Symptom cluster is associated with prolonged return-to-play in symptomatic athletes with acute respiratory illness (including COVID-19): a cross-sectional study—AWARE study I

Abstract

Background

There are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP).

Objective

To determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes with other ARI.

Design

Cross-sectional descriptive study.

Setting

Online survey.

Participants

Athletes with confirmed/suspected COVID-19 (ARI _COV) (n=45) and athletes with other ARI (ARI _OTH) (n=39).

Methods

Participants recorded days to RTP and completed an online survey detailing ARI symptoms (number, type, severity and duration) in three categories: ‘nose and throat’, ‘chest and neck’ and ‘whole body’. We report the association between symptoms and RTP (% chance over 40 days) and compare the days to RTP and symptoms (number, type, duration and severity) in ARI _COV versus ARI _OTH subgroups.

Results

The symptom cluster associated with more prolonged RTP (lower chance over 40 days; %) (univariate analysis) was ‘excessive fatigue’ (75%; p<0.0001), ‘ chills’ (65%; p=0.004), ‘ fever’ (64%; p=0.004), ‘ headache’ (56%; p=0.006), ‘altered/loss sense of smell’ (51%; p=0.009), ‘ Chest pain/pressure’ (48%; p=0.033), ‘ difficulty in breathing’ (48%; p=0.022) and ‘ loss of appetite’ (47%; p=0.022). ‘ Excessive fatigue’ remained associated with prolonged RTP (p=0.0002) in a multiple model. Compared with ARI _OTH, the ARI _COV subgroup had more severe disease (greater number, more severe symptoms) and more days to RTP (p=0.0043).

Conclusion

Symptom clusters may be used by sport and exercise physicians to assist decision making for RTP in athletes with ARI (including COVID-19).