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| Returning to Exercise After Recovery From Coronavirus | Returning to Exercise After Recovery From Coronavirus |
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| Is it OK to resume athletic training, even if you have gotten through a bout of Covid-19 or tested positive for coronavirus or suspect you might have been infected? Two new expert-consensus statements from pulmonologists and cardiologists, published separately in The Lancet and JAMA Cardiology, urge caution. | Is it OK to resume athletic training, even if you have gotten through a bout of Covid-19 or tested positive for coronavirus or suspect you might have been infected? Two new expert-consensus statements from pulmonologists and cardiologists, published separately in The Lancet and JAMA Cardiology, urge caution. |
| The new statements point out that the always-thorny issue of when injured or ill athletes can return to training is further complicated now, since the novel coronavirus is novel and much about its short- and long-term effects on the body remain unknown. So, the authors of the new statements lay out tentative evaluations and protocols that, ideally, ill or homebound athletes would complete before returning to strenuous exercise. They also highlight a few troubling symptoms that potentially could raise new concerns down the road. | The new statements point out that the always-thorny issue of when injured or ill athletes can return to training is further complicated now, since the novel coronavirus is novel and much about its short- and long-term effects on the body remain unknown. So, the authors of the new statements lay out tentative evaluations and protocols that, ideally, ill or homebound athletes would complete before returning to strenuous exercise. They also highlight a few troubling symptoms that potentially could raise new concerns down the road. |
| By now, of course, almost all of us recognize that fitness is no guarantee against Covid-19. Marathon runners, competitive cyclists, professional basketball players and other athletes are among the many who have tested positive for the virus, and some reportedly have developed severe illnesses. Untold numbers of other athletes may have been infected but asymptomatic and never realized they carried the virus. | By now, of course, almost all of us recognize that fitness is no guarantee against Covid-19. Marathon runners, competitive cyclists, professional basketball players and other athletes are among the many who have tested positive for the virus, and some reportedly have developed severe illnesses. Untold numbers of other athletes may have been infected but asymptomatic and never realized they carried the virus. |
| Many of these athletes might now feel ready to resume heavy training. But the usual return-to-play criteria for sick athletes probably do not apply to someone who has been infected with the coronavirus, says Dr. James Hull, a sports pulmonologist at Royal Brompton Hospital in London and co-author of the new statement in The Lancet about athletes and coronavirus. | Many of these athletes might now feel ready to resume heavy training. But the usual return-to-play criteria for sick athletes probably do not apply to someone who has been infected with the coronavirus, says Dr. James Hull, a sports pulmonologist at Royal Brompton Hospital in London and co-author of the new statement in The Lancet about athletes and coronavirus. |
| Since the 1990s, he says, sports medicine physicians typically have relied on the “neck check” to decide if and when an athlete with a respiratory condition should train. Using this measure, if an athlete’s symptoms are confined, by and large, to his head — meaning, above or in the neck, such as a runny nose, sinus pain and sore throat — he or she usually would be cleared to train and play. | Since the 1990s, he says, sports medicine physicians typically have relied on the “neck check” to decide if and when an athlete with a respiratory condition should train. Using this measure, if an athlete’s symptoms are confined, by and large, to his head — meaning, above or in the neck, such as a runny nose, sinus pain and sore throat — he or she usually would be cleared to train and play. |
| But the novel coronavirus worries sports pulmonologists, Dr. Hull says, in part because in some people, the illness can seem benign at first, then rapidly go downhill. “We have seen people have some mild symptoms to start with and seem to improve,” he says, “only to then deteriorate really badly at seven days following their first symptoms.” | But the novel coronavirus worries sports pulmonologists, Dr. Hull says, in part because in some people, the illness can seem benign at first, then rapidly go downhill. “We have seen people have some mild symptoms to start with and seem to improve,” he says, “only to then deteriorate really badly at seven days following their first symptoms.” |
| Because of this potential disease trajectory, he says, “it is important that, unlike what people would do with a normal viral infection,” such as a head cold, “they don’t exercise hard” while they have symptoms, especially in those first seven days, he says. | Because of this potential disease trajectory, he says, “it is important that, unlike what people would do with a normal viral infection,” such as a head cold, “they don’t exercise hard” while they have symptoms, especially in those first seven days, he says. |
| Instead, he and other pulmonologists, writing in The Lancet, advise athletes who have tested positive for the coronavirus or suspect they might be positive to rest, without any exercise, for at least 10 days from the point when they first feel symptoms. Then, assuming their illness remains mild, they should continue to rest for another week, even after their symptoms resolve. | Instead, he and other pulmonologists, writing in The Lancet, advise athletes who have tested positive for the coronavirus or suspect they might be positive to rest, without any exercise, for at least 10 days from the point when they first feel symptoms. Then, assuming their illness remains mild, they should continue to rest for another week, even after their symptoms resolve. |
