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Return to Play During a Pandemic

Original Editor - Wanda van Niekerk

Top Contributors - Wanda van Niekerk, Ahmed M Diab, Kim Jackson, Vidya Acharya, Tarina van der Stockt, Alexandra Stead, Lucinda hampton and Jess Bell  

Introduction

The COVID-19 pandemic disrupted sport and physical activity at every level from school-age athletes to elite competitors. Lockdowns and public health restrictions led to prolonged periods of reduced or absent structured training. In many cases, this represented the longest interruption to training that athletes had experienced within their sporting careers.[1]

Although many athletes were able to engage in home-based training, these activities were often substantially different from the competition and training demands of their sport. When planning return to play during a pandemic, it is essential to adopt a safe and progressive strategy that accounts for multiple factors. These include:

  • The duration of lockdown/ isolation/ quarantine
  • The health status of the athlete (COVID-19 infection history, severity and vaccination status)
  • The complexity and demands of the sport
  • The content, volume and intensity of training performed during isolation [2][3][4]

A framework for return to training has been developed by Aspetar (Aspetar Clinical Guideline: Safe Return to Sport during the COVID-19 Pandemic), based on an admission process of gathering athlete-specific information to guide individualised strategy.

Impact of COVID-19 on Athletes

The COVID 19 pandemic has significant effects on athletes. These include[5]:

  • Physical deconditioning
  • Altered sleep patterns
  • Worsening nutrition
  • Uncertainty on Return to Sport
  • Feelings of depression

Athletes generally remain well-informed about COVID-19, but require access to reliable, evidence-based resources. Research highlights the need for integrated medical, nutritional and psychological support during and after lockdown periods.[5]

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Practical and Medical Recommendations on Resumption of Sport

The 2022 American College of Cardiology (ACC) Expert Consensus Decision Pathway is the current leading reference for return-to-play decision-making following COVID-19 infection.[7]

Athlete group Assessment Investigations Return-to-play recommendations
Asymptomatic/

Non-cardiopulmonary symptoms[7]

Clinical evaluation only;no routine cardiac screening Non required Resume sport without cardiac testing; follow graded, supervised return-to-play
Cardiopulmonary symptoms[7] Symptom-based evaluation Cardiac triad testing:12-lead ECG, high-sensitivity troponin,echocardiography Clearance required before return; graded supervised progression
Hospitalised athletes(suspected cardiac cause)[7] Full cardiac evaluation Cardiac triad testing mandatory Clearance required; gradual supervised return
All athletes(regardless of symptoms)[7] General clinical review Cardiopulmonary exercise testing (CPET) if reduced exercise capacity or prolonged detraining suspected[8] Graded, supervised return-to-play protocol
Children with possible cardiac involvement[9] Symptom-based evaluation(same principle as adults) Cardiac assessment only if cardiopulmonary symptoms present Graded, supervised return-to-play; no routine cardiac testing if asymptomatic
Population-level findings[10] Low prevalence of myocarditis and abnormal MRI findings MRI not routinely indicated Recommendations apply to elite, recreational and high-school athletes(≥14 years)

Effects of Detraining on Physiological Systems

Detraining is defined as the partial or complete loss of training-induced adaptations in response to cessation or substantial reduction of training.[11] Factors influencing the magnitude of detraining include:

  • Pre-existing fitness levels and training history
  • Genetics and age
  • Volume, intensity and specificity of training performed during lockdown
  • Whether the athlete contracted COVID-19 and the severity of illness[12][13]

Physiological losses generally progress through two distinct phases:

  • Short-Term Detraining (< 4 Weeks): rapid haematological and metabolic shifts such as plasma volume contraction and reduced insulin sensitivity, while structural muscle mass and maximal strength remain relatively well-preserved. There is no change in cortisol levels.[11][14]
  • Long-Term Detraining (> 4 Weeks): structural tissue remodelling, including muscle fibre atrophy, decreased capillary density, reduced cardiac dimensions and altered tendon compliance.[11]

Detraining affects many physiological systems and muscle and tendon tissues in the human body. Some of these effects include[11][15]:

Neuromuscular Effects of Detraining

Cardiorespiratory Effects of Detraining

  • Reduced maximal oxygen uptake
  • Increased mean blood pressure
  • Increased maximal heart rate
  • Increased submaximal heart rate
  • Decreased maximal cardiac output
  • Decreased lactate threshold
  • Decreased endurance performance

