Medical guidance for athletes returning to sport after an acute respiratory illness

Posted on November 01, 2021

The sport and exercise medicine physician is responsible for guiding the athlete with recent acute respiratory illness to full and safe sports participation in the shortest possible time, while minimising the risk of potential medical complications. However, evidence-based clinical guidelines to assist the SEM physician with their decision on the athlete’s return to sport after an acute respiratory illness are lacking. Historically, athletes with localised symptoms above the neck (e.g. sore throat, rhinorrhea or nasal congestion) were advised that exercise can resume at a low intensity for a short duration, and if exercise is well tolerated, training can continue. If symptoms were below the neck (e.g. fever, myalgia or cough), the athlete was advised to rest until symptoms have resolved. These guidelines are referred to as the ‘neck check’, however there is no scientific evidence for these guidelines and the validity of the ‘neck check’ as a guide for return to sport has been challenged. A systematic review with a meta-analysis was recently undertaken to determine the effects of acute respiratory illness on return to sport in athletes. The research reported that accurate data detailing the actual number of days to return to sport after acute respiratory illness in athletes are very limited. The study found that approximately 20% of acute respiratory illnesses in athletes result in more than 1 day of time loss from training/competition, and that symptoms of an acute respiratory illnesses in athletes last on average for 7 days. The researchers observed significant individual variability in study results, highlighting the fact that future studies are needed where days until return to sport, individual and regional symptoms, and severity of symptoms, are accurately recorded and reported in athletes with a confirmed diagnosis of acute respiratory infection (pathogen identified). They suggest this information will refine future return to sport clinical decision making, and anticipate that this will be highly customized and based on the individual athlete response to infection from a specific pathogen.


Reference for this article:

Acute respiratory illness and return to sport: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’ Snyders C, Pyne DB, Sewry N, et al. Br J Sports Med Epub ahead of print. doi:10.1136/bjsports-2021-104719

Published by Jill Borresen

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