Need for resuming sports and physical activity for children and adolescents following COVID-19 infection, 2022, Calcaterra et al

Abstract

Introduction
A decline in sports activities among children and adolescents was noted during the stay-at-home restrictions imposed by COVID-19. With the easing of restrictions, physical activities are being resumed.

Evidence acquisition
A data search was conducted to identify the role of parents in resuming sporting activities, the risks and benefits of doing so, the physical examination to be conducted prior to physical activity, the existence of guidelines/protocols for return to sports and physical activity, the role of comorbidities in influencing the restart of the same.

Evidence synthesis
Parents should consult the child’s physician prior to allowing he/she to resume physical exercise. In preparation for this, a careful physical examination should be performed. Children with COVID-19, even if asymptomatic, should not resume any physical activity until at least 10 days after testing positive. Those with moderate or severe COVID-19 should be referred for cardiological evaluation. The level of activity should be resumed gradually, as per the GRTP protocol. Athletes with a positive COVID-19 test in the presence of concomitant medical conditions (diabetes, cardiovascular or respiratory or renal disease) should undergo medical evaluation prior to adhering to a GRTP. Those with complicated COVID19 infection or long Covid may need additional investigations.

Conclusions
While there is no doubt that it will bring multiple benefits in terms of general health, returning to play sport should be gradual and preceded by an accurate physical examination in those young subjects previously affected by the coronavirus disease, especially when their heart and/or lungs and/or kidneys were affected.

Open access, https://link.springer.com/article/10.1007/s11332-022-00930-3

 

Yikes!
Table 1 Proposed progression in re-starting physical exercise [27].
Stage Length and proposed training
Stage 1 Day 1 and 2. 2 days minimum Sessions of 15 min or less Light exercise. Do not get over 70% of maximum cardiac frequency.
Endurance training is not allowed
Stage 2 Day 3. One day minimum Sessions of 30 min or less Add simple movement light exercise. Do not get over 80% of maximum
cardiac frequency
Stage 3 Day 4. One day minimum Sessions of 45 min or less Progress to more complex exercise. Do not get over 80% of maximum
cardiac frequency. Light endurance training is allowed
Stage 4 Day 5 and 6. 2 days minimum Sessions of 60 min Normal intensity exercise. Do not get over 80% of maximum cardiac
frequency
Stage 5 Day 7 Return to full activity, competitive sport included

 

Looks like this is targeted at parents who are expecting their bambini to play for Roma or win the Giro !

 

There's a lot of wishful thinking here. Medicine doesn't do well with such an open mandate, it looks for specific problems based on information. There really isn't such a thing as a comprehensive physical exam, we even know by now that for the impacts of Covid, all tests will miss problems. And with the general attitude that "children don't get sick" mixed with the belief that worry is worse than illness, it would not amount to much.

The deeply ingrained belief that medicine is infallible, capable of things they can only dream of, has been massively damaging. This is mostly performative, healthcare services do not have the capacity to do something like this, not with most children being infected. Even in normal times healthcare neglects many problems and is always behind, never catching up to huge backlogs.

So they won't, but somehow there are many working in healthcare who seem to think that this is something that happens. Or they pretend. Or they just write it down like this, hoping it's true.

This is frankly more about managing the imaginary worry in illness being worse than actual illness. Rousing reassurance in action. This is not useful to anyone.

 

I have not read the article but do the authors have any recognition of the issues of PEM in Long Covid and for some the risks of exercise causing deterioration in health over and above any heart or lung issues resulting from structural damage that occurred at the acute phase?

 

The protocol for resuming exercise is from one of the references, no. 27, listed below. The authors of the protocol are sports scientists and it seems to be medical guidance for elite athletes looking to resume sport after Covid infection:

"It is applicable to performance athletes who have had mild to moderate illness. Those requiring hospital admission merit further assessment."

https://bjsm.bmj.com/content/54/19/1174

The authors of the paper listed at the top of the thread are from a mix of cardiology, paediatrics, intensive care backgrounds and one sports physiologist. They seem to be well are aware of the risks for the acute and hospitalized patients.

It is basically a review paper. They originally identified 514 papers, but after exclusion of those not relevant to their inclusion criteria, they were left with 24 papers and found another 11 in the references from the remaining papers.

They seem to be trying to cover several different things:

The general reduction on physical activity and sport for children and young people because of pandemic restrictions, lockdowns, school closures, restrictions of group activities, etc. and how to resume activity safely.

The role of parents in encouraging physical activity.

The additional risks for those severely affected by Covid

I can only find a couple of mentions of Long Covid, a need to continue to collect data of the impact.

They do stress approaching an increase in activity with caution and gradually, but it seems odd to reproduce a protocol for performance athletes who had mild/moderate Covid in full. I wonder if they couldn't find anything else as specific

While there will be some young elite athletes looking to resume their sport, this is only a small subset of the whole.