| This protocol is conservative, but aligns with a new consensus opinion about athletes, coronavirus, exercise and hearts published this month in JAMA Cardiology, with the backing of the American College of Cardiology’s Sports & Exercise Cardiology Council. | This protocol is conservative, but aligns with a new consensus opinion about athletes, coronavirus, exercise and hearts published this month in JAMA Cardiology, with the backing of the American College of Cardiology’s Sports & Exercise Cardiology Council. |
| The cardiologists felt compelled to release this statement in part because the new coronavirus seems sometimes to have unexpected and perilous effects on hearts, even among robust athletes, says Dr. Jonathan Kim, a sports cardiologist at Emory University in Atlanta, and co-author of the new recommendations, with Dr. Dermot Phelan of the Sanger Heart and Vascular Institute in Charlotte, N.C., and Dr. Eugene Chung of the University of Michigan. | The cardiologists felt compelled to release this statement in part because the new coronavirus seems sometimes to have unexpected and perilous effects on hearts, even among robust athletes, says Dr. Jonathan Kim, a sports cardiologist at Emory University in Atlanta, and co-author of the new recommendations, with Dr. Dermot Phelan of the Sanger Heart and Vascular Institute in Charlotte, N.C., and Dr. Eugene Chung of the University of Michigan. |
| With most viral respiratory infections, he says, perhaps 1 percent of people who are infected develop related heart problems, such as myocarditis, which is an inflammation of the heart muscle. But there are indications that people infected with the coronavirus could have a much higher incidence of heart issues, he says, although the actual risks are hard to assess, with so much about the virus still mysterious. | With most viral respiratory infections, he says, perhaps 1 percent of people who are infected develop related heart problems, such as myocarditis, which is an inflammation of the heart muscle. But there are indications that people infected with the coronavirus could have a much higher incidence of heart issues, he says, although the actual risks are hard to assess, with so much about the virus still mysterious. |
| Updated June 12, 2020 | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| Even so, he and his fellow cardiologists suggest, much like the authors of the Lancet paper, that athletes and committed exercisers who have tested positive for the virus but have mild or no symptoms — or who worry they might have been infected, without testing — stay home and rest for at least two weeks from the date of their first symptoms or positive test. This time period also is the length of self-isolation mandated by current health guidelines following any possible exposure to the virus. | Even so, he and his fellow cardiologists suggest, much like the authors of the Lancet paper, that athletes and committed exercisers who have tested positive for the virus but have mild or no symptoms — or who worry they might have been infected, without testing — stay home and rest for at least two weeks from the date of their first symptoms or positive test. This time period also is the length of self-isolation mandated by current health guidelines following any possible exposure to the virus. |
| After a minimum of two weeks of resting at home and assuming symptoms have improved, the pulmonologists and cardiologists advise returning slowly to exercise training, with a wary eye on symptoms. “You might have a mild cough and minimal shortness of breath when returning to sport now,” Dr. Hull says. But those symptoms should lessen day by day, he says. If they do not or you develop new wheezing or shortness of breath, “go to your doc and get your chest examined,” he advises, or arrange a telehealth call. | After a minimum of two weeks of resting at home and assuming symptoms have improved, the pulmonologists and cardiologists advise returning slowly to exercise training, with a wary eye on symptoms. “You might have a mild cough and minimal shortness of breath when returning to sport now,” Dr. Hull says. But those symptoms should lessen day by day, he says. If they do not or you develop new wheezing or shortness of breath, “go to your doc and get your chest examined,” he advises, or arrange a telehealth call. |
| Dr. Kim agrees. For most athletes who have spent weeks at home recovering from the virus, the first few workouts could feel lousy, he says, since any lingering viral effects may combine with general physical deconditioning. So, expect some discomfort. But if you experience considerable or increasing chest tightness or new heart palpitations, stop exercising, contact your doctor and discuss whether you should complete cardiac testing, he says. | Dr. Kim agrees. For most athletes who have spent weeks at home recovering from the virus, the first few workouts could feel lousy, he says, since any lingering viral effects may combine with general physical deconditioning. So, expect some discomfort. But if you experience considerable or increasing chest tightness or new heart palpitations, stop exercising, contact your doctor and discuss whether you should complete cardiac testing, he says. |
| Any athletes who have been hospitalized or bedridden by the virus will be likely to need extensive pulmonary and cardiac testing and clearance from their physicians before working out again, he says. | Any athletes who have been hospitalized or bedridden by the virus will be likely to need extensive pulmonary and cardiac testing and clearance from their physicians before working out again, he says. |
| But for those of us who are casual exercisers who have not tested positive for the virus or felt ill during this pandemic, walking, jogging, cycling and other activities remain safe and desirable, he says, with proper social distancing and face covering, of course. “It’s a good idea to be cautious now,” he says, “but exercise is still one of the best things you can do for your health.” | But for those of us who are casual exercisers who have not tested positive for the virus or felt ill during this pandemic, walking, jogging, cycling and other activities remain safe and desirable, he says, with proper social distancing and face covering, of course. “It’s a good idea to be cautious now,” he says, “but exercise is still one of the best things you can do for your health.” |