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AAP Updates Guidance for Return to Sports and Physical Activities

As pandemic restrictions ease and young athletes once again take to fields, courts, tracks, and rinks, doctors are sharing ways to help them get back to sports safely.

That means taking steps to prevent COVID-19.

It also means trying to avoid sports-related injuries, which may be more likely if young athletes didn’t move around so much during the pandemic.

For adolescents who are eligible, getting a COVID-19 vaccine may be the most important thing they can do, according to the American Academy of Pediatrics (AAP).

“The AAP encourages all people who are eligible to receive the COVID-19 vaccine as soon as it is available,” the organization wrote in updated guidance on returning to sports and physical activity.

“I don’t think it can be overemphasized how important these vaccines are, both for the individual and at the community level,” says Aaron L. Baggish, MD, an associate professor of medicine at Harvard Medical School and director of the Cardiovascular Performance Program at Massachusetts General Hospital in Boston.

Baggish, team cardiologist for the New England Patriots, the Boston Bruins, the New England Revolution, US Men’s and Women’s Soccer, and US Rowing, as well as medical director for the Boston Marathon, has studied the effects of COVID-19 on the heart in college athletes and written return-to-play recommendations for athletes of high school age and older.

“Millions of people have received these vaccines from age 12 up,” Baggish says. “The efficacy continues to look very durable and near complete, and the risk associated with vaccination is incredibly low, to the point where the risk-benefit ratio across the age spectrum, whether you’re athletic or not, strongly favors getting vaccinated. There is really no reason to hold off at this point.”

While outdoor activities are lower-risk for spreading COVID-19 and many people have been vaccinated, masks still should be worn in certain settings, the AAP notes.

“Indoor spaces that are crowded are still high-risk for COVID-19 transmission. And we recognize that not everyone in these settings may be vaccinated,” says Susannah Briskin, MD, lead author of the AAP guidance.

“So for indoor sporting events with spectators, in locker rooms or other small spaces such as a training room, and during shared car rides or school transportation to and from events, individuals should continue to mask,” adds Briskin, a pediatrician in the Division of Sports Medicine and fellowship director for the Primary Care Sports Medicine program at University Hospitals Rainbow Babies & Children’s Hospital.

For outdoor sports, athletes who are not fully vaccinated should be encouraged to wear masks on the sidelines and during group training and competition when they are within 3 feet of others for sustained amounts of time, according to the AAP.

Get Back Into Exercise Gradually

In general, athletes who have not been active for more than a month should resume exercise gradually, Briskin says. Starting at 25% of normal volume and increasing slowly over time — with 10% increases each week — is one rule of thumb.

“Those who have taken a prolonged break from sports are at a higher risk of injury when they return,” she notes. “Families should also be aware of an increased risk for heat-related illness if they are not acclimated.”

Caitlyn Mooney, MD, a team doctor for the University of Texas at San Antonio, has heard reports of doctors seeing more injuries like stress fractures. Some cases may relate to people going from “months of doing nothing to all of a sudden going back to sports,” says Mooney, who is also a clinical assistant professor of pediatrics and orthopedics at UT Health San Antonio.

“The coaches, the parents, and the athletes themselves really need to keep in mind that it’s not like a regular season,” Mooney says. She suggests gradually ramping up activity and paying attention to any pain. “That’s a good indicator that maybe you’re going too fast,” she adds.

Athletes should be mindful of other symptoms too when restarting exercise, especially after illness.

It is “very important that any athlete with recent COVID-19 monitor for new symptoms when they return to exercise,” says Jonathan Drezner, MD, a professor of family medicine at the University of Washington in Seattle. “A little fatigue from detraining may be expected, but exertional chest pain deserves more evaluation.”

Drezner — editor-in-chief of the British Journal of Sports Medicine and team doctor for the Seattle Seahawks — along with Baggish and colleagues, found a low prevalence of cardiac involvement in a study of more than 3000 college athletes with prior SARS-CoV-2 infection.