Musculoskeletal Effects of Detraining

  • Reduced bone mineral density
  • Reduced oxidative enzyme activity
  • Reduced glycogen synthase activity
  • Reduced mitochondrial ATP Production
  • Reduction in tendon quality

Healthcare professionals and coaches need to consider the training history of athletes during periods of lockdown or isolation as this guides the appropriate training loads and activities to be performed for the level of conditioning of the athlete, as well as the progression of training load and activities. It is evident that physiological systems that improve with training also decline when the training stimulus is removed.[15] Factors that may influence the level of decline are[15]:

  • Pre-existing fitness levels
  • Training history
  • Genetics
  • Age
  • Specificity and characteristics of training during lockdown/isolation

Athletes who have had COVID-19 might have a greater reduction in physical conditioning. This will be related to the severity and duration of COVID-19 symptoms. It is recommended and advised that athletes who had COVID-19 should undergo a complete medical and physical assessment before return to play and that the return to play guidelines should be based on the outcomes of the medical and physical assessment and adapted as needed. Athletes should also be monitored regularly.[15]

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Evidence for the Effects of Detraining

A decline in cardiovascular, metabolic and neuromuscular performance has been reported in elite athletes as a result of detraining or lack of activity.[11] Maintaining some form of training may be enough to alleviate these losses and it has been reported that retraining may recover performance parameters within 2-6 weeks. In the musculoskeletal system extreme situations of inactivity may affect bone mineral density.[15]

Insufficient training may lead to a reduction in aerobic capacity in highly trained athletes. This will cause an increase in heart rate for any given workload, compared to when the athlete is fully trained.[18]

Periods of inactivity/deconditioning leads to a reduction in endurance capacity and repeated sprint ability after just two weeks, as seen in semi-professional soccer players.[19] The extent of the aerobic capacity decline is dependent on initial performance levels and the extent of the detraining or inactivity period.[19]

In well-trained cyclists a reduction in aerobic capacity and power output has been reported after four weeks of detraining.[20] Furthermore, endurance capacity declines with detraining in endurance athletes, but at least one short 35-minute high intensity bout of exercise per week may help to maintain VO2 max in well-trained endurance athletes.[20]

Studies have reported a loss of force and power-generating capacity between 2% and 60% after periods of detraining.[18]

Planning Graded Return to Training and Competition

In this unique situation of a pandemic, the length and degree of detraining/deconditioning/inactivity are key considerations in the planning of return to play strategies. Athletic populations do show a quick return to original performance levels.[21]

High intensity training, such as plyometric and fast eccentric loading activities should be carefully introduced, especially if the athlete has not been able to maintain this during lockdown/isolation. There may be an increased risk of injury if these activities are introduced without caution.[15]

Assessing and Monitoring Fitness Levels

Some factors to consider with the assessment and monitoring of fitness levels to individualise training are[15]:

  • Assess training status of athlete when training resumes
  • In the first phase of return to play, avoid maximal testing activities to reduce injury risk and perform physical assessments at submaximal performance
  • Sports-specific testing, observations and assessments may be performed and gradually introduced as part of the warm-up and/or training activities – approach this like a pre-season training resumption
  • Use the data from the sport-specific testing to develop an individualised training programme
  • Assess training history, details of detraining/deconditioning/inactivity
  • Regular monitor training activities and athlete feedback and adjust the training regime where necessary
  • Monitor internal and external load
  • Evaluate cardiorespiratory responses to training, especially in athletes who had COVID-19
  • Assess the cognitive, technical and tactical skills relevant to the sport of the athlete

Injury Prevention

Athletes may be more at risk of injury after prolonged periods of lockdown/isolation. During the National Football League (NFL) lockout in 2011 in the United States, there was a prolonged off-season (more than 3 months) with no access to training facilities.[22] A higher rate of Achilles tendon injuries, occurring during the first period of training camp and the season was reported after this lockout period. It is important to monitor the physical status of athletes to determine the readiness of the athlete to safely return to play.[22]

Monitor the athlete’s training load and ensure that the training load is not too high for the athlete’s fitness level or even too different in movement patterns and intensity.[23] Athletes may also have developed poor sleeping and eating habits during the lockdown period and this may also affect their readiness to return to play. Assess the athlete’s wellbeing regularly. One way of doing this is to routinely assess pain perception with body maps as this may help the medical staff identify potential issues.[24]

