Background Initial protocols for return to play cardiac testing in young competitive athletes following SARS‐CoV‐2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS‐CoV‐2 infection. Methods and Results This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS‐CoV‐2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS‐CoV‐2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS‐CoV‐2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS‐CoV‐2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS‐CoV‐2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing. Conclusions Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS‐CoV‐2 infection appears to have limited diagnostic utility.

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The primary objectives of the preparticipation physical evaluation (PPE) are screening for conditions that may be life threatening or disabling, or may predispose to injury or illness [1]. Secondary objectives include identifying personal health information that initiates discussion with the athlete, for example, taking knowledge gained, educating the athlete based on screening results, and applying precautions as warranted.The PPE, historically, has had little impact on the mortality of athletes in sports. In our college athlete screening, we seek, preeminently, to protect life. Success in screening, then, depends on identifying those conditions, diseases, or processes that cause death in college athletes. Four common causes of nontraumatic death in an athlete in action are cardiac, asthma, exertional heat stroke, and exertional sickling [2]. These same 4 causes are echoed in the 16 nontraumatic National Collegiate Athletic Association (NCAA) Division I football deaths since 2000. Of the 16 deaths, 4 were cardiac, one was asthma, and one was exertional heat stroke, and the inconvenient truth was that exertional sickling was the leading cause of death and accounted for 10 of the 16 deaths. A complication of a condition, sickle cell trait (SCT), present in 3%-4% of NCAA Division I football players, accounted for 63% of the deaths.Effective PPE screening must, to the best of our abilities and resources, identify those athletes with a condition, disease, or predisposition to the 4 aforementioned causes of death. Sensitive and affordable testing for SCT in the PPE is available, beginning with a hemoglobin solubility test to detect hemoglobin S and follow-up testing as necessary to confirm SCT, exclude other hemoglobin variants, and quantify hemoglobin S. The cost of not testing must also be considered: athletes with SCT who carry a risk of serious or fatal sickling crisis go undetected, the incalculable cost of a human life lost to exertional sickling, the financial fallout in gaining closure in death of an athlete [3], and the potential impact upon careers [4]. A futuristic ideal is to have trait status identified at birth, which will be charted, communicated, and follow the patient and/or athlete and offset future repetitive testing and expense.SCT status as a priority point of personal health information is evidenced by required natal hemoglobinopathy testing in all 50 states and the District of Columbia. However, results of a recent survey found that only 37% of families were told of a positive newborn test for SCT [5]. In testing for SCT in our PPE at the University of Oklahoma, we identified 20 football players with SCT. Only 3 knew their status, and, in one case, the parents were unaware. "Screening" for SCT is PM&R

This study compared exercise performance and comfort while wearing an N95 filtering facepiece respirator (N95), cloth mask, or no intervention control for source control during a maximal graded treadmill exercise test (GXT). Twelve Division 1 athletes (50% female, age = 20.1 ± 1.2, BMI = 23.5 ± 1.6) completed GXTs under three randomized conditions (N95, cloth mask, control). GXT duration, heart rate (HR), respiration rate (RR), transcutaneous oxygen saturation (SpO2), transcutaneous carbon dioxide (TcPCO2), rating of perceived exertion (RPE), and perceived comfort were measured. Participants ran significantly longer in control (26.06 min) versus N95 (24.20 min, p = 0.03) or cloth masks (24.06 min, p = 0.04). No differences occurred in the slope of HR or SpO2 across conditions (p > 0.05). TcPCO2 decreased faster in control (B = −0.89) versus N95 (B = 0.14, p = 0.02) or cloth masks (B = −0.26, p = 0.03). RR increased faster in control (B = 8.32) versus cloth masks (B = 6.20, p = 0.04). RPE increased faster in the N95 (B = 1.91) and cloth masks (B = 1.79) versus control (B = 1.59, p < 0.001 and p = 0.05, respectively). Facial irritation/itching/pinching was higher in the N95 versus cloth masks, but sweat/moisture buildup was lower (p < 0.05 for all). Wearing cloth masks or N95s for source control may impact exercise performance, especially at higher intensities. Significant physiological differences were observed between cloth masks and N95s compared to control, while no physiological differences were found between cloth masks and N95s; however, comfort my differ.

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