y)
and ha e been designed o six di e en
g oups acco ding o he le el o exposu e
o COVID-19. These g oups a e based on
a p e ious epo by Phelan e al,3 which
a e applicable o bo h leisu e ime and
p o essional a hle es. I is impe a i e ha
g oup alloca ion is de e mined be o ehand
h ough a medical examina ion pe o med
in coope a ion wi h a espi a o y physi-
cian and/o ca diologis . Speci ic ecom-
menda ions o each g oup a e p o ided
based on cu en e idence and expe
opinion (see able 1).
SPECIAL CONSIDERATIONS
The esump ion o spo ing ac i i y
should be de e mined on a case- by-
case basis and conside he indi idual
si ua ion o he a hle e, including p e-
exis ing condi ions, as well as he ype
o spo and he isk o in ec ion om
o he a hle es (eg, inc eased isk in
con ac / eam spo s). Ideally, he inal
decision o e u n o play will be based
on he esul s o he indi idual assess-
men in consul a ion wi h he spo and
exe cise medicine physician, special-
is s in pulmona y medicine and spo
Figu e 1 Recommenda ions o e u n o spo du ing he COVID-19 pandemic. BNP, b ain
na iu e ic pep ide; CRP, C- eac i e p o ein.
P o ec ed by copy igh . on Ma ch 3, 2021 a Uni e sidad de Za agoza. Biblio eca.h p://bjsm.bmj.com/B J Spo s Med: i s published as 10.1136/bjspo s-2020-102985 on 3 Sep embe 2020. Downloaded om
345
LöllgenH, e al. B J Spo s Med Ma ch 2021 Vol 55 No 6
In og aphic
ca diologis s (o ex ended mul idis-
ciplina y eam), coaches and aining
specialis s. A e a p olonged pe iod
o in e up ion in spo caused by
mo e se e e heal h issues, inc emen s
in aining should be g adual, indi-
idualised and supe ised by pe iodic
moni o ing o ca diac and espi a o y
ma ke s o de ec po en ial signs and
symp oms. Al hough he p esen ecom-
menda ions a e ocused p ima ily on
pulmona y and ca diac assessmen s,
gi en he wide heal h- ela ed issues
caused by COVID-19, mo e comp e-
hensi e e alua ion including psycho-
logical s a us, examina ion o muscula
unc ion and o he suspec ed colla e al
issues should be conside ed o p o ide
mo e de ailed and ho ough in o ma-
ion o sa e e u n o play.
FURTHER ESSENTIAL READING
Fo mo e de ailed desc ip ion o he
isk ac o s and symp oms ha could
in o m he decision o e u n o spo
as sa ely as possible, consul Baggish
e al,5 Ca mody e al7 and Niess e al.8
1Eu opean Fede a ion o Spo s Medicine Associa ions
(EFSMA), Lausanne, Swi ze land
2Ca diology P ac ice, Remscheid, Ge many
3In e na ional Fede a ion o Spo s Medicine (FIMS),
Lausanne, Swi ze land
4Ins i u e o Spo s Science, Uni e si y o Vienna,
Vienna, Aus ia
5Aus ian Ins i u e o Spo s Medicine, Vienna, Aus ia
6Lowe Limbs- ADMR Hip & G oin, De ence Medical
Rehabili a ion Cen e Headley Cou , Loughbo ough ,
UK
7B i ish Associa ion o Spo and Exe cise Medicine,
Doncas e , UK
8Depa men o Pulmology, Medical Uni e si y o
Vienna, Vienna, Aus ia
9Uni e si y o Li e pool, Li e pool, UK
10Union Cyclis e In e na ionale (UCI), Aigle, Swi ze land
11Depa men o Ca diology, Uni e si y Hea Cen e
Zu ich, Zu ich, Swi ze land
12Ge man Respi a o y Socie y (DGP), Be lin, Ge many
13Lungenzen um (Bogenhausen- Ha laching), München
Klinik, Munich, Ge many
14GENUD (G ow h, Exe cise, Nu i ion and
De elopmen ), Depa men o Physia y and Nu sing,
Uni e si y o Za agoza, Za agoza, Spain
15Ins i u e o Medicine and Spo , Ljubljana, Slo enia
16Di ision o Spo s and Rehabili a ion Medicine, Ulm
Uni e si y Hospi al, Ulm, Ge many
17Depa men o Spo Medicine, Humbold Uni e si y
and Cha i é Uni e si y School o Medicine, Be lin,
Ge many
18Depa men o Heal h, Uni e si y o Ba h, Ba h, UK
19Spo s Medicine, "Ca ol Da ila" Uni e si y o
Medicine, Bucha es , Romania
20Spo Medical Cen e , Japan Ins i u e o Spo s
Sciences, Tokyo, Japan
21UCT Resea ch Uni o Exe cise Science and Spo s
Medicine, Uni e sis y o Cape Town, Cape Town, Sou h
A ica
