Successful Return to Performance After COVID-19 Infection in an Elite Athlete

Purpose: To present training load (TL) and heart-rate variability (HRV) in an elite sprinter monitored before, during, and after a COVID-19 infection until successful return to performance. Methods: TL, subjective morning fatigue (MF), and supine HRV were monitored during a 12-week period. Results: During a high-TL period (training camp), MF and heart rate increased and vagally mediated HRV variables decreased. MF increased and stayed high 3 days after the camp despite decrease in TL. In contrast, 4 days after the camp, heart rate decreased and vagally mediated HRV variables increased, reflecting parasympathetic hyperactivity. Elevated MF and suboptimal training performance led to a PCR test decision, which returned positive. After a 10-day training suspension, TL was progressively increased with low MF and high vagal tone. The athlete was able to return to competition 17 days after medical clearance for return to participation and 1 week later beat his indoor 60-m personal best. Conclusions: In this athlete, COVID-19 infection induced parasympathetic hyperactivity with subjective fatigue. This case report presents how performance capacity was only negatively influenced by a COVID-19 infection in the short term, with a quick and successful return to performance, thanks to state-of-the-art medical management. This highlights the importance of TL and HRV monitoring in return-to-participation and return-to-competition decisions.