 How could contracting COVID-19 affect your cycling or other athletic endeavors even after recovery? This is what we're going to be getting into today by taking a look at the science, as well as discussing what returning to cycling should look like after a positive test, and some of the other side effects that athletes may be facing by simply living in the age of COVID, particularly on the mental side. Welcome back to another video. The topic of COVID can really split people at this point. Some are still taking it very seriously, not doing any group rides or races or cycling events, and then I'm sure there's plenty of you that are outright tired of hearing about it. I don't know what you're talking about, man. The COVID lockdowns were the best possible thing that could have happened to cycling. Finally, people stopped caring about actual bike racing and started respecting the only real cycling competitions that matter, chasing Strava KOMs and Zwift racing. Now, obviously for some people, the long-term effects of COVID may be much more dire than having difficulty riding your bike or not hitting the same FTP numbers when you start training again. But since this is a cycling channel, this is what we're going to focus on today. My goal with this video was to simply look at the evidence that we currently have available to us, which admittedly is not a lot because COVID is still so new. As always, I tried to go into the research for this video with as little bias as possible one way or the other and just follow the science. Keep in mind that I'm using the research that we currently have and all of it could change as our understanding of the virus is constantly evolving at a fast rate. When in doubt, follow the guidance of the WHO and the CDC. All right, let's go ahead and get into it. Could getting COVID affect your ability to ride or participate in any other sport for that matter? Let's start with what we know about the potential long-term effects of getting COVID. This review on COVID-19 and cardiac injury found that up to 20 to 30% of patients hospitalized with COVID-19 have evidence of myocardial involvement manifested by elevated troponin levels. There's likely to be a diverse response, but based on other studies of patients recovering from cardiac injury, it is expected that some patients will have subclinical and possibly overt cardiovascular abnormalities, putting them at a higher risk for further complications. This study from Wuhan confirms these findings stating that of 416 patients, cardiac injury occurred in nearly 20% of them during hospitalization. The potential long-term health implications here are obviously very serious, and given how important the heart and circulatory system are for endurance sports, it's not far fetched to think that COVID may have an adverse effect on one's ability to ride. But these studies were looking at hospitalized individuals, which are the people who are hit the hardest from the virus. For fit and healthy individuals, which cyclists tend to be, is there as much of a risk of long-term complications? This research letter shares findings made by looking at the hearts of college athletes recovering from COVID and found that 15% had signs of myocarditis, or inflammation of the heart muscle. Myocarditis can cause the heart muscle to weaken, which is not good news if you're an endurance athlete who relies heavily on your heart to pump blood to the working muscles. And that 15% figure is a bit alarming, especially since this was in a population of college athletes, and we know that for older individuals, the virus can be even more vicious. This study again looking at college student athletes recovering from COVID found that of the subjects who all tested positive for COVID, 30% were asymptomatic, 66% had mild symptoms, and only 4% had moderate symptoms. So obviously this is a very young and healthy group of individuals here, as most of them dealt with the virus fairly easily. However, using CMR to look at their hearts, almost 40% saw signs of pericardial inflammation or inflammation around the heart. This being said, no athletes showed significant imaging features to suggest an ongoing myocarditis. That last bit is promising because while a large number of young healthy athletes did show inflammation around the heart, which we could only assume would be a higher proportion in an older population, it didn't seem to be an ongoing problem. That doesn't mean, however, that symptoms can't linger for quite a long time. From this review on cardio respiratory considerations in athletes after COVID-19, there are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia, and extreme fatigue. This article gets into what we know about long COVID, which is a term used to describe illness in people who have either recovered from COVID-19, but are still reporting lasting effects of the infection, or have had the usual symptoms for far longer than we would expect. It highlights that a team of researchers from Italy reported that nearly 9 in 10 patients discharged from a Rome hospital after recovering from COVID-19 were still experiencing at least one symptom 60 days after onset. These symptoms included fatigue, dyspnea, joint pain, and chest pain. Two-fifths of the patients reported a worsened quality of life. That last data set was not from athletes, but from people who were hospitalized with COVID, which again are the people most likely to experience lasting symptoms. However, what this data does tell us is that a significant proportion of people are likely to experience symptoms long after being diagnosed with COVID. One of the big symptoms is fatigue, and the reason I point this out is because cycling and other sports for that matter are inherently fatiguing. If you add in the fatigue from lingering COVID symptoms on top of this, then it could take you a couple weeks or potentially months to get back to your normal self on the bike. This proportion is likely small in younger populations, but expect the proportion to rise with age, because all of the other available data that we have on the virus shows that it gets worse the older you are. Exactly how long symptoms are going to last is going to be highly variable, and whether or not there may be permanent damage or effects lasting years is a question that we simply don't have the answer to at this time. Most people will recover from COVID, get back on the bike, and feel fine, but a small proportion of riders will have lasting symptoms that will affect their energy levels and their numbers for weeks to months. Right? Yeah, that sounds pretty serious, man. So, um, does this mean I can add still recovering from COVID to the official list of cycling excuses? With that being said, what should your return to training look like after testing positive for COVID? This is obviously a very important question because we don't know what kind of damage you could cause by training through this thing. Again, research is limited at this point, but there are some preliminary guidelines that you can follow. This article on COVID considerations for competitive athletes goes into what an athlete's return to training should look like. They say that athletes can begin training again once symptoms are gone and energy levels are normal. 