Psychological Support

The suspension and cancellation of competitions may and have caused grief, frustration, stress, anxiety, sadness and depression for athletes. However, return to play may also cause significant stress and anxiety to athletes as they are concerned about their health, the fear of contagion and concerns about falling ill with COVID-19, as the risk is always present.[25]

Many athletes will be able to cope with these unique circumstances, but there are athletes that might struggle with this and not have the coping resources. These athletes will be at an increased risk of mental health issues, injuries and a drop in performance levels.[25][26] Healthcare professionals working with these athletes should anticipate this and be aware that some athletes may need additional mental health support.[27]

Practical Recommendations for Healthcare Professionals Working with Athletes

Healthcare professionals should check in regularly with athletes, help them develop resilience by learning from life experiences and drawing confidence from past successes, and facilitate consultations with psychologists when needed.

Specific Athlete Populations

School Children, Adolescents, Young athletes and School Sports

Many young athletes had to deal with the disappointment of not being able to take part in any sports or school sports activities during the pandemic. For many of these young athletes, their final year of school and school sports was a stepping stone to a career in professional sport, or access to university or college on sport scholarships. These young athletes had to deal with a great deal of uncertainty and disappointment during the pandemic and that may have an effect on their mental health and performance.[28]

For many, the lockdown periods in many countries led to children spending a lot more time indoors, spending more time on digital devices and being sedentary. They also had to cope with minimal social interaction with their peers, and many developed poor eating habits. With schools reopening and young people got more involved in organised sports within the relevant COVID-19 regulations, some children appeared a bit more sluggish with some carrying a bit more weight or showing a change in body composition compared to before lockdown periods.[28]

The sedentary lifestyle during lockdown resulted in young athletes developing certain musculoskeletal issues. For example[28]:

  • Tightness or shortening of the hip flexors
  • Tightness or shortening of the hamstrings
  • Atrophy of gluteal muscles
  • Weakness of core muscles

With the return to school and some sporting activities being allowed, coaches were at risk of being overzealous in increasing the level of fitness of these young athletes, which could lead to overuse injuries, such as medial tibial stress syndrome (MTSS). Many young athletes had not done any proprioceptive training during lockdown adding to the risk of ankle injuries.[28]

With the return to sport in young athletes during a pandemic, physiotherapists could expect a few growth-related injuries as well as inactivity-related injuries, with young athletes probably showing signs of a loss in strength and stability.[28]

Return to Play Tips for School Children

After extended periods of reduced activity during the COVID-19 pandemic, school-aged children benefit from a gradual and structured approach to resuming sport.

  • Advise coaches on gradual return to play principles
  • Building blocks to concentrate on may include:
    • Core muscle strength
    • Stabilising muscles
    • Balancing muscles
    • Proprioception
  • Slow and gradual progression of cardiorespiratory fitness
  • Provide psychological support to young athletes, reassurance of future opportunities, etc[29][30]
Return to Play Tips for Runners
  • Physiotherapists should advice these athletes on a slow return to fitness
  • Provide guidance on strength building at home – include exercises such as gluteus maximus strengthening and hip extension exercises[28]
  • Running analysis where needed and teach athletes the proper running technique
  • Assess shoe wear
  • Watch out for over-striding as this is a risk for injury, especially in the hamstring complex[28]

Athletes

Elite Athletes

The Covid-19 pandemic has significantly impacted elite athletes. A South African study on elite and semi-elite athletes during the pandemic found[5]:

  • Most kept training solo at moderate intensity (30-60 min/day)
  • Preference shifted toward sedentary leisure activity
  • Athletes’ sleep patterns changed significantly
  • Athletes had changes in nutritional behaviour with a significant number of athletes consuming excessive carbohydrates
  • Athletes felt depressed and required motivation to keep active

Olympic Athletes

Olympians were affected by the Games' postponement.[31] Many were in the final stages of training preparation when the postponement occurred, requiring a sudden shift from peak performance training to deconditioning and restructured training programmes, in order to reduce the risk of burnout or overuse injury.[28]

Return to Sport and Mental Health

As sports such as rugby, cricket, football, tennis and golf gradually resumed under strict COVID-19 protocols, many athletes experienced a loss of income due to event cancellations. This loss may negatively affect athletes' mental health, contributing to increased stress and anxiety. As athletic identity is often closely linked to sporting performance, psychological support and motivation are important during this period.[28]

