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A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection

Educational Objective
To understand how physicians can help athletes return to exercising after being infected with COVID-19
1 Credit CME

Coronavirus disease 2019 (COVID-19) is associated with significant mortality and morbidity, including adverse cardiovascular sequelae.1 As public health policy begins to guide the resumption of recreational and competitive sport, clinicians are charged with determining when competitive athletes and highly active individuals who have been infected with COVID-19 and recovered are medically appropriate to return to play. There are limited data establishing the epidemiologic and clinical metrics required to facilitate this process. Specifically, the prevalence of asymptomatic COVID-19 cases in the community, the prevalence of cardiac injury among nonhospitalized individuals with COVID-19, and long-term outcomes attributable to COVID-19 cardiac injury remain unknown. Recognizing these limitations, members of the American College of Cardiology’s Sports & Exercise Cardiology Council, with input from national leaders in sports cardiology, provide a consensus expert opinion clinical framework on return to play in the era of COVID-19.

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Article Information

Corresponding Author: Eugene H. Chung, MD, MSc, Cardiac Electrophysiology Service, Sports Cardiology Clinic, Frankel Cardiovascular Center, Michigan Medicine, 1500 E Medical Center Dr, SPC 5853, Office 2369, Ann Arbor, MI 48109-5853 (chungeug@med.umich.edu).

Published Online: May 13, 2020. doi:10.1001/jamacardio.2020.2136

Author Contributions: Drs Phelan and Kim contributed equally as co–first authors.

Conflict of Interest Disclosures: Dr Kim receives compensation for his role as team cardiologist for the Atlanta Falcons. No other disclosures were reported.

Additional Contributions: This Viewpoint is endorsed by the American College of Cardiology Sports and Exercise Cardiology Section. In addition, the Section acknowledges contributions from Aaron L. Baggish, MD (Massachusetts General Hospital, Boston); Michael S. Emery, MD (Indiana University School of Medicine, Indianapolis); Benjamin D. Levine, MD (University of Texas Southwestern Medical Center, Dallas); and Mathew W. Martinez, MD (Atlantic Health System, Morristown, New Jersey). These individuals were not compensated for their effort and contributed to all recommendations put forth in this expert consensus document

References
1.
Clerkin  KJ , Fried  JA , Raikhelkar  J ,  et al.  Coronavirus disease 2019 (COVID-19) and cardiovascular disease.   Circulation. Published online March 21, 2020. doi:10.1161/CIRCULATIONAHA.120.046941PubMedGoogle Scholar
2.
Driggin  E , Madhavan  MV , Bikdeli  B ,  et al.  Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic.   J Am Coll Cardiol. Published online March 18, 2020. doi:10.1016/j.jacc.2020.03.031Google Scholar
3.
Maron  BJ , Udelson  JE , Bonow  RO ,  et al; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology.  Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities.   Circulation. 2015;132(22):e273-e280.PubMedGoogle Scholar
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