72 hours after this low intensity indoor training may resume. After discontinuing training, athletes should gradually return to training. This article gives the same advice that I usually give to my athletes when they get sick, not just with COVID, but with anything. Wait until you're symptom free and then slowly keyword there being slowly get back into training. As hard as this may be for those of us that are serious about training, that article actually seems to give the least aggressive advice when it comes to returning to sport. This article on cardiopulmonary considerations for student athletes stated that regardless of whether you're symptomatic or not, you shouldn't exercise for at least 14 days after diagnosis and seven after symptoms are gone. This may seem like overkill, but there are reasons to believe that an approach like this may be necessary. In this article on respiratory health and athletes, they stated that an apparent height and risk of further deterioration has been suggested to occur between days seven and nine. With individuals developing more fulminant lower respiratory tract manifestations and thus requiring more intense medical care. The neck check in which athletes return to training if symptoms are confined to above the neck has a weak scientific basis and using this method to return too soon may pose a risk of myocardial damage, and this is especially relevant for COVID-19. The article recommends at least 10 days off from the onset of symptoms and seven days off after symptoms subside. Again, this article is taking a fairly aggressive stance, but I think it's important to remember that not everybody is reacting to COVID in the same way and that perhaps an athlete's return to training should reflect how severe their case is. This article on resumption of sport after COVID takes this into account. For asymptomatic individuals, two weeks of rest is recommended with slow resumption of exercise after that. For mild symptoms, two weeks of no exercise after symptoms are resolved and for those with significant symptoms who required hospitalization, a minimum of two weeks is needed before even getting evaluated by a medical professional and cardiac testing should be considered. With these kinds of recommendations, I could see how athletes would be fearful about training hard during this time. After all, they could be positive for COVID and not show any symptoms and train right through it. Unless you are confirmed positive though, laying off the riding during this time may be the wrong approach because exercise is so important for our immune health, which I went over in my first coronavirus video that I did way back in March. The other reason has to do with our own mental health, which is a perfect segue into our last topic of the day, which I don't think is getting enough coverage, and that is how the pandemic is affecting cyclists and other athletes' mental health. Cycling, while it's not a team sport, can be fairly social, often done with a buddy or in big groups, and that camaraderie can be a huge motivator for many riders. Strip that away for a year or more and what might the effects be. This study on psychological distress of athletes during COVID-19 restrictions found that over 50% of athletes were worried about the future of their sport or their own future in sports. Feeling worse during the pandemic was common with 72% of women and 40% of men, with notable amounts of athletes at risk of depression, anxiety, and gambling problems. From this article on perceived stress in athletes, they stated that athletes have reported challenges and issues associated with social isolation, career disruption, qualification process uncertainty, and unconventional, limited, and mostly denied access to effective training environments, partners, and teammates. Additional stressors for athletes include changes to competitive calendars. As a coach, I can say that all of that is true and had a big effect on my athletes this year. Many of us were training for an event that got postponed or cancelled, and given that cycling is a sport where proper planning pays off, this created a lot of uncertainty. Many riders thrive off of group rides or race themselves into shape, and for most of us that simply wasn't an option this year. Add to the fact that gyms were closed and cyclists had to make do with what they had to maintain their strength, and that's a recipe for a loss of motivation at the least and potentially more serious mental health issues. Fortunately, exercise may be one of the best medicines, not only for our immune system, but also for our mental health. And while riding the trainer all year may seem extra safe, remember that vitamin de-exposure may play a significant role in reducing the risk of COVID-19, so I would ride outside if possible. Racing and group rides are starting to come back, which I think is a good thing for more social riders who need that to fuel their motivation. The effects of the pandemic are very real, but the mental health issues caused by isolation could significantly affect a person's well-being. I think when deciding whether or not to ride in a group, you should take into account whether you're in a high-risk category or whether you're in contact with other people in a high-risk category. Hey man, it's been a couple videos since I promoted Hypergain Beast Mode. Is now a good time? No? No? All right, yeah, okay, all right. I'll do it in the next video. Thanks for watching. If you enjoyed this video, be sure to give it a like, subscribe for weekly science-based cycling videos just like this one, and be sure to share this video with your cycling friends. I'll see you in the next one.