“Any athlete, despite their initial symptom course, who has cardiopulmonary symptoms on return to exercise, particularly chest pain, should see their physician for a comprehensive cardiac evaluation,” Drezner says. “Cardiac MRI should be reserved for athletes with abnormal testing or when clinical suspicion of myocardial involvement is high.”

If an athlete had COVID-19 with moderate symptoms (such as fever, chills, or a flu-like syndrome) or cardiopulmonary symptoms (such as chest pain or shortness of breath), cardiac testing should be considered, he notes.

These symptoms “were associated with a higher prevalence of cardiac involvement,” Drezner said in an email. “Testing may include an ECG, echocardiogram (ultrasound), and troponin (blood test).”

For kids who test positive for SARS-CoV-2 but do not have symptoms, or their symptoms last less than 4 days, a phone call or telemedicine visit with their doctor may be enough to clear them to play, says Briskin, who’s also an assistant professor of pediatrics at Case Western Reserve University School of Medicine.

“This will allow the physician an opportunity to screen for any concerning cardiac signs or symptoms, update the patient’s electronic medical record with the recent COVID-19 infection, and provide appropriate guidance back to exercise,” she adds.

Baggish, Briskin, Mooney, and Drezner had no relevant financial disclosures.

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This post originally appeared on Medscape Medical News Headlines

AP-NORC Poll: Many Americans Resuming Pre-Virus Activities

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

MEMPHIS, Tennessee (AP) — Many Americans are relaxing precautions taken during the COVID-19 pandemic and resuming everyday activities, even as some worry that coronavirus-related restrictions were hastily lifted, a new poll shows.

The poll from The Associated Press-NORC Center for Public Affairs Research finds that majorities of Americans who were regularly doing so before the pandemic say they are returning to bars or restaurants, traveling, and attending events such as movies or sports.

Just 21% are very or extremely worried about a COVID-19 infection in their inner circle — the lowest level since the pandemic began — and only 25% are highly concerned that the lifted restrictions will lead to additional people being infected in their community.

Andrea Moran, a 36-year-old freelance writer and mother of two boys, said she feels both relief and joy at the chance to resume “doing the little things,” such as having drinks on a restaurant patio with her husband.

“Honestly, I almost cried,” Moran said. “It’s such a feeling of having been through the wringer, and we’re finally starting to come out of it.”

Still, 34% of Americans think restrictions in their area have been lifted too quickly, while somewhat fewer — 27% — say they were not lifted quickly enough. About 4 in 10 rate the pace of reopening about right.

The way Americans approached their daily lives suddenly changed after COVID-19 spread through the US in early 2020. Following the advice of health officials and governments, people isolated in their homes — either alone or with families — to avoid exposure to the virus, which has sickened more than 33 million people and killed 600,000 people in the US.

During the height of the pandemic, restaurants, movie theaters, and stores either closed or continued operating with limited occupancy; church services, schools, and government meetings went virtual; and many employers made working from home an option or a requirement. Mask wearing in public became the norm in most places, with some states and cities making it mandatory.

The emergence of the vaccine has helped slow down rates of infection and death, allowing state and local economies to reopen and leading Americans to return to activities they once enjoyed.

The Centers for Disease Control and Prevention advised last month that fully vaccinated Americans don’t have to wear a mask in most scenarios, indoors or out. The latest CDC data shows 53% of all Americans — 65% of those 18 and older — have received at least one dose of the vaccine.

According to the AP-NORC poll, American adults who have not yet rolled up their sleeves for the shot remain hesitant to do so. Just 7% of those who have not been vaccinated say they definitely will get a COVID-19 vaccine, and 15% say they probably will.

Forty-six percent of Americans who have not been vaccinated say they will definitely not get a vaccine, and 29% say they probably will not. Young adults, Americans without a college degree, white evangelicals, rural Americans, and Republicans are most hesitant to get vaccinated.

The poll finds many Americans are still wearing masks and taking precautions to avoid contact with other people, but the percentage of those doing so is down significantly from just a few months ago.

In late February, 65% said they were always wearing a mask around people outside their households. Now, just 37% say so, though 19% say they often wear one.

