TrueSport: November 2020
Top medical considerations for returning to sport after COVID-19, how and why to teach mindfulness to young athletes, five easy ways for young athletes to practice gratitude and health snacking habits at home, this month from TrueSport.
Trending
Top medical considerations for returning to sport after COVID-19
There has been a lot of focus on protecting young athletes’ physical and mental wellbeing during the COVID-19 pandemic, but despite all the precautions, not everyone has been fortunate enough to avoid infection. And unfortunately, after recovering from COVID-19, people are at higher risk of myocarditis -- inflammation of the heart often caused by a viral infection -- and even asymptomatic, healthy young athletes are at risk.
“COVID-19 has an affinity for heart tissue," explains Dr. Michele LaBotz, TrueSport Expert and sports medicine physician. There have been reports of professional and collegiate athletes, as well as children, suffering from myocarditis after recovering from COVID-19. "Even before COVID-19, myocarditis was one of the biggest causes of sudden cardiac death in athletes. We've always known about it, but it's newly prominent,” LaBotz adds.
Myocarditis after COVID-19 isn’t a death sentence and it usually resolves after an appropriate recovery period. But it’s important to know the symptoms of myocarditis and to return to sport the right way based on the severity of a young athlete’s symptoms and intensity of the sport. LaBotz also notes that the guidelines for students with COVID-19 are changing all the time, so if your athlete does test positive for the virus, it’s important to contact their physician to get the current return-to-play recommendations.
Recognize the symptoms of myocarditis
Have your athlete be on the lookout for warning signs, like a sudden increase in perceived exertion (if an exercise that was easy before is suddenly feeling difficult), undue fatigue, chest pain and shortness of breath. If your athlete starts to exhibit any of these symptoms, contact your primary care provider immediately. Typically, a doctor will run an EKG and possibly some additional labs looking for damage to heart tissue. Your child may need to see a cardiologist for a follow-up, and if diagnosed with myocarditis, expect your athlete to need between three and six months of rest to recover completely.
Account for symptom severity and sport intensity
All athletes who have had documented COVID-19 infections should ideally contact their primary care physician before returning to practice or high intensity physical activity. Although myocarditis can develop in any athlete infected with COVID-19, it is more likely to occur in patients who had more severe or prolonged COVID-related symptoms.
Asymptomatic COVID-19 infections
“If you have a child who has no symptoms but has had a positive test, they should not do any intense physical activity for 14 days,” says LaBotz. “As long as they don't have any symptoms emerge and as long as they're otherwise healthy, then they can gradually ramp up their activity over a period of about 5-7 days.” That means starting with low-intensity exercise like walking, and slowly progressing for a week before returning to full practice.
If your child has been exposed to someone with COVID-19, current recommendations are for two weeks away from practice regardless of test results. This is key to both slowing the spread of COVID-19 through a team, and ensuring that your athlete isn’t training through an asymptomatic bout of the virus.
Mild symptoms
Mild symptoms include runny nose, slight cough, mild fever -- typical ‘cold-like’ symptoms, LaBotz explains. In cases where an athlete experiences any COVID-19 symptoms, the two weeks of rest start after your child no longer has any signs or symptoms of the virus. “As long as your child remains asymptomatic, then they can gradually build up their activity, again, starting with low intensity and progressing over the course of several days,” LaBotz adds. "And while they are building up activity levels, if they develop any symptoms of myocarditis or COVID-19, they should stop immediately and talk to a doctor.”
Particularly if your athlete is returning to a high-intensity sport, LaBotz recommends contacting the athlete’s primary care physician to get cleared for play. “If your athlete is in a high-intensity sport, has a family history of cardiac issues, or even has anxiety around return to play, your primary care doctor may want to perform an EKG before returning to sport,” she says.
Moderate symptoms
If symptoms are slightly worse -- higher fever, bad cough -- but hospitalization isn’t required, current recommendations are that an athlete get an EKG before returning to play. However, depending upon the athlete’s previous history, some health care providers may require additional testing before athletes can be cleared to play. After symptoms subside, athletes then need two weeks of rest. If they remain asymptomatic during this time, then athletes can gradually return to sport as described above.
Severe symptoms
If your athlete is hospitalized with severe symptoms of COVID-19 or has been diagnosed with Multi-System Inflammation Syndrome in Children (MIS-C), they should be treated as though they have myocarditis and only return to sport after being cleared by a cardiologist.
“There will be a lengthy recovery period and your athlete will need multiple tests to return to play,” LaBotz adds. “It typically takes 3-6 months for recovery. You just have to let the heart heal, because if you don’t, scar tissue develops and that means permanent damage to a really important muscle.”
