15/06/2020 12:00 AM

Aspetar clinical guideline on return to sport

Guideline	Date	Editor	PDF file
Aspetar Clinical Guidelines : Safe Return to Sport during the COVID-19 Pandemic (2020)	June 2020	Guidelines Development Group	Download PDF

 

While the Eredivisie and Ligue 1 decided to pull the plug on their campaign, other top European teams are considering an appropriate date to resume training, and the Bundesliga is set to restart behind closed doors this week. It will be the first league to return after lockdown in Europe.

Many sport clubs from different sports have announced their return to sports training after players trained individually for over two months during the COVID-19 lockdown measures. Significant uncertainty exists over safe return to football training and competition in a world gripped with the reality of the COVID-19 pandemic; the Bundesliga could well provide some clarity on that in the near future.

The Aspetar Clinical Guidelines and Pathway Committee (ACGPC), chaired by Dr Paul Dijkstra, established a Guideline Development Group (GDG) to produce updated guidelines and pathways for the safe return to sports training and competition during COVID-19.

"These guidelines will assist clubs and federations to plan for a safe return to sports training and competition when the current COVID-19 measures allow it. The GDG will regularly update the document as new evidence emerge"

said Dr. Emin Ergen, who is leading the GDG.

 

Is it the right time to return to competition?

But is it the right to return to sports training and competition? Members of the Aspetar COVID-19 return to sports GDG say that it depends on many factors that differ from one country and region to another, such as the prevalence of COVID-19 in a country/ region, the capacity of the health system, the individual risk profiles of the athletes and the pressure to resume play.

“Until there is an effective treatment or a vaccine, resuming training or competition will always bear a risk. This risk can of course be mitigated by the usual infection control measures, but at the end it all comes down to how much risk a country or an organisation is willing to take"

Dr.Olaf Schumacher from Aspetar said.

Some football clubs in Qatar resumed some form of training while complying with the Government’s current COVID-19 measures. While the Qatar Stars League has not yet made a formal decision in this regard, Aspetar through its National Sports Medicine Programme (NSMP) conducted several club doctors’ meetings providing recommendations on how to follow the Ministry of Public Health’s current recommendations to protect the health of the players, and medical and technical staff as much as possible.  Aspetar recommendation will provide best evidence based clinical guidelines and will be shared with the relevant stakeholders.

It isn’t entirely safe to play yet.

Manchester City star Sergio Aguero believes most players are "scared" to return to action in the Premier League amid the COVID-19 pandemic. A day earlier, Manchester City star Raheem Sterling and Newcastle player Dany Rose raised their concerns on social media channels, adding that family members had died after contracting COVID-19.

Aspetar psychologist Sofiane Souissi stressed that suspending seasons and canceling competitions could cause significant grief, stress, anxiety, frustration, and sadness for an athlete. It is completely normal that ‘Return To Play’ under the current circumstances might generate significant fear and worry of falling ill.

"The good news is that most athletes will be able to handle the stress and anxiety and build on existing coping resources. However, we can expect that some will struggle and might need further support"

One of Aspetar’s recommendations to be published will stipulate additional mental health support measures for athletes by sports medicine providers.  These measures might include regular check-ins with athletes, facilitating consultation with a psychologist, and encouraging maintenance of social support and interactions with family, friends, and teammates.

 Are you ready?

Many rightly ask, “How can the athletes be fit for returning to competition after almost two months of modified training while staying home?” The Aspetar guideline will provide some direction:

"Athletes’ ability to return to competition will depend largely on the type of sport and the quality of the home training they were able to do. In Sports like cycling, it is likely that athletes can perform training sessions that mimic the demands of competition (indoor cycling/e-races/smart trainers) and maintain levels of training similar to the pre-COVID-19 situation, therefore, the return to training and competition may be relatively easier and smoother"

comment Dr Marco Cardinale, executive director of Research and Scientific Support at Aspetar.

 

In sports with reduced access to appropriate facilities (e.g. Aquatics/Gymnastics/Court and pitch sports), one can assume that normal intensity training has been reduced or absent for at least 4 weeks or longer.  These athletes will unfortunately experience a reduction in strength, power, speed and endurance as a result and home training might mitigate this to a certain extent. 

The Aspetar team explained that athletes and coaching staff will need to plan a progressive return to training and competition very similar to pre-season training or return to training after an injury. It is likely that technical and tactical skills as well as the ability to control contrasts and one to one situation will be reduced and therefore a cautious, progressive approach to return to training and competition is needed. This requires a detailed, individualised approach and an assessment of each athlete's status when training resumes. These measures will all contribute to reduce the risk of injury.

The return to training and competition will be exciting and pressure to speed up the return to competition fitness will be high. Athletes and coaches need to be mindful of the risk of training overload and over-exposure to certain high-speed technical movements.

Evidence -Based recommendations

The Aspetar Clinical Guidelines published in June, with many specific recommendations related to return to training, including general considerations related to indoor training where physical distancing is even more important, and guidelines on how to reduce the risk of infection, including the proper cleaning of gym- and other equipment.

The approach to training should focus on ‘get in, train, get out’, keeping in mind physical distancing and minimizing unnecessary contact in changing rooms, bathrooms and shared areas. The training content and activity depends on the phase: individual training with 1-2 players, group training with less than 8 players or full team training phase (11v11 players). Clubs and individuals should apply a graded return to football to mitigate injury risk and understanding that sudden increase in training load will predispose to injury.

Appropriate hydration during and after training is important—drinks   bottles must be available, but with physical distancing in mind. Each bottle should be clearly labelled to avoid confusion.    

Players should comply with the current Government regulations on masks. It is now compulsory to ALWAYS wear a mask when leaving the house in Qatar—also during sports training. Players should leave the hotel wearing their training kit, and there should be a clean kit laid out for them to travel back and to the hotel after their session if necessary.

A number of individuals from different Aspetar and Aspire departments representing different specialties are formulating the COVID-19 return to sport guidelines as a reference for the sports healthcare practitioners and different sports clubs in Qatar.

Aspetar launched its Covid-19 Evidence for Athletes Service in early April. This unique platform provides athletes and those involved in athlete health care with evidence-based information on the Covid-19 pandemic.

 

About Aspetar:

Aspetar is a world leading specialised orthopaedic and sports medicine hospital, and the first of its kind in the Middle East. Since 2007, with a world expert team, the hospital has provided top-level comprehensive medical treatment to all athletes in a state-of-the-art facility that sets new standards internationally.

In 2009, Aspetar was accredited as a “FIFA Medical Centre of Excellence”. In 2013, Aspetar was adopted as a reference collaborator centre by the Gulf Countries Council (GCC) Health Ministers Council and “IOC Research Centre for Prevention of Injury and Protection of Athlete Health” in 2014.

In 2015, Aspetar has been recognised as the “IHF Reference Centre for Athlete and Referee Health”.  In 2017, Aspetar was awarded World Health Organization’s Patient Safety Friendly Hospital-Level 3 designation.

In 2018, Aspetar – Orthopaedic and Sports Medicine Hospital was officially awarded Diamond Level accreditation status by Accreditation Canada. This is the highest level of accreditation award possible under the program and awarded to highly committed and quality-oriented organizations that monitor outcomes, use evidence and best practice to improve services.  Aspetar is now the first hospital in the State of Qatar to be awarded this coveted Diamond Level Status. Aspetar is a member–organisation of Aspire Zone Foundation, Qatar’s innovative sports and healthy lifestyle destination.