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  • 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

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Original research
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
  1. Martin Schwellnus1,2,
  2. Nicola Sewry1,
  3. Carolette Snyders1,
  4. Kelly Kaulback3,
  5. Paola Silvia Wood3,
  6. Ishen Seocharan4,
  7. Wayne Derman2,5,
  8. James H Hull6,
  9. Maarit Valtonen7,
  10. Esme Jordaan4,8
  1. 1 Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Faculty of Health Sciences, Pretoria, Gauteng, South Africa
  2. 2 IOC Research Center of South Africa, Pretoria, Gauteng, South Africa
  3. 3 Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Division of Biokinetics and Sports Science, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
  4. 4 Biostatistics Unit, South African Medical Research Council (SAMRC), Tygerberg, South Africa
  5. 5 Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  6. 6 Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  7. 7 Research Center for Olympic Sports, Jyväskylä, Finland
  8. 8 Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  1. Correspondence to Professor Martin Schwellnus, Sport, Exercise Medicine and Lifestyle Institute, University of Pretoria Faculty of Health Sciences, Pretoria 0020, Gauteng, South Africa; mschwell{at}iafrica.com

Abstract

Background There are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP).

Objective To determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes with other ARI.

Design Cross-sectional descriptive study.

Setting Online survey.

Participants Athletes with confirmed/suspected COVID-19 (ARICOV) (n=45) and athletes with other ARI (ARIOTH) (n=39).

Methods Participants recorded days to RTP and completed an online survey detailing ARI symptoms (number, type, severity and duration) in three categories: ‘nose and throat’, ‘chest and neck’ and ‘whole body’. We report the association between symptoms and RTP (% chance over 40 days) and compare the days to RTP and symptoms (number, type, duration and severity) in ARICOV versus ARIOTH subgroups.

Results The symptom cluster associated with more prolonged RTP (lower chance over 40 days; %) (univariate analysis) was ‘excessive fatigue’ (75%; p<0.0001), ‘chills’ (65%; p=0.004), ‘fever’ (64%; p=0.004), ‘headache’ (56%; p=0.006), ‘altered/loss sense of smell’ (51%; p=0.009), ‘Chest pain/pressure’ (48%; p=0.033), ‘difficulty in breathing’ (48%; p=0.022) and ‘loss of appetite’ (47%; p=0.022). ‘Excessive fatigue’ remained associated with prolonged RTP (p=0.0002) in a multiple model. Compared with ARIOTH, the ARICOV subgroup had more severe disease (greater number, more severe symptoms) and more days to RTP (p=0.0043).

Conclusion Symptom clusters may be used by sport and exercise physicians to assist decision making for RTP in athletes with ARI (including COVID-19).

  • sport
  • infection
  • COVID-19

Data availability statement

No data are available. No additional data are available.

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.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bjsports-2020-103782

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    Data availability statement

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    Footnotes

    • Twitter @wderman

    • Contributors MS: responsible for the overall content as guarantor, study concept, study planning, data collection, data interpretation, manuscript (first draft), manuscript editing and facilitating funding. NS: study planning, data collection, data cleaning, data interpretation, manuscript (first draft) and manuscript editing. CS: study planning, data collection, data interpretation and manuscript editing. KK and PSW: study planning, data collection, data interpretation, manuscript (first draft) and manuscript editing. IS: study planning, development of the data management system, data collection, data cleaning and manuscript editing. WD, JHH and MV: data interpretation and manuscript editing. EJ: study planning, data cleaning, data management, data analysis including statistical analysis, data interpretation and manuscript editing.

    • Funding IOC Research Centre (South Africa) (partial funding). South African Medical Research Council (partial funding, statistical analysis).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.