Beware of a fast return in general
“This fall we're seeing an increase in the severity of some of the injuries we typically see in high school athletes,” LaBotz adds. “Some athletes went from not doing much to suddenly jumping right into the full season without the usual preseason work. I’ve also seen a few kids injured because they were training a lot over the summer since there wasn’t much else going on, and now they have stress fractures and other overuse injuries. The same thing can happen if an athlete has to take a few weeks off to recover from COVID-19, so that slow return is extremely important.”
Takeaway
As more young athletes return to school and sport, it’s important to understand that past COVID-19 infections, and even undiagnosed or asymptomatic infections, can impact an athlete’s health and their heart health in particular. Learn to recognize the symptoms of heart issues and moderate your athlete’s return to play based on symptom severity and intensity of sport.
Parents
How and why to teach mindfulness to young athletes
As a coach or parent, you may have heard that mindfulness or meditation has been shown to be a highly effective, free tool for calming nerves and decreasing stress levels. And that research doesn’t just apply to adults: Much has been reported in recent years on how important mindfulness can be to the mental health of children as well. On the playing field, visualization and other mental techniques have even been shown to improve performance.
Professor John Gabrieli, PhD, has been studying mindfulness in young children for the past few years, and his recent research at MIT led to some noteworthy results around why all schools should institute mindfulness practices that helped students focus on the present and get in touch with their feelings and thoughts. Here, he explains why it’s important to help young athletes develop a mindfulness routine and how to do it.
WHY
Understand the importance
Mindfulness may be a lifesaver, Gabrieli says. “We've been struggling against a rising tide of anxiety and depression in adolescence,” he says. “In the last 10 years, there's been an estimated 50 percent increase in depression. We don’t know why this is happening, but we’re trying to find ways to work towards lessening that. School-based mindfulness was one of the ways we wanted to approach it. As far as interventions go, it's arguably the cheapest and easiest one to try.” Gabrieli tested mindfulness practices in a school setting, and the results were promising: Students reported greater feelings of calm and focus, and lowered levels of stress.
It’s not all in their heads
For Gabrieli, the most exciting outcome of his research was the result of brain scans done on the children who began a mindfulness practice. Not only were they reporting feeling less stressed, their brains were actually changing as a result. “Children who practiced mindfulness showed changes in the brain in the areas involved in emotion and cognition,” he adds. “Often, people dismiss meditation and mindfulness as something that’s perceived versus factual, so it was important to see these brain changes that corresponded to their subjective feelings of stress."
Keep their heads in the game
Teaching mindfulness doesn’t just keep athletes calm before a big competition, it can also help them pay better attention during the game, according to one study that found meditation helped children ignore distractions -- like parents shouting in the stands -- and concentrate better. Researchers explained that this is because mindfulness teaches people how to pay attention to the present moment without judgement, so a young athlete can focus in on the task at hand and ignore outside stimuli.
There’s no age limit
It might be hard as an adult to understand the complex emotions that children can face throughout the day, but remember, their emotions and responses to stimuli are just as valid as yours. And even very young children can experience benefits from mindfulness and meditation -- one study showed that when a school introduced yoga and meditation to third graders, their anxiety levels decreased while their wellbeing and overall emotional health increased.
Savor the side benefits
One study done on adults showed that helping them focus internally on how they felt at the present moment through body scanning, one of the primary methods of mindfulness used in many yoga practices, actually helped promote a positive body image. For adolescent athletes, this could mean a massive shift in how they view themselves and that could potentially help avoid issues around body composition and disordered eating. And with regards to food, another study demonstrated that mindfulness could actually help children avoid overeating by changing brain patterns.
HOW
Teaching present focus
“We want to encourage focus on the present moment, as opposed to the past or worries about the future,” says Gabrieli. “We start with focusing on one’s breath.” In its simplest form, this can mean taking two minutes at the beginning of practice for athletes to sit with their eyes closed simply counting breaths. It doesn’t need to be a guided meditation or involve diffused essential oils, specific pillows, or postures. Keep it simple to start.
There’s an app for that
Gabrieli is quick to note that not every coach or parent will feel comfortable teaching mindfulness to children, but there are plenty of free resources available. He prefers Inner Explorer, which has programs for classes, as well as apps directed at different age groups that can be used independently. Calmer Choice is another great resource for coaches and teachers that he recommends often, and for parents hoping to meditate alongside of their children, Headspace is another simple starting point appropriate for most ages.
