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While experts' understanding of COVID-19 evolves, it is clear that many patients continue to have symptoms, obvious or subtle, following infection. And while not every athlete with COVID-19 will experience myocarditis, it’s dangerous enough to make doctors take notice.

\"Myocarditis is a very rare but serious complication of COVID,\" Bhave said. \"Patients with COVID myocarditis really should be managed at a high-level center [with the proper equipment], because these patients can go south fast.\"

Guidance for athletes

The new ACC guidance suggests that it is safe for athletes with no symptoms from COVID-19 to return to exercise three days following self-isolation. For those with mild symptoms not involving the heart or lungs, it is safe to return to exercise once symptoms resolve.

Athletes suffering from persistent chest pain, palpitations or passing out require further cardiac testing. If the findings are concerning for myocarditis, the ACC recommends abstinence from exercise for three to six months.

\"We don’t think that a routine MRI is needed for everyone who has had COVID before they start exercising again,\" Bhave said.

If an athlete has persistent symptoms, Bhave said, \"One of the recommendations that we’re making in the document is that people engage in recumbent exercise, so rather than trying to walk, doing something where they’re actually sitting down, so that orthostatic intolerance [the inability to tolerate quick movements] isn’t a big deal.\"

\"PHOTO:
STOCK IMAGE/Getty Images
PHOTO: People run on treadmills in a gym.
>

For athletes who experience long-haul COVID-19 symptoms, the recovery process can be frustrating.

\"You’re essentially seeing someone who has had a decade and a half, maybe even two decades, of unrestricted sports participation and unlimited exercise capacity who now has severe limitations,\" Singh said. \"They’re losing not only their physical connection to self, but also their social connection to their community, which can be really mentally devastating.\"

Singh and Bhave both said that re-introduction of exercise following infection should be gradual, starting with small amounts and increasing frequency, duration and intensity as tolerated.

\"It’s important as physicians to say, ‘Hey, I’m here with you, and I know you’re still not back to where you were. I share your frustration and I’m not going to abandon you,'\" Bhave said. \"We still have a lot to learn, and I think that’s a message that is very helpful to patients who are feeling frustrated.\"

Nicholas P. Kondoleon, M.D., is an internal medicine resident at Cleveland Clinic and a contributor to the ABC News Medical Unit.

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