Forty percent of Americans say they are extremely or very likely to wear a mask when participating in indoor activities outside their homes, while just 28% say the same about outdoor activities.

Aaron Siever, 36, of New Market, Virginia, said he and his wife have consistently worn masks and taken other precautions, including getting vaccinated. But Siever said virus-related restrictions were not lifted quickly enough, lamenting that some precautions were politicized and caused an “inherent panic.”

“I think with masks being worn and people getting vaccinated, I think we could have opened a little earlier,” said Siever, who maintains the grounds of Civil War battlefields in Virginia. “We started focusing on the politics of reopening, rather than the health.”

Now that most states have lifted restrictions, the poll finds about two-thirds of Americans who used to travel at least monthly say they will do so in the next few weeks. About three-quarters of frequent restaurant or bar-goers before the pandemic say they will now return. A year ago, only about half said they would travel or go to restaurants if they could.

Likewise, more are returning to activities such as visiting friends and family, seeing movies or concerts, attending sporting events, and shopping in-person for nonessential items.

In Cookeville, Tennessee, Moran said her family still regularly wears masks in public, especially when they are indoors or around a lot of people. Both she and her husband have been vaccinated. Moran said she has eaten at outdoor restaurants, but she is avoiding indoor dining.

“Even if the air conditioning circulation is good, I just don’t feel comfortable right now going inside, where there’s a lot of people in fairly close proximity who I don’t know,” Moran said.

Moran said her family avoided nonessential travel during the height of the pandemic, canceling a trip to see her brother in Fort Lauderdale, Florida. But last weekend, the family traveled for the first time in more than a year — a roughly 3 1/2-hour road trip to Asheville, North Carolina, to visit a childhood friend.

“I felt a little bit nervous just because being around people is such a surreal thing after so long,” Moran said. “I was really excited and I was thrilled for my kids that they were able to get out and get back to some semblance of normality.”

The AP-NORC poll of 1125 adults was conducted June 10-14 using a sample drawn from NORC’s probability-based AmeriSpeak Panel, which is designed to be representative of the US population. The margin of sampling error for all respondents is plus or minus 4.2 points.

Hannah Fingerhut reported from Washington.

This post originally appeared on Medscape Medical News Headlines

Heart attack warning: Avoid certain activities if you have a heart condition

The British Heart Foundation (BHF) advises people diagnosed with a heart condition to “avoid strenuous everyday activities”. This can include carrying very heavy objects, heavy DIY, or digging in the garden. Highly competitive and vigorous sports, such as squash, may not be the best way to spend your time. Any activity that involves breath-holding, grunting or straining may put the heart under unnecessary pressure.

This tends to occur when lifting heavy weights, doing sit-ups, push-ups and chin-ups.

“This type of activity can be harmful as it causes a sudden rise in blood pressure,” the BHF explained.

For those who are adamant that they’d like to continue weight training, the BHF suggests you make sure you’re not holding your breath while doing so.

The charity also recommends avoiding “static exercises that require you to exert force against a fixed object”.

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Static exercises also include holding the body in a fixed position for a short period of time.

Examples include pushing against a wall, or holding a weight steady out to the side.

“If you’re taking medicines which lower your blood pressure, you should avoid sudden changes in posture,” the BHF cautioned.

This includes standing up very quickly, or suddenly moving from floor-based activities to standing, as it can cause dizziness.


It’s also advisable for people with heart conditions to extend their cool-down period after exercising.

This is because prescribed medication could cause your blood pressure to drop too low if you suddenly stop exercising.

“If you have high blood pressure, you should also avoid physical activity that involves lots of overhead arm work,” added the BHF.

For people who have recently had a heart attack or heart surgery, don’t be quick to cool off in a pool.

When exercising, the heart demands more oxygen, but the narrowed arteries can’t deliver enough oxygen-containing blood, hence chest pain arises.

“It is important to find out how much activity you can manage to do easily without getting your angina symptoms,” said the BHF.

This is because regular physical activity can improve angina symptoms if done in a sensible way.

The most ideal exercise recommended for people with angina is to walk more often.

This post originally appeared on Daily Express :: Health Feed
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