It doesn’t take much
You don’t need your team to take up full practices meditating, Gabrieli says. “The people I know who are the most enthusiastic about mindfulness believe that if you do 10 minutes a day, you're good,” he says. “And you can start even smaller, especially with a whole team or class. You want to fit it into your day, not have it replace practice.”
But given that 10 minutes daily seems to be the sweet spot for creating measurable benefits, it might be worth getting started with a few weeks of guided mindfulness training with your athletes.
Takeaway
There are plenty of reasons why it’s worth helping your athletes learn how to incorporate mindfulness techniques into their regular routine, from lowered stress levels to improved concentration. It’s easy to get started with breathing exercises, apps, and quick sessions.
Coaches
Five easy ways for young athletes to practice gratitude
Practicing gratitude has been a trending topic amongst mental health and wellness experts in recent years, and for good reason: This simple shift in thinking can lead to big change. According to the American Psychological Association, teens who practice gratitude are more likely to be happier in general and less likely to have behavior problems at school. They’re also likely to be healthier overall, according to new research, and could even be more likely to easily make friends.
But can gratitude also help them on the field? TrueSport Expert Kevin Chapman, PhD, clinical psychologist and founder of The Kentucky Center for Anxiety and Related Disorders, says yes, and explains how coaches and parents can help their athletes practice an attitude of gratitude.
1. Understand process versus outcome
Gratitude helps ground athletes in the present moment by reminding them of the positives that are happening right now. "Depending on what an athlete is struggling with, you may find that getting them to be more attentive to feelings of gratitude is an antidote to some of the difficulties they face,” Chapman says. “Anytime you have negative self-talk and thoughts, those lead to strong emotional experiences that can inhibit your performance. In those cases, it’s always helpful to identify the things that you're grateful for.”
“For instance, some athletes struggle with not scoring goals. Many of those athletes will focus on that negative outcome and will tend to perceive their identity as part of their results and their performance, which can result in a lot of negative self-talk. But you can help them by reminding them why they're playing the sport, as opposed to the outcome of playing their sport. That’s a simple way to get them to shift their attention to being present, being grateful, being thankful that they can play. The goal is to get them back to enjoying the game, as opposed to focusing on the future or the outcome of the game."
2. Rewrite self-talk
“When I have an athlete who struggles with self-talk, I think it’s really important to specifically identify the negative things that they're saying to themselves that are outcome-focused,” Chapman says. "Once they can identify the negative self-talk, then that forms the basis to replace it with more flexible thoughts associated with gratitude.”
You can work on this with your athletes by first having them list five negative self-talk phrases that come to mind for them, then identifying what they could say instead to flip the script to something more positive.
"I get athletes to focus on what they're going to say to themselves before, during, and after competition,” he adds. “Statements like 'I love this game,’ or ‘I feel good when I focus on my own game,’ can help them concentrate on those feelings of gratitude. I get athletes to memorize about five positive self-talk statements that they can easily recall in various instances during sport performance. That way, when they do have a bad performance, they can use one of those affirmations while doing some deep breathing, and then move on. And outside of the game, I want athletes looking at those statements twice a day to get them fixed in their brains.”
3. Make a cue card
Chapman recommends having each athlete make his or her own index card with a list of a few things they’re grateful for, and at least one positive self-talk mantra at the bottom. “I have athletes write this out and put it in their locker, keep it in their duffel bag for competitions, or even go digital and put it on the home screen of their phone so they can see it all the time,” he says.
You can also recommend that athletes make one of these cue cards on a monthly basis. New negative self-talk will constantly be buzzing in the background, so it’s important to make sure that positive self-talk is regularly responding to the new stimulus.
4. Ask the right questions
After a competition, a lot of athletes, parents, and coaches will focus on the outcome, what went wrong, and what a team can do better the next time rather than the effort and the process.
“Asking athletes -- and getting them to start asking themselves -- things like, ‘What did I learn today?' is a really good way to not only keep a process-focus, but to also focus on gratitude,” Chapman says. You can also ask gratitude-specific questions, like what they were most thankful for during the game, or have them tell a teammate how grateful they were for their support.
Overall, Chapman advises parents and coaches to “Allow them to experience their emotions and thoughts, just try to shift them towards a more positive pattern."
5. Start a gratitude board or team practice
As the coach, you can create a team culture of gratitude. One way to do so, especially with younger athletes, but also with teens, is by having a large team gratitude board set up where athletes can write out one thing that they’re grateful for each day. Alternatively, you can have athletes do this out loud.
Let your team decide on how they want to start a gratitude practice together, Chapman suggests. “It depends on the athletes and it depends on what speaks to them."
Takeaway
Gratitude can be practiced just like standard skills and drills, leading to both performance and general wellness benefits.
