Febrile Illness in the Athlete

Abstract

Context:Acute febrile illnesses are common in athletes over the course of training and competition seasons. Complete recovery and rapid yet safe return to participation are critical for competitive athletes. Alterations in thermoregulation, metabolism, fluid homeostasis, muscle strength, and endurance, as well as potential complications for the athlete and others, must be considered.Evidence Acquisition:The PubMed database was searched (1970-2013) for all English-language articles related to febrile illness in sport, using the keywords fever, febrile, body temperature, thermoregulation, infection, illness, disease, exercise, athlete, sport, performance, return to play, metabolism, hydration, and dehydration.Study Design:Clinical review.Level of Evidence:Level 4.Results:Limited data confirm that febrile illness is correlated with alterations in the body’s thermoregulatory system, with increases in metabolic rate, and with effects in fluid homeostasis. Human and animal studies demonstrate a decrease in muscle strength and endurance secondary to muscle catabolism in febrile illness. However, indirect evidence suggests that regular exercise enhances the immune response. No strong clinical research has been published on return to play during or following acute febrile illness, excluding mononucleosis and myocarditis.Conclusion:Fever is correlated with an increase in insensible fluid losses, dehydration, metabolic demands, and dysregulation of body temperature. Fever can have detrimental effects on the musculoskeletal system, including decreasing strength and endurance, generalized muscle catabolism, and increase in perceived fatigue. Participating in strenuous exercise during febrile illness can worsen the illness and has demonstrated increased lethality in animal models. No consensus recommendations support return to activity before resolution of fever, and training should be resumed gradually once fever and dehydration have resolved.

Role of increasing the aerobic capacity on improving the function of immune and respiratory systems in patients with coronavirus (COVID-19): A review

“…However, the performance of mild to moderate intensity aerobic exercises is beneficial in increasing the function of the immune system in patients with COVID-19, the performance of high intensity aerobic exercises should be avoided for those patients because of its adverse effects on suppressing the function of the immune system [79]. Also, aerobic exercises should be avoided in high fever because of its adverse effects on decreasing the immunity [80].…”

The Assessment of the Paediatric Athlete

“…Recent infections can have a low but appreciable risk myocarditis and need to be accurately assessed to give advice on training intensity and volume. Based on physician experience, pyrexia, should mandate a break, whereas in simple upper airway only infection light endurance training can be continued [26,27]. Nutritional assessment is of importance for the paediatric sports cardiologist as athlete anorexia is no uncommon especially in gymnastics with a female predominance [28], additionally nutritional supplements can be arrhythmogenic by adrenergic overstimulation, in particular found with the use of energy drinks [29].…”

The adolescent athlete's heart; A miniature adult or grown‐up child?

“…Reproduced with permission from Reference 40.Medical history will detect symptoms such as palpitations, exercise dependent respiratory symptoms, dizziness, and syncope and recent infections. Based on physician experience, pyrexia, should result in a training break, whereas in simple upper airway only infection light endurance training can be continued50,51 Nutritional assessment should be included, also as anorexia is relatively common especially in sports with a female predominance,52 and nutritional supplements such as energy drinks can be arrhythmogenic by adrenergic overstimulation 53. Examination will investigate for congenital lesions (specific heart murmurs or pulse, BP differences in hand and feet (eg, coarctation).…”