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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’
  1. Carolette Snyders1,
  2. David B Pyne2,
  3. Nicola Sewry1,3,
  4. James H Hull4,5,
  5. Kelly Kaulback1,6,
  6. Martin Schwellnus1,3
  1. 1Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  2. 2Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, Canberra, Australia
  3. 3IOC Research Centre, Pretoria, Gauteng, South Africa
  4. 4Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  5. 5Institute of Sport, Exercise and Health, University College London, London, UK
  6. 6Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  1. Correspondence to Professor Martin Schwellnus, Sport, Exercise Medicine and Lifestyle Institute, University of Pretoria Faculty of Health Sciences, Pretoria 0084, South Africa; mschwell{at}


Objective To determine the days until return to sport (RTS) after acute respiratory illness (ARill), frequency of time loss after ARill resulting in >1 day lost from training/competition, and symptom duration (days) of ARill in athletes.

Design Systematic review and meta-analysis.

Data sources PubMed, EBSCOhost, Web of Science, January 1990–July 2020.

Eligibility criteria Original research articles published in English on athletes/military recruits (15–65 years) with symptoms/diagnosis of an ARill and reporting any of the following: days until RTS after ARill, frequency (%) of time loss >1 day after ARill or symptom duration (days) of ARill.

Results 767 articles were identified; 54 were included (n=31 065 athletes). 4 studies reported days until RTS (range: 0–8.5 days). Frequency (%) of time loss >1 day after ARill was 20.4% (95% CI 15.3% to 25.4%). The mean symptom duration for all ARill was 7.1 days (95% CI 6.2 to 8.0). Results were similar between subgroups: pathological classification (acute respiratory infection (ARinf) vs undiagnosed ARill), anatomical classification (upper vs general ARill) or diagnostic method of ARinf (symptoms, physical examination, special investigations identifying pathogens).

Conclusions In 80% of ARill in athletes, no days were lost from training/competition. The mean duration of ARill symptoms in athletes was 7 days. Outcomes were not influenced by pathological or anatomical classification of ARill, or in ARinf diagnosed by various methods. Current data are limited, and future studies with standardised approaches to definitions, diagnostic methods and classifications of ARill are needed to obtain detailed clinical, laboratory and specific pathogen data to inform RTS.

PROSPERO registration number CRD42020160479.

  • athletes
  • respiratory system
  • infection

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  • Contributors Conceptualisation: CS, DBP, NS, MS, KK and JHH. Methodology: CS, DBP, NS and MS. Writing and original draft: CS, DBP, MS and NS. Writing, review and editing: CS, DBP, NS, MS, KK and JHH.

  • Funding Partially supported by funding from the IOC Research Centre of South Africa.

  • Competing interests CS received a scholarship made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC Clinician Researcher Programme. The content hereof is the sole responsibility of the authors and does not necessarily represent the official views of the SAMRC.

  • 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.