Nutrition
Health snacking habits at home
This season, your kids (and likely you as a parent) are in the house more than ever thanks to revised school schedules, canceled sports seasons, and limited social interactions. That means now more than ever, your kitchen has likely become snack time central, allowing easy access to whatever is stocked in the fridge or pantry. If you’re concerned about your child’s snacking habits, or hoping to avoid food boredom as the months of life-at-home wear on, keep reading for some important nutritional tips around snacking at home.
Make a list of ‘approved snacks’
There’s a fine line between letting your child have autonomy in the kitchen and letting them roam freely through your pantry. Research has found that without parental intervention, snacks tend to get sweeter and less healthy. And another study found that when children had many snack options available, they tended to eat more than if they only had a few choices. While you probably don’t want to install a lock on the freezer door to block your fifth grader from getting into the ice cream mid-morning, you can create an ‘approved snack list’ that gets prominently displayed in the kitchen so your child knows exactly what’s snack-able and what’s not. Depending on the age of your child, creating a specific snack station section in the kitchen where healthy options are stacked for easy, anytime access might keep the household running smoother.
Check in on hunger cues
Children struggle to understand their own hunger cues, or more simply put, kids have a hard time knowing when they actually feel hungry, since they’re so used to being told when to eat. With this in mind, avoid having food out in plain sight. One study showed that younger children who are consistently exposed to food may end up struggling with overeating and obesity, and won’t learn to read their own hunger cues. So rather than keeping food set on the counter, put it away in the pantry. Research done at Brigham Young University also showed that the number of calories children eat post-practice tends to far exceed the number of calories they burn while playing. Try to have your child tell you when they are hungry rather than asking if they are ready for a snack.
Get a handle on emotions
Remember that children are currently experiencing unprecedented levels of stress thanks to the COVID-19 pandemic, and as a result, they may be more prone to emotional eating. Unfortunately, emotional eating starts at a young age: One study showed that children who were sad ate more chocolate than the happy or the neutral groups. This can be mitigated by pre-portioning out snacks so overeating is less likely, but it’s also a reminder to pay attention to how your child’s eating habits are changing, since that may be an early warning sign that your child is feeling more sad, stressed, or anxious.
Create snack boundaries
It’s important to separate eating from other activities. It’s easy to let your kids snack while they work or relax in front of the TV, especially if you’re helping with remote learning while trying to handle your own work as well. But studies have shown that when teens eat snacks in front of a screen, they’re at a heightened risk for developing diabetes and even heart disease. Set rules around not eating at the desk or on the couch, and instead, create specific ‘snack zones’ for your child like the kitchen or a picnic area in the backyard.
Keep junk food out of the house
When kids were out at school and practice all day, keeping junk food at home may not have been an issue, but with kids at home, access to candy, chips, and soda becomes problematic. Moreover, one study points to genetics playing a role in what your children will be most prone to overindulging on, meaning that if you’re an ice cream eater, there’s a good chance your child will follow in your footsteps and take advantage of that well-stocked freezer. This makes it all the more critical to keep particularly overindulgent snacks out of the house entirely.
Meal prep smart choices
Prevent food boredom by letting your child choose three or four snack options for the week, but keep things simple by meal planning and prepping ahead of time so you’re not constantly making messes in the kitchen. Help your child come up with one or two grab-and-go options like string cheese or chopped up vegetables with hummus, plus one baking/cooking project that you can prep together once a week. Chop up veggies in advance, and even consider pre-portioning out higher-calorie snacks like crackers, nuts, and dried fruit so it can’t be eaten by the handful. Snacks high in protein have been shown to be the best options for helping children recover from practice and games, and will also improve feelings of satiety, so there’s less likelihood of overindulging on less healthy options.
Takeaway
With kids at home more than ever, it might be getting harder to both set boundaries around snacking and keep everyone satisfied. Keep these tips in mind for healthy, satisfying snacking at home.
About TrueSport
TrueSport®, a movement powered by the experience and values of the U.S. Anti-Doping Agency, champions the positive values and life lessons learned through youth sport. TrueSport inspires athletes, coaches, parents and administrators to change the culture of youth sport through active engagement and thoughtful curriculum based on cornerstone lessons of sportsmanship, character-building and clean and healthy performance, while also creating leaders across communities through sport.
For more expert-driven articles and materials, visit TrueSport's comprehensive LEARN resource.
This content was reproduced in partnership with TrueSport. Any content copied or reproduced without TrueSport and the U.S. Anti-Doping Agency's express written permission would be in violation of our copyright, and subject to legal recourse. To learn more or request permission to reproduce content, click here.