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Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians
  1. Mathew G Wilson1,2,
  2. James H Hull1,3,4,
  3. John Rogers5,6,7,
  4. Noel Pollock1,8,
  5. Miranda Dodd2,
  6. Jemma Haines5,6,9,
  7. Sally Harris5,7,
  8. Mike Loosemore1,4,
  9. Aneil Malhotra5,6,10,
  10. Guido Pieles1,11,
  11. Anand Shah3,12,
  12. Lesley Taylor5,7,
  13. Aashish Vyas5,6,13,
  14. Fares S Haddad1,2,14,
  15. Sanjay Sharma15
  1. 1 Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK
  2. 2 The Princess Grace Hospital (HCA Healthcare UK), London, United Kingdom
  3. 3 Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  4. 4 English Institute of Sport, London, United Kingdom
  5. 5 Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom
  6. 6 Manchester University NHS Foundation Trust, Manchester, United Kingdom
  7. 7 The Wilmslow Hospital (HCAHealthcareUK), Wilmslow, United Kingdom
  8. 8 British Athletics, London, United Kingdom
  9. 9 NIHR Manchester BRC and University of Manchester, Manchester, United Kingdom
  10. 10 Department of Cardiovascular Science, University of Manchester, Manchester, United Kingdom
  11. 11 Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
  12. 12 Department of Infectious Diseases Epidemiology, Imperial College London, London, United Kingdom
  13. 13 Lancashire Teaching Hospitals Trust, Lancashire, United Kingdom
  14. 14 Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, London, United Kingdom
  15. 15 St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
  1. Correspondence to Professor Mathew G Wilson, Institute of Sport Exercise and Health (ISEH), University College London, London W1T 7HA, UK; mathew.wilson{at}


SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.

  • infection
  • respiratory
  • cardiology
  • exercise

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Contributors MGW manuscript conception. MGW, JHH, JR, NP, FH and SS wrote first draft. All authors edited and approved final document.

  • Funding No public, commercial or not-for-profit funding was provided for this document.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.

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