Return to Exercise after COVID-19

boys playing soccer

As students return to school, parents of children who had contracted COVID-19 may have concerns about their child participating in physical education, organized sports or moderate/vigorous play.

First, it is important for parents to understand that the risks and benefits of children who had COVID-19 participating in athletics are continuously being evaluated by the American Academy of Pediatrics, American College of Cardiology and health care professionals.

Parents are often concerned that their child will develop cardiac symptoms, though the likelihood is very low. However, your child should be assessed by their primary care provider (PCP) before returning to exercise.

Your child’s PCP will provide guidance based on how severe your child’s COVID-19 infection was.

The guidelines for returning to exercise include:

  • Asymptomatic: Children without symptoms should not exercise for a 10-day period following a positive COVID-19 test. Your child should be cleared for gradual return to exercise by their PCP and referred to Pediatric Cardiology if necessary.
     
  • Mild: Children with mild symptoms (fever for less than 4 days or systemic symptoms lasting less than 1 week) should not exercise for a 10-day period once they have no symptoms. They should be cleared for gradual return to exercise by their PCP and referred to Pediatric Cardiology if necessary.
     
  • Moderate: Children with moderate symptoms (fever for 4 or more days or systemic symptoms lasting 1 week or more) should not exercise for a 10-day period once they have no symptoms. They should be cleared for gradual return to exercise by their PCP, including an in-person evaluation with electrocardiogram (ECG) and referred to Pediatric Cardiology if necessary, based upon that evaluation.
     
  • Severe: Children with severe illness (hospitalization or multisystem inflammatory syndrome – a condition where different parts of the body can become inflamed, including the heart, lungs and kidneys – also known as MIS-C) should be evaluated and cleared for gradual return to exercise by Pediatric Cardiology. Those with MIS-C will likely be treated as though they have heart inflammation (myocarditis) and restricted from all forms of exercise for 3-6 months.

All children who have had COVID-19 should gradually return to exercise and stop if any symptoms develop.

In the event that your child exhibits concerning symptoms such as new or unexplained chest pain, palpitations, dizziness, fainting or unexpected shortness of breath, please contact their PCP immediately.

It is important to keep in mind that each week off from exercise results in the loss of several weeks of conditioning, so it is likely your child will experience some loss of muscle strength and/or energy when they do start to exercise again.