Lifestyle and Physical effects

Elite athletes, just as the general population, also underwent drastic lifestyle changes during lockdown measures with the majority choosing sedentary behaviour, especially watching television. The negative effects of a sedentary lifestyle are well documented. Some issues that physiotherapists may see are weakness of the gluteal muscles, tightness of the hip flexors and hamstrings and low back pain and/or neck pain from ongoing stress.[28]

A positive that may come out of this is that physiotherapists may now be able to spend more time on prehabilitation and injury prevention with athletes, instead of only focusing on rehabilitation after injury.[28]

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Athletes with Disabilities

Athletes with disabilities have also been significantly affected by the pandemic. The postponement of the 2020 Paralympic Games left many facing disappointment and uncertainty, as the Paralympics represent a key global platform for showcasing their abilities, one with far fewer alternative competition opportunities than exist for able-bodied athletes.[28]

Training presents unique challenges for this population, including muscle imbalances, spasticity, weakness and difficulties with balance and proprioception. Lockdown restrictions compounded these issues, as many athletes lacked appropriate equipment and facilities for home training, while enforced inactivity contributed to poor circulation and breathing patterns.[28]

Healthcare professionals should remain sensitive to these unique challenges. A gradual return to play is recommended, focusing on correcting muscle imbalances, foundational rehabilitation, strengthening, prehabilitation, mobility and stability, while maintaining motivation through small, specific goals.[28]

Practical Implications for Athletes with disabilities

The COVID-19 pandemic and the measures to curb the spread of the disease has significantly affected athletes around the world. Some practical implications to consider are[5]:

  1. A culture of education for athletes and support staff needs to be created and implemented regarding hand hygiene, the wearing of face masks, social distancing and self-isolation. This may improve health literacy and promote the necessary required behavioural changes
  2. Athletes need health, nutritional and psychological support during lockdown periods
  3. Progression in training load and allowing maximal adaptation to training stimuli before competitions may reduce the risk of injury
  4. Athletes need to be educated on sleep hygiene and its effect on performance
  5. A thorough medical assessment, including nutrition assessment, is needed before athletes return to high intensity sporting activities
  6. The mental health of athletes is paramount and forms an integral part of athlete performance and any issues regarding this should be addressed
  7. Athletes need to be educated on financial planning for their future
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Collision Sports

The COVID-19 pandemic has created an unusual period of training restriction for all athletes around the world. Return to play activities need to be carefully planned by all sporting bodies and governments. These methods will differ between countries and sports, considering the different levels of impact COVID-19 has had on training restriction and modification and the different stages of the season athletes were in.[34]

In collision sports, return to play will be more difficult to manage following a period of modified isolated training. Reasons for this are[34]:

  • High-risk nature of participation in collision sports
  • Importance of strength and power in collision sports (this may have been affected by restricted access to training equipment and space)
  • Executing skills in high-risk areas of the game, such as tackling in rugby, and the lack of opportunity available to train these skills
  • Training progressions will also be influenced by:
    • The limit on the number of players allowed to train together
    • The limit on the amount of time it is acceptable for players to be in close contact with other players

However, this unique period of non-contact training in collision sports, may not all be negative. It could create a positive period for physical and psychological rest and recovery for athletes.[34] This may improve an athletes’ performance and well-being, if appropriate and progressive return to play and reconditioning practices are in place.[34] Furthermore, athletes now have the chance to target and develop specific physical weaknesses without the pressure of being match-ready for weekly competitive matches.[34]

Telehealth and Social Media Platforms

The COVID-19 pandemic has caused many healthcare professionals to consider and implement Telehealth in their practices and patient care. Telehealth can provide physiotherapists ways to connect with athletes and still provide ongoing care, advice and rehabilitation where necessary.[28]

It is also important to be aware of the effect of social media on athletes. Unfortunately, there are many irresponsible fitness challenges available online and athletes often try these out because of boredom or just testing their limits. with some negative effects such as injuries.[28]

Summary

The COVID-19 pandemic created unprecedented challenges for athletes worldwide. A safe and progressive return to play requires careful consideration of health status, training history and sport demands. Special populations such as children, adolescents and collision sport athletes need tailored strategies, including gradual progression, injury prevention and psychological support. Sporting bodies and governments play a critical role in ensuring safe practices, with approaches varying across countries and contexts. Evidence-based guidelines and recent consensus statements provide a framework for coaches, clinicians and educators to support athletes in resuming sport safely and sustainably.

