Resumption of sport post-Covid – Docdusport

The COVID 19 disease is a pandemic that will soon enter its third year. We can see from this screenshot from the Johns Hopkins Institute taken in September that about 1,700,000 people have been affected by the disease.

By Doctor Jean ISRAEL, sports cardiologist and Doctor Colette NORDMANN, health cycling doctor at the FFC

It is certain that vaccination has considerably reduced both the transmission of the virus and the severity of the attacks. We should also note the progress made in management, somewhat erratic in the initial period, of ignorance of this new condition.

It is no less true that, in a certain number of cases, sequelae, respiratory, cardiac and muscular damage risk hampering recovery once the acute period has passed in patients in remission.

The severity of the attacks linked to the disease depends a lot on the terrain, carriers of chronic pathologies, immunocompromised, higher age group. However, it is not uncommon to observe attacks with recovery difficulties in younger subjects. There is then a limitation to the resumption of physical activity which can last for several weeks.

Finally, a new pathology has appeared, commonly called “Long COVID”, the subject of study by researchers and in the process of being dismembered.

Subjects complain of variable and lasting manifestations, weeks or even months after the initial viral attack.

The manifestations reported are essentially chronic fatigue, exercise intolerance, and sometimes chest pain.

Analyze symptoms

Once any respiratory, cardiac or neurological sequelae have been eliminated, conventional complementary examinations do not find any specific elements likely to explain it. In a certain number of cases there is the weight of a more or less prolonged deconditioning, in interference with a deconditioning related to a lack of physical practice during the acute period.

However, this does not explain this fatigue and this limit to the efforts that these patients can essentially endure. One of the hypotheses invoked would be the disturbance of the neurovegetative system which regulates the level of activity of individuals.

The figure above shows the close relationship between the initial respiratory attack and its spread to the rest of the body. It illustrates the vicious circle engendered by multivisceral damage and the impact on the heart, an impact which itself will increase the severity of the disease.

This viral attack will be all the more marked when the subject is old, when he presents the cardiovascular risk factors represented by overweight, arterial hypertension or diabetes. The other aggravating factor is a drop in the immune system, often linked, apart from specific drug intake, to a disturbance of the microbiota, that is to say of the intestinal flora; microbiota which is of major importance in our metabolism. The attack at the cardiological level will be favored in the event of pre-existing pathology. These are coronary diseases, linked to cholesterol deposits in the arteries. These obstructions are likely to destabilize during the acute period, with a risk of infarction multiplied by three the first week, depending on the intensity of the inflammatory phenomenon, with an increased metabolic demand, the direct action of the virus, the attacks coagulation, the release of excess inflammatory molecules (pro-inflammatory cytokines) and the lack of oxygen linked to lung damage. Thus, an already impaired myocardial function, due to a pre-existing pathology, will be likely to decompensate under such conditions.

Coagulation disorders generated by inflammation are likely to be the cause of phlebitis and pulmonary embolisms, which will aggravate the cardiac condition and general condition.

More particularly in the world of sport there is the fear of developing heart muscle damage or myocarditis.

Watch his heart

This type of inflammatory heart condition is not unique to COVID and can be found in different circumstances and other viral conditions. The risk is to develop heart rhythm disorders, even sudden death in very serious forms (9% of sudden deaths in athletes) or to cause dilation with fatigue of the heart in its chronic form. Myocardial involvement may go completely unnoticed. But it can also be an extremely painful form simulating a myocardial infarction.

Myocarditis will be systematically eliminated before resuming sporting activity, whether competitive or not.

The table above describes the recommendations intended for doctors with a view to resuming cycling: the nature of these examinations is correlated with the absence or absence of clinical manifestations. The clinical recovery medical examination is the basis of the decision. It will most often be associated with an electrocardiogram, which becomes mandatory in the event of clinical manifestations (as opposed to a totally asymptomatic systematic screening).

Depending on the results, a cardiac ultrasound will be proposed.

In cases of suspected myocardial involvement, a myocardial MRI will be prescribed.

These recommendations are in line with those of the Club des Cardiologues du Sport in the face of any suspicion of viral infection associated with a febrile episode.

All in all, COVID is a particular condition, very contagious especially in its variants, which can take variable forms ranging from the total absence of manifestations, through a more or less intense flu-like syndrome, even to serious forms requiring appropriate care in the intensive care unit.

Whatever the form adopted by the disease, it is essential, once a medical risk has been eliminated, to resume cycling in all its forms in endurance, associated with muscle reinforcement and flexibility.

Getting back on the bike with peace of mind

The exercise bike, through a gradual effort of increasing intensity, is certainly the ideal tool for resuming a cycling activity in restrictive forms, prior to resuming a more complete activity in the discipline of cycling. .

It can continue in a second time, especially if the physiological muscular functions or the tiredness impose it, by the use of the VAE.

Whether they are utility/urban type, multi-purpose road and path, or downright VTTAE, pedelecs provide electric assistance to all types of bicycles, tandems, tricycles, recumbent bicycles, etc.

Because the VAE is first and foremost a bicycle, it is necessary to pedal to be able to benefit from the electric assistance. It therefore makes it possible to apprehend the effort in an assisted mode by taking into account the physical condition of the moment. Above all, the VAE makes it possible to preserve the benefits of the sport carried and to bring into play in a progressive and adapted way the mechanics of pedaling.

The performance of the engine makes the weight of the VAE negligible. It smooths out unevenness, reduces the impact of the wind and offers « à la carte » exercise rehabilitation, according to the cyclist’s feelings or the doctor’s prescription. It assists cardiac function smoothly, where endurance effort is required, allowing the gradual reintroduction of aerobic and then anaerobic metabolisms in a more programmable way than on a conventional bicycle.

In the post-Covid and long Covid context, when we see a loss of muscular and physiological capacities witnessing a disadaptation to the effort, the VAE represents the ideal tool which allows the cyclist to pass the course at his own pace. retraining. Well taken care of for several months, and sometimes almost a year, the improvement is most often favorable for, in the long term, reinvesting the initial sporting level.