Snyders, CaroletteDyer, MarliseSewry, Nicola AnnJordaan, EsmeSchwellnus, Martin Peter2025-01-202025-01-202024-05Snyders, C., Dyer, M., Sewry, N., Jordaan, E. & Schwellnus, M. 2024, 'Increased number of symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with prolonged time to return to full sports performance—AWAREVIII', Journal of Sport and Health Science, vol. 13, no. 3, pp. 280-287, doi : 10.1016/j.jshs.2023.10.005.2095-2546 (print)2213-2961 (online)10.1016/j.jshs.2023.10.005http://hdl.handle.net/2263/100184PURPOSE : The aim of the study was to identify factors associated with prolonged time to return to full performance (RTFP) in athletes with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS : Prospective cohort study with cross sectional analysis. A total of 84 athletes with confirmed SARS-CoV-2 infection assessed at a coronavirus disease 2019 recovery clinic gave a history of age, sex, type/level of sport, co-morbidities, pre-infection training hours, and 26 acute SARS-CoV-2 symptoms from 3 categories ("nose and throat", "chest and neck", and "whole body"/systemic). Data on days to RTFP were obtained by structured interviews. Factors associated with RTFP were demographics, sport participation, history of co-morbidities, pre-infection training history, and acute symptoms (type, number). Outcomes were: (a) days to RTFP (median, interquartile range (IQR)) in asymptomatic (n = 7) and symptomatic athletes (n = 77), and (b) hazard ratios (HRs; 95% confidence interval) for symptomatic athletes with vs. without a factor (univariate, multiple models). HR < 1 was predictive of higher percentage chance of prolonged RTFP. Significance was p < 0.05. RESULTS : Days to RTFP were 30 days (IQR: 23-40) for asymptomatic and 64 days (IQR: 42-91) for symptomatic participants (p > 0.05). Factors associated with prolonged RTFP (univariate models) were: females (HR = 0.57; p = 0.014), endurance athletes (HR = 0.41; p < 0.0001), co-morbidity number (HR = 0.75; p = 0.001), and respiratory disease history (HR = 0.54; p = 0.026). In symptomatic athletes, prolonged RTFP (multiple models) was significantly associated with increased "chest and neck" (HR = 0.85; p = 0.017) and "nose and throat" (HR = 0.84; p = 0.013) symptoms, but the association was more profound between prolonged RFTP and increased total number of "all symptoms" (HR = 0.91; p = 0.001) and "whole body"/systemic (HR = 0.82; p = 0.007) symptoms. CONCLUSION : A larger number of total symptoms and specifically "whole body"/systemic symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with prolonged RTFP.en© 2024 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)AthletesPerformanceRecoveryCOVID-19 pandemicCoronavirus disease 2019 (COVID-19)Return to full performance (RTFP)Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)SDG-03: Good health and well-beingArticle