A cluster of symptoms can predict how long an athlete might need to recover before resuming training after an acute respiratory infection.

Posted on April 22, 2021

Protecting athletes against illness is a key function of health professionals involved in sport. And with about half of all acute illnesses in athletes being in the respiratory system, this is a particularly important area to study. Added to this, the arrival of COVID-19 in 2019, brought with it a broad range of symptoms related to the upper respiratory tract (e.g. anosmia, dysgeusia, coryzal symptoms and throat discomfort), general thoracic symptoms (e.g. cough, shortness of breath, headache or chest pain) and systemic symptoms (e.g. myalgia, fever or excessive fatigue).  Even mild / moderate COVID-19 infection (ie, non-hospitalised individuals), can be associated with protracted or ‘Long-COVID’ symptoms in previously healthy individuals. A key role within sport and exercise medicine is to provide guidelines to athletes for the safe return to their training after illness.  However, there is limited scientific information describing the symptoms in athletes during the acute phase of a respiratory infection (including COVID-19), that might inform these guidelines.

A team of researchers lead by UP’s Sport, Exercise Medicine and Lifestyle Institute (SEMLI) set out to determine if symptoms experienced by athletes during the acute phase of a respiratory infection was related to the number of days it took them to return to their sports training. They found that athletes that exhibited a collection/cluster of symptoms had a much lower chance of returning to sport within 40 days after developing symptoms.  This cluster of symptoms included excessive fatigue, chills, fever, headache, altered/loss of sense of smell, chest pain/pressure, difficulty in breathing and loss of appetite. Of these symptoms, excessive fatigue was found to have the greatest negative effect, i.e. a 70% lower chance of the athlete returning to sport within 40 days. The research team also found that athletes who had COVID-19 had a significantly greater number of symptoms, were more likely to have altered/loss of sense of smell and altered/loss of sense of taste, fever, chills, loss of appetite and headaches, had more severe symptoms and took significantly longer to return to training than athletes with other respiratory infections.


These findings may be useful for sport and exercise physicians to assist their decision making when it comes to advising the athlete on when to return to training. For example, clinicians can use the symptom cluster found in this research to identify athletes that may require more time to recover. This research also identified the % chance of return to play within 40 days for each symptom, which could also be used by clinicians as an indicator for how long the athlete might need before resuming training.


Symptom cluster is associated with prolonged return-to-play in symptomatic athletes with acute respiratory illness (including COVID-19): a cross-sectional study—AWARE study I. British Journal of Sports Medicine 2021;0:1–9, Epub ahead of print: doi:10.1136/bjsports-2020-103782.

Martin Schwellnus, Nicola Sewry, Carolette Snyders, Kelly Kaulback, Paola Silvia Wood, Ishen Seocharan, Wayne Derman, James H Hull, Maarit Valtonen, Esme Jordaan. 


Published by Jill Borresen

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