Evidence-based Sports Medicine

Exercising with a fever and/or acute infectionBox 6.1 Clinical manifestations of infectious mononucleosisModerate to severe sore throat (frequent)Tonsillar enlargement (frequent)Exudative tonsillopharyngitis (frequent)Lymphadenopathy (frequent)Moderate fever (frequent)Palpable splenomegaly (frequent)Headache (frequent)Soft palate petechiae (less frequent)Periorbital oedema (infrequent)Myalgia (infrequent)Jaundice (unusual)Diagnosis of infectious mononucleosis is made by taking intoaccount the clinical picture along with peripheral blood examinationand serology for EBV. Once the diagnosis is made, return to playconsiderations are related to the general condition of the athlete andconcerns about complications. The spectrum of patient responses tothis illness ranges widely; many have significant malaise, weaknessand inablility to perform hard physical exertion – obviously theiractivities will be self restricted. In contrast, around 50% of EBVinfections occur prior to adolescence and are generally mild and donot prompt a visit to a healthcare provider. 29Welch et al examined the aerobic capacity after the subject hadcontracted infectious mononucleosis. The authors studied 16 cadetsat the United States Military Academy who were recovering frominfectious mononucleosis. The aerobic capacity was determined at thepoint at which the subjects became afebrile. (VO 2max approximately60 ml/kg/min for males and 50 ml/kg/min for females) Nine of thecadets were allowed to do a low intensity exercise programme for twoweeks while the other seven remained inactive. After two weeks allwere allowed to exercise ad lib. Aerobic capacity was remeasured atthis time and no differences between groups were found. Additionally,no detrimental effects were found in either group. The authorsconcluded that athletes recovering from infectious mononucleosiscould begin a non-contact exercise programme as soon as theybecome afebrile. 30 Another study suggested that athletes recover fasterthan other students, although the finding was not consideredsignificant because of the small sample size. 31The more difficult questions about the management of athleteswith infectious mononucleosis involve issues concerning potentialcomplications which are relatively infrequent. Although EBV affectsmost organ systems, complications occur in less than 5% of cases. 32Since some of these complications have potential catastrophicoutcomes, they should be considered when decisions for each athlete89