22I.M. Secheno Fi s Moscow S a e Medical Uni e si y
(Secheno Uni e si y), Minis y o Heal h o Russia,
Moscow, Russian Fede a ion
23Moscow Resea ch and P ac ical Cen e o Medical
Rehabili a ion, Res o a i e and Spo s Medicine,
Moscow Heal hca e Depa men , Moscow, Russian
Fede a ion
24I alian Fede a ion o Spo s Medicine (FMSI), Rome,
I aly
25Depa men o Public, In e na ional and Eu opean
Law, Uni o In e na ional Law, Uni e si y o Salzbu g,
Salzbu g, Aus ia
26Mo emen , Human and Heal h Sciences, Uni e si y o
Rome Fo o I alico, Rome, I aly
27School o Spo and Se ice Managemen , Uni e si y
o B igh on, Eas bou ne, UK
28Wo ld Olympians Associa ion, Lausanne, Swi ze land
29Spo s Medicine Uni , Uni e si y o Rome Fo o I alico,
Rome, I aly
30FIFA Medical Cen e o Excellence, Villa S ua Spo
Clinic, Rome, I aly
31Collabo a ing Cen e o Spo s Medicine, Uni e si y o
B igh on, Eas bou ne, UK
Co espondence o P o esso Yannis P Pi siladis,
Collabo a ing Cen e o Spo s Medicine, Uni e si y o
B igh on, Eas bou ne BN20 7SN, UK;
Y. Pi siladis@ B igh on. ac. uk
Co ec ion no ice This a icle has been co ec ed
since i published Online Fi s . Re 8 has been co ec ed.
Twi e Theodo a Papadopoulou @Do a_Spo med,
James Lee John Bilzon @JBilzon, Michiko Dohi @ insho
and Pa ick Single on @PSingle on33
Con ibu o s All au ho s con ibu ed signi ican ly
and in line wi h he ins uc ions o au ho s o me i
publica ion.
Funding The au ho s ha e no decla ed a speci ic
g an o his esea ch om any unding agency in he
public, comme cial o no - o - p o i sec o s.
Compe ing in e es s None decla ed.
Pa ien consen o publica ion No equi ed.
P o enance and pee e iew No commissioned;
ex e nally pee e iewed.
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acco dance wi h BMJ’s websi e e ms and condi ions
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To ci e LöllgenH, BachlN, PapadopoulouT, e al.
B J Spo s Med 2021;55:344–345.
Accep ed 22 Augus 2020
Published Online Fi s 3Sep embe 2020
B J Spo s Med 2021;55:344–345.
doi:10.1136/bjspo s-2020-102985
ORCID iDs
Da idNiede see h p:// o cid. o g/ 0000- 0003- 3089-
1222
Jü gen MS einacke h p:// o cid. o g/ 0000- 0001- 6210-
2449
James Lee JohnBilzon h p:// o cid. o g/ 0000- 0002-
6701- 7603
MichikoDohi h p:// o cid. o g/ 0000- 0002- 1126- 7849
Yannis PPi siladis h p:// o cid. o g/ 0000- 0001- 6210-
2449
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1 Fulle R. No ak Djoko ic mus ’ eel esponsibili y’ a
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esump ion o spo and exe cise a e co ona i us
disease 2019 (COVID-19) in ec ion. JAMA Ca diol 2020.
doi:10.1001/jamaca dio.2020.2136. [Epub ahead o
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ac i i y a e COVID-19 pandemic. A ailable:
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Table 1 Clinical ecommenda ions o es ing indi idual g oups
Recommenda ions
G oups
123456
Tes ed andomly o by inding an ibodies. Only possible PPE o s anda d exam X
Need o usual check- up including ECG and echo X
Tes ed ollowing con ac wi h somebody who was posi i e o es ed because ha ing ypical signs
and symp oms and ou o hospi al ea men
X
In- hospi al ea men bu qua an ine a home XX
Fo diagnosis only X
T ea men wi h close moni o ing due o symp oms bu no mal wa d wi h isola ion and qua an ine X
Need ho ough p epa icipa ion exam, CPET, echo and o he necessa y assessmen s XX
Se ious illness wi h di icul p og ession and in ensi e ca e uni wi hou a i icial en ila ion X X
A i icial en ila ion X
Need ho ough examina ion be o e discha ge (eg, MRI) X X
CPET, ca diopulmona y exe cise es ing; PPE, p e- pa icipa ion e alua ion.
P o ec ed by copy igh . on Ma ch 3, 2021 a Uni e sidad de Za agoza. Biblio eca.h p://bjsm.bmj.com/B J Spo s Med: i s published as 10.1136/bjspo s-2020-102985 on 3 Sep embe 2020. Downloaded om