Resources

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References

  1. ↑ Musa DI, Toriola AL, Bamidele BB, Lawal B, Sunday A, Toriola OO, Ahmed JM, David A. Elite athletes and sports training during the COVID-19 pandemic: A mini review. Arab Gulf Journal of Scientific Research. 2024 Nov 28;42(4):1518-29.
  2. ↑ Calpino KM, Morrissette JD. Return-to-play recommendations after COVID-19 diagnosis in high school athletes. Journal of Athletic Training. 2021 Oct 1;56(10):1057-60.
  3. ↑ Csulak, E., Petrov, Á., Kováts, T., Tokodi, M., Lakatos, B., Kovács, A., Staub, L., Suhai, F.I., Szabó, E.L., Dohy, Z. and Vágó, H., 2021. The impact of COVID-19 on the preparation for the Tokyo Olympics: a comprehensive performance assessment of top swimmers. International journal of environmental research and public health, 18(18), p.9770.
  4. ↑ Parpa K, Michaelides M. The impact of COVID-19 lockdown on professional soccer players' body composition and physical fitness. Biology of sport. 2021 Oct 4;38(4):733-40.
  5. ↑ 5.0 5.1 5.2 5.3 Pillay L, van Rensburg DC, van Rensburg AJ, Ramagole DA, Holtzhausen L, Dijkstra HP, Cronje T. Nowhere to hide: The significant impact of coronavirus disease 2019 (COVID-19) measures on elite and semi-elite South African athletes. Journal of science and medicine in sport. 2020 Jul 1;23(7):670-9.
  6. ↑ Olympic channel. How has COVID-19 affected athletes’ dreams of Tokyo 2020? Available from https://www.youtube.com/watch?v=PyybSCupXOY (last accessed 3 November 2020)
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Gluckman TJ, Bhave NM, Allen LA, Chung EH, Spatz ES, Ammirati E, Baggish AL, Bozkurt B, Cornwell III WK, Harmon KG, Kim JH. 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2022 May 3;79(17):1717-56.
  8. ↑ Lopes LR, Medeiros R, Tavares V, Dias F, Amaral MV, Goes RA, Matheus Guimarães JA, Perini JA. A systematic review and meta-analysis on aerobic fitness dynamics in post-COVID-19 athletes: implications in the return-to-play performance. Sports. 2025 Feb 5;13(2):40.
  9. ↑ Paglialonga L, Aurelio C, Principi N, Esposito S. Return to Play after SARS-CoV-2 Infection: Focus on the Pediatric Population with Potential Heart Involvement. Journal of Clinical Medicine. 2023 Oct 29;12(21):6823.
  10. ↑ Tsampasian V, Androulakis E, Catumbela R, Gati S, Papadakis M, Vassiliou VS. Prevalence of abnormal cardiovascular magnetic resonance findings in athletes recovered from COVID-19 infection: a systematic review and meta-analysis. Journal of Clinical Medicine. 2024 Jun 3;13(11):3290.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Barbieri A, Fuk A, Gallo G, Gotti D, Meloni A, La Torre A, Filipas L, Codella R. Cardiorespiratory and metabolic consequences of detraining in endurance athletes. Frontiers in Physiology. 2024 Jan 22;14:1334766.
  12. ↑ Córdova-Martínez A, Caballero-García A, Roche E, Pérez-Valdecantos D, Noriega DC. Effects and causes of detraining in athletes due to COVID-19: A review. International journal of environmental research and public health. 2022 Apr 28;19(9):5400.
  13. ↑ Heo SJ, Park SK, Jee YS. Detraining effects of COVID-19 pandemic on physical fitness, cytokines, C-reactive protein and immunocytes in men of various age groups. International journal of environmental research and public health. 2022 Feb 6;19(3):1845.
  14. ↑ Celestrin CP, Rocha GZ, Stein AM, Guadagnini D, Tadelle RM, Saad MJ, Oliveira AG. Effects of a four week detraining period on physical, metabolic, and inflammatory profiles of elderly women who regularly participate in a program of strength training. European Review of Aging and Physical Activity. 2020 Dec;17(1):12.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 15.5 15.6 Aspetar Clinical Guideline. Safe Return to Sport during the COVID-19 Pandemic. June 2020
  16. ↑ Soccer Physiologist. DETRAINING - What Happens When We Stop Exercising? Available from https://www.youtube.com/watch?v=-dT5CC3LaV0 (last accessed 3 November 2020)
