Return to sports after infection: Exercise Infection Recovery

Table of Contents

  1. Slidedeck
  2. References
  3. One-Minute-Paper Topics

Slidedeck

Contents of this lecture can be found in the Slidedeck.

References

  • Haunhorst, S. et al. Current return to sports recommendations after non-severe COVID-19 from an exercise immunology perspective: A scoping review. Sports Orthop. Traumatol. 39, 378–388 (2023).
  • Elliott, N. et al. Infographic. Graduated return to play guidance following COVID-19 infection. Brit J Sport Med 54, 1174–1175 (2020).
  • Diaz, D. et al. A composite symptoms severity score based on survey self-reports as a predictor of SARS-CoV-2 infection and viral load. BMC Infect. Dis. 25, 1116 (2025).

One-Minute-Paper Topics

A One-Minute-Paper (OMP) is a short, focused prompt that students answer in ~60 seconds at the end of a session to consolidate learning, surface misconceptions, and provide formative feedback. When answering, be concise, specific, and use terminology from today’s session.

  1. What is the Exercise Infection Recovery Questionnaire (EIRQ) and what clinical purpose does it serve?
  2. Describe the scoping review rationale from Haunhorst et al. (2023): what gap in return-to-sport evidence did it address?
  3. Explain the graduated return-to-play protocol by Elliott et al. (2020): how many stages does it contain, and what is the criterion for progressing between stages?
  4. Why is a symptom severity scoring approach (Diaz et al. 2025) used in conjunction with the EIRQ rather than a simple symptom checklist?
  5. Define post-exertional malaise (PEM) and explain why it is a critical contraindication to premature return-to-sport after infection.
  6. What immunological time windows justify a minimum rest period of 10 days after SARS-CoV-2 infection before resuming structured training?
  7. Describe the “below-the-neck” rule: which symptoms trigger it, and what does it mandate in terms of rest?
  8. Explain how the EIRQ integrates subjective symptom reports with objective recovery indicators in a clinical decision workflow.
  9. What role does resting heart rate or heart rate variability play as a monitoring parameter during post-infection recovery?
  10. Name three red-flag symptoms after infection that would warrant medical investigation before any exercise resumption.
  11. How would you counsel an athlete who insists on returning to competition after 5 symptom-free days following a moderate COVID-19 infection?
  12. Describe the composite symptom severity score from Diaz et al. (2025): what domains does it cover and how is the total score interpreted?
  13. What is the clinical rationale for a stepped, criterion-based return-to-sport approach versus a fixed calendar-based protocol?
  14. Explain how silent organ complications (myocarditis, pulmonary dysfunction) can be missed without a systematic EIRQ evaluation.
  15. How should a sports medicine practitioner modify the return-to-sport protocol for an athlete with a history of Long COVID or ME/CFS?
  16. What distinguishes “return to training” from “return to competition” in the context of post-infection management?
  17. Describe one scenario from the case-study approach used in this lecture and identify the key decision point you found most instructive.
  18. Why cannot a graded exercise therapy (GET) approach be applied to athletes with post-exertional malaise?
  19. Which aspect of the EIRQ workflow was most surprising or clinically useful to you, and why?
  20. Formulate one question about post-infection exercise decision-making that you would like to investigate further.