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Amateur athletes returning to activity after recovering from COVID-19 should take a gradual approach, says an Edmonton sports medicine physician.
When it comes to sports and COVID-19, much of the research and attention has been on elite athletes.
Team Canada soccer star Alphonso Davies, who is from Edmonton, is currently dealing with a mild case of myocarditis.
The signs of inflammation in his heart muscle were detected during testing his German club team, Bayern Munich, did on all players who were returning from bouts with COVID-19.
Two Edmonton Oilers were also sidelined this season by myocarditis. According to recent media reports, goalie Alex Stalock was recently cleared to play, while forward Mike Archibald remains on the long-term injury list but is showing some improvement.
But most people who like to get out for a bike ride or play recreational basketball don't have easy access to sports medicine experts, and they aren't going through a return-to-play screening process like what's in place for many pros.
How do you know?
Edmonton runner Dania Spillett got into running seriously in 2014. Her focus is marathons and half-marathons, and she ran her first 50-kilometre ultra-marathon last summer.
While Spillett knows there's always a risk of serious outcomes if she were to be infected with COVID-19, she feels it's more likely that she'll be OK as she's had three doses of vaccine.
It's the prospect of lingering or invisible issues that worry her most now.
"If you have inflammation of the heart, that's not a thing that you can feel or sense on a day-to-day basis," Spillett said. "Even if I handled it just fine and then decided to run again once I felt good enough, then am I doing more damage to myself when I don't actually realize it?"
When Spillett reads stories about elite athletes dealing with ongoing health troubles post-COVID, it's often accompanied by descriptions of testing they've undergone that uncovered the issues.
The advice she has been able to find is varied, and she wonders how applicable it is to people of various ages and genders, or if it should differ depending on what type of activity a person does.
"How are people getting access to that information, and are there even studies being done on activity that's not at an elite level?" she said.
A gradual return
Myocarditis is a rare complication in healthy young adults, but Dr. Terry De Freitas said she and her colleagues at the University of Alberta's Glen Sather Sports Medicine Clinic have taken a slow approach to returning athletes to play.
"Knowing that it can happen, we have been very cautious in returning them to play," said De Freitas, who is also the team physician for FC Edmonton and has attended the Olympics as team doctor for Canada's taekwondo athletes.
In a pre-COVID world, one to two people out of one million might get myocarditis after an illness. De Freitas said at this point, it's being reported that about 38 per cent of people who are very sick with COVID will experience some heart issues.
When it comes to mild COVID, research is ongoing and experts can't yet say how likely it is for someone to get it after a COVID-19 infection, and there is a lot of variability that could factor in such as age and fitness baseline, De Freitas said.
De Frietas and her colleagues follow a gradual return-to-play protocol for professional and varsity athletes that varies depending on severity of illness.
She said a general guideline for most people returning to any kind of fitness activity is to wait seven days after symptoms have resolved, and then to try a 500-metre walk.
If an athlete can do the walk with no problems, they can gradually increase exercise, staying below their maximum heart rate, and check-in with themselves every few days. She said it's important not to rush the process.
She said symptoms to watch for include:
Irregular heart beats;
Shortness of breath (for a level of exercise lower than your previous baseline);
Sudden onset of coughing.
If low intensity exercise does produce symptoms, the person should see a doctor right away, who can determine if testing is needed or if the person should be referred to a specialist.
She said at this point researchers aren't sure if someone could have issues but not experience any symptoms.
"We do know that if you do a gradual return to exercise, we have a better chance of picking up any worrying symptoms without significant damage," she said.
De Freitas said practitioners will have to be mindful about when to order these types of tests because most people will be fine and the health-care system simply doesn't have the resources to automatically order them for everyone who has had COVID.
"I think if we're wise about it, we can avoid overwhelming the system," she said.
De Freitis added that if a patient is still having symptoms after 10 weeks, they can ask their family physician about a referral to a COVID recovery clinic run by the Primary Care Network.