What are the recommendations for returning athletes who have experienced long term COVID-19 symptoms?

Rosie Lindsay, Jason Wilson, Mike Trott, Olawale Olanrewaju, Mark Tully, Guillermo F López-Sánchez, Jae Il Shin, Damiano Pizzol, Peter Allen, Laurie Butler, Yvonne Barnett, Lee Smith

Research output: Contribution to journalReview articlepeer-review

18 Citations (Scopus)
77 Downloads (Pure)


Currently, there is limited research reporting the symptoms of long COVID among athletes, and the recommendations for athletes returning to competition/training who have experienced long COVID symptoms. Therefore, the aim of this systematic review is to synthesise the recommendations for returning athletes who have experienced long COVID symptoms. The protocol was registered in PROSPERO under CRD42021265939. Two authors searched the electronic databases PubMed, Embase, Scopus, the Cochrane Library, Web of Science, CINAHL, PsycINFO, and SPORTDiscus from August 2019-July 2021. Search terms included words related to “long COVID”, “athlete” and “return”. Data extraction was completed for each study by two independent investigators for: (1) first author name; (2) year of publication; (3) journal; (4) Definition of athlete (i.e. elite or non-elite) (5) Recommendations reported. A total of 220 records were found. Following title and abstract screening, 61 studies were eligible for full text screening. Overall, no studies, commentaries, editorials or reviews provided specific recommendations for “long COVID” defined as COVID-19 signs and symptoms lasting for over 4 weeks as a result of COVID-19 infection. In addition, we found no studies which reported symptoms of athletes suffering from long COVID. Despite the lack of evidence, we did find eight separate professional recommendations for managing “long-term effects” and “ongoing” or “prolonged” symptoms and COVID-19 complications among athletes. Practitioners should be aware of both mental and physical symptoms of long COVID, and additional considerations may be required for athletes who have undergone intensive care. The present review provides a list of recommendations based on existing literature that may be followed and implemented for returning athletes.

Further research, including longitudinal research of athletes who have tested positive for COVID-19, is required to develop evidenced-based guidelines for athletes with ongoing COVID-19 symptoms.

Prior to returning to play after COVID-19 infection, a thorough medical history, physical and psychological examination should be conducted by a medical professional.

Athletes should continue to monitor and record their own physical and psychological markers of health.
Original languageEnglish
Pages (from-to)1935-1944
Number of pages10
JournalAnnals of Medicine
Issue number1
Early online date2 Nov 2021
Publication statusPublished (in print/issue) - Dec 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • Athletes
  • physical activity
  • long-COVID
  • COVID-19
  • rehabilitation
  • return to play
  • recommendations


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