- Yifeng Song
Effects of COVID-19 on Athletes
Edited by: Temi Toba-Oluboka
(Rogers Center Photo, (1))
Introduction: COVID-19 Effects on Sports
The effects of the pandemic have been felt at every level of sports. Even major international events such as the UEFA European Football Championships have suffered postponements. Athletes are forced to train at home, but home training programs and video interactions with fitness trainers cannot overcome logistical barriers and lack of sport-specific exercises requiring official facilities (2). Additional challenges include inadequate sunlight exposure, decreased communication between athletes and coaches, and isolated lifestyle (e.g. can lead to poor nutrition, poor sleep, loneliness, etc.) (3). Many of these challenges are universal and apply to people of all activity levels.
Athletes likely have experienced various levels of detraining (loss of training-induced adaptations) during quarantine, making it more difficult to return to peak level performance once sports resume (2,3). Cardiorespiratory detraining effects can occur within 2-4 weeks of inactivity, including decrease of VO2max, decreased blood volume/hemoglobin content, muscle capillarization, changes in cardiac hypertrophy, and disrupted temperature regulation (2-4). Morphological and physiological changes due to training cessation include muscle atrophy, tendon stiffness, decreased mental sharpness and unwanted weight gain (2,5). Decrease in flexibility has been reported after 8 weeks of inactivity, which can increase the risk of injury (3,6). Non-elite athletes likely have a less stringent training regimen, and are encouraged to maintain their activity level to avoid detraining.
Heart and Lungs
Elevated troponin levels and cardiac myocyte necrosis have been frequently observed in hospitalized COVID-19 patients. However, because athletic patients are often asymptomatic or mild, prevalence of myocardial injury is likely low. Respiratory symptoms (e.g. persistent cough or edema) in athletes are expected to recover progressively within 4 weeks, but any deterioration or prolongation should prompt re-evaluation by a health-care professional (7).
Many young COVID-19 patients appear to recover over 5-7 days with mild symptoms, however days 7-9 have increased risk of deterioration requiring intense medical care. Athletes that develop respiratory infections in general require careful evaluation of ability to return to full physical exertion (return-to-play strategy) to address concerns of myocardial damage, myocarditis, and other complications with vigorous exercise (8). Important symptoms include chest pain worse with inspiration, increasing dyspnea, and palpitations (7).
Elite athletes suffer from mental health symptoms at rates greater or equal to the general population even before the challenges COVID-19 introduced (9). Sudden cancellations/postponements of competitive events can have immediate consequences on mental health, especially if the opportunities to compete are few in a lifetime. Although continued training is important to reduce risk of anxiety and depression, during the pandemic athletes face excessive isolation, less training and a lack of target (8). Competition schedule is an important developmental stimulus in athlete training. An important consideration in home training of athletes is precise compliance of high-intensity exercise schedules (3). Training mistakes can lead to disproportion or injury.
Above all, prevention of COVID-19 transmission takes priority, via hygiene, protocol adherence, and vaccination (10). Multidisciplinary support systems are necessary to maintain athlete health in the pandemic. Examples include ensuring connection with experts (e.g. nutritionist, sports coaches, etc.) via technology, educating on hygiene, nutrition, supplementation, and recovery. Personalized skills/conditioning training should be organized, including a focus on neuromuscular plyometrics and flexibility (3). Connectivity is essential in a time of isolation. This can be in the form of monitoring mental fatigue, self-assessments of physical metrics, daily check-ins, consultation with sports psychologists, and regular interactions with loved ones (3,10). Though some of the challenges and effects of COVID-19 may impact athletes to a greater extent, points-of-focus in fighting against isolation (nutrition, connectivity etc.) apply to everyone. `Though isolation causes challenges, it also provides time for recovery from stressors and injuries (3). Sometimes, when athletes use the rehabilitation period from serious injury for athletic development and mental/physical reset, they return in even better condition than pre-injury. Similarly, it is encouraged that the pandemic break be viewed as a window of opportunity for personal growth (11).For athletes that could mean focused personal training; for someone with a sedentary lifestyle that could mean enjoying a brisk walk around the neighborhood.
Take Home Points
Athletes can experience detraining effects after breaks from high-intensity training. Everybody is encouraged to avoid extended periods of inactivity.
Address flexibility and restart training slowly to prevent injury.
Evaluate risk of heart and lung symptoms before restarting training.
Stay connected to supports during isolation and view it as an opportunity for self-improvement.
Rogers Center Photo: https://thespaces.com/get-know-toronto-11-buildings/
Sarto F, Impellizzeri FM, Spörri J, Porcelli S, Olmo J, Requena B, Suarez-Arrones L, Arundale A, Bilsborough J, Buchheit M, Clubb J, Coutts A, Nabhan D, Torres-Ronda L, Mendez-Villanueva A, Mujika I, Maffiuletti NA, Franchi MV. Impact of Potential Physiological Changes due to COVID-19 Home Confinement on Athlete Health Protection in Elite Sports: a Call for Awareness in Sports Programming. Sports Med. 2020 Aug;50(8):1417-1419. doi: 10.1007/s40279-020-01297-6. PMID: 32468329; PMCID: PMC7254973.
Jukic I, Calleja-González J, Cos F, Cuzzolin F, Olmo J, Terrados N, Njaradi N, Sassi R, Requena B, Milanovic L, Krakan I, Chatzichristos K, Alcaraz PE. Strategies and Solutions for Team Sports Athletes in Isolation due to COVID-19. Sports (Basel). 2020 Apr 24;8(4):56. doi: 10.3390/sports8040056. PMID: 32344657; PMCID: PMC7240607.
Neufer, P.D.; Costill, D.L.; Fielding, R.A.; Flynn, M.G.; Kirwan, J.P. Effect of reduced training on muscular strength and endurance in competitive swimmers. Med. Sci. Sports Exerc. 1987, 19, 486–490.
Kalkhoven JT, Watsford ML, Impellizzeri FM. A conceptual model and detailed framework for stress-related, strain-related, and overuse athletic injury. J Sci Med Sport. 2020. https://doi. org/10.1016/j.jsams.2020.02.002.
Caldwell, B.P.; Peters, D.M. Seasonal variation in physiological fitness of a semiprofessional soccer team. J. Strength Cond. Res. 2009, 23, 1370–1377.
Wilson MG, Hull JH, Rogers J, Pollock N, Dodd M, Haines J, Harris S, Loosemore M, Malhotra A, Pieles G, Shah A, Taylor L, Vyas A, Haddad FS, Sharma S. Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. Br J Sports Med. 2020 Oct;54(19):1157-1161. doi: 10.1136/bjsports-2020-102710. Epub 2020 Sep 2. PMID: 32878870; PMCID: PMC7513247.
Hull JH, Loosemore M, Schwellnus M. Respiratory health in athletes: facing the COVID-19 challenge. Lancet Respir Med. 2020 Jun;8(6):557-558. doi: 10.1016/S2213-2600(20)30175-2. Epub 2020 Apr 8. PMID: 32277869; PMCID: PMC7194966.
Reardon CL, Hainline B, Aron CM, et al. Mental health in elite athletes: international Olympic Committee consensus statement (2019). Br J Sports Med 2019;53:667–99.
Toresdahl BG, Asif IM. Coronavirus Disease 2019 (COVID-19): Considerations for the Competitive Athlete. Sports Health. 2020;12(3):221-224. doi:10.1177/1941738120918876
Roy-Davis, K.; Wadey, R.; Evans, L. A Grounded Theory of Sport Injury-Related Growth. Sport Exerc. Perform. Psychol. 2017, 6, 35–52.