  17. ↑ Ross Tucker. Detraining in lockdown part 2. Available from https://www.youtube.com/watch?v=ByD9HjJL554. (last accessed 3 November 2020)
  18. ↑ 18.0 18.1 Mujika I, Padilla S. Detraining: loss of training-induced physiological and performance adaptations. Part I. Sports Medicine. 2000 Aug 1;30(2):79-87.
  19. ↑ 19.0 19.1 Joo CH. The effects of short term detraining and retraining on physical fitness in elite soccer players. PloS one. 2018 May 10;13(5):e0196212.
  20. ↑ 20.0 20.1 Maldonado-Martín S, Cámara J, James DV, Fernández-López JR, Artetxe-Gezuraga X. Effects of long-term training cessation in young top-level road cyclists. Journal of sports sciences. 2017 Jul 18;35(14):1396-401.
  21. ↑ Staron RS, Leonardi MJ, Karapondo DL, Malicky ES, Falkel JE, Hagerman FC, Hikida RS. Strength and skeletal muscle adaptations in heavy-resistance-trained women after detraining and retraining. Journal of Applied Physiology. 1991 Feb 1;70(2):631-40.
  22. ↑ 22.0 22.1 Myer GD, Faigenbaum AD, Cherny CE, Heidt RS, Hewett T. Did the NFL lockout expose the achilles heel of competitive sports. Journal of Orthopaedic and Sports Physical Therapy. 2011 Oct;41(10):702-5.
  23. ↑ Drew MK, Finch CF. The relationship between training load and injury, illness and soreness: a systematic and literature review. Sports medicine. 2016 Jun 1;46(6):861-83.
  24. ↑ Caseiro M, Woznowski‐Vu A, De Oliveira AS, Reis FJ, Wideman TH. From paper to digitalized body map: a reliability study of the pain area. Pain Practice. 2019 Jul;19(6):602-8.
  25. ↑ 25.0 25.1 Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, Du B. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain, behavior, and immunity. 2020 Apr 15.
  26. ↑ Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, Budgett R, Campriani N, Castaldelli-Maia JM, Currie A, Derevensky JL. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine. 2019 Jun 1;53(11):667-99.
  27. ↑ Toresdahl BG, Asif IM. Coronavirus Disease 2019 (COVID-19): Considerations for the Competitive Athlete. Sports Health. 2020 Apr 6;12(3):221-4.
  28. ↑ 28.00 28.01 28.02 28.03 28.04 28.05 28.06 28.07 28.08 28.09 28.10 28.11 28.12 28.13 28.14 28.15 Brent Grimsley. Return to Play During a Pandemic. Plus Course. 2020
  29. ↑ Calcaterra G, Fanos V, Cataldi L, Cugusi L, Crisafulli A, Bassareo PP. Need for resuming sports and physical activity for children and adolescents following COVID-19 infection. Sport Sciences for Health. 2022 Dec;18(4):1179-85.
  30. ↑ Paglialonga L, Aurelio C, Principi N, Esposito S. Return to Play after SARS-CoV-2 Infection: Focus on the Pediatric Population with Potential Heart Involvement. Journal of Clinical Medicine. 2023 Oct 29;12(21):6823.
  31. ↑ Banning A, van Meurs E, Dreiskämper D. COVID-19 affected elite track-and-field athletes’ Olympic preparation before Tokyo 2020 compared to Rio 2016. Scientific Reports. 2025 Feb 19;15(1):6044.
  32. ↑ SABC News. Coronavirus and sport | Effects of COVID-19 on elite athletes discussed. Available from https://www.youtube.com/watch?v=4zsHPAVtyq8&t=1s (last accessed 3 November 2020)
  33. ↑ Netball Queensland. RHP Physio Return to Play. Available from https://www.youtube.com/watch?v=7Ov5xSHxMF4&t=10s (last accessed 3 November 2020)
  34. ↑ 34.0 34.1 34.2 34.3 34.4 Stokes KA, Jones B, Bennett M, Close GL, Gill N, Hull JH, Kasper AM, Kemp SP, Mellalieu SD, Peirce N, Stewart B. Returning to play after prolonged training restrictions in professional collision sports. International journal of sports medicine. 2020 May 29.
  35. ↑ Memorial Health Care System. Return to Sport in a time of COVID-19. Available from https://www.youtube.com/watch?v=PJSKJS8chys (last accessed 29 October 2020)
  36. ↑ The Aspen Institute. Coronavirus and Youth Sports: How Should Youth Sports Return to Play? Available from https://www.youtube.com/watch?v=x8rnND2F9Pc (last accessed 29 October 2020)
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