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Balancing act: when is an elite athlete who has had COVID-19 safe to return to play? When does prudent investigation go offside into overmedicalising?
  1. Harald T Jorstad1,
  2. Joost G van den Aardweg2
  1. 1 Heart Center, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
  2. 2 Pulmonary Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands
  1. Correspondence to Dr Harald T Jorstad, Cardiology, Amsterdam University Medical Centres, Amsterdam 1100DD, The Netherlands; h.t.jorstad{at}

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Sport and exercise medicine (SEM) physicians are faced with the challenge of advising elite athletes with (suspected) COVID-19 wishing to return to play. Elite athletes are markedly different from the typical hospitalised patients with COVID-19. Elite athlete populations have a low prevalence of overweight and obesity, hypertension and smoking, and of lifestyle-related diseases, such as atherosclerotic coronary artery disease, congestive heart failure and obstructive lung disease, all of which are associated with severe COVID-19.1–3 However, from an athlete’s point of view, COVID-19 sequelae leading to even a small long-term decrease in physical performance capacity can be career limiting.

Return-to-play guide from experts in the UK

To assist SEM physicians in their medical support of athletes returning to intensive training and competitive sport, this issue of the British Journal of Sports Medicine includes a practical guide by London’s Professor Mathew Wilson et al.4 In a comprehensive, multidisciplinary document, they propose a clear, disease-oriented clinical pathway for cardiac and pulmonary medical decision making to support return to play. Laudable is that Wilson et al also include psychological factors that should be considered in the postlockdown setting where return to play takes place.

They include an integrated flowchart which includes both cardiac and pulmonary considerations. …

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