Return to Activity After SARS-CoV-2 Infection: Cardiac Clearance for Children and Adolescents

Devyani Chowdhury, Michael A. Fremed, Peter Dean, Julie S. Glickstein, Jeff Robinson, Neil Rellosa, Deepika Thacker, David Soma, Susannah M. Briskin, Chad Asplund, Jonathan Johnson, Christopher Snyder

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Context: Sedentary behavior and inability to participate in organized physical activity has negatively affected the physical and mental health of children and adolescents; however, cardiac injury and associated risk for sudden cardiac death with return to activity remains a major concern. Guidelines have been proposed for return to activities; however, these fail to address the needs of younger children and those participating in more casual activities. Guidance is needed for primary care providers to facilitate safe return to everyday activity and sports and to help direct appropriate laboratory, electrocardiographic, and anatomical assessment. Evidence Acquisition: Review of computerized databases of available literature on SARS-CoV-2 infection in children and postinfection sequelae, risk factors for sudden cardiac death, and previous return to play recommendations. Study Design: Clinical guidelines based on available evidence and expert consensus. Level of Evidence: Level 4. Results: In this report, we review the literature on return to activity after SARS-CoV-2 infection and propose recommendations for cardiac clearance for children and adolescents. Though severe disease and cardiac injury is less common in children than in adults, it can occur. Several diagnostic modalities such as electrocardiography, echocardiography, cardiac magnetic resonance imaging, and serologic testing may be useful in the cardiac evaluation of children after SARS-CoV-2 infection. Conclusion: Gradual return to activity is possible in most children and adolescents after SARS-CoV-2 infection and many of these patients can be cleared by their primary care providers. Providing education on surveillance for cardiopulmonary symptoms with return to sports can avoid unnecessary testing and delays in clearance.

Original languageEnglish (US)
Pages (from-to)460-465
Number of pages6
JournalSports Health
Issue number4
StatePublished - Jul 2022


  • COVID-19
  • MIS-C
  • cardiac injury
  • myocarditis
  • return to play
  • sports clearance

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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