{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:17:50Z","timestamp":1783505870928,"version":"3.55.0"},"reference-count":19,"publisher":"BMJ","issue":"14","funder":[{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"crossref","award":["project No: 356770"],"award-info":[{"award-number":["project No: 356770"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003965","name":"International Olympic Committee","doi-asserted-by":"publisher","award":["Research Centre of South Africa"],"award-info":[{"award-number":["Research Centre of South Africa"]}],"id":[{"id":"10.13039\/501100003965","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015777","name":"Division of Research Capacity Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015777","id-type":"DOI","asserted-by":"publisher"}]},{"name":"State Research Funding, Kuopio University Hospital"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2026,6,3]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Objective<\/jats:title>\n To identify factors associated with return-to-sport (RTS) outcomes following confirmed acute respiratory infections (ARinf) in athletes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This prospective cohort study included 114 confirmed ARinf cases among athletic individuals. Causative pathogens were identified using multiplex PCR testing, and illness severity was classified per International Olympic Committee consensus (mild, moderate and severe). RTS outcomes included time (days) to return-to-training (RTT), return-to-full-training (RTFT) and return-to-full-performance (RTFP). Cox regression models (HRs) assessed associations between RTS outcomes and demographics, sport participation, pathogen groups and illness severity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The median (IQR) days to RTT were 3.5 (0\u20137), RTFT 8 (6\u201311) and RTFP 11 (7\u201314). Amateur athletes had prolonged RTS outcomes (HR range=0.51\u20130.59; p\u22640.03) compared with professional athletes. RTS outcomes differed between the most common pathogen groups: influenza and SARS-CoV-2 had longer RTS than rhinovirus (HR range=0.11\u20130.23; p\u22640.003).\n Severe<\/jats:italic>\n illness was associated with prolonged RTS outcomes compared with\n mild<\/jats:italic>\n and\n moderate<\/jats:italic>\n illnesses (HR range=0.17\u20130.31; p<0.0001). Pathogen-related differences in RTS persisted within each severity group. Within\n mild<\/jats:italic>\n \/\n moderate<\/jats:italic>\n illnesses, the influenza\/SARS-CoV-2 subgroup had longer RTS than rhinovirus (HRs: RTT=0.35; RTFT=0.05; RTFP=0.06; p<0.05) and within\n severe<\/jats:italic>\n illnesses (HRs: RTT=0.23; RTFT=0.21; RTFP=0.13; p\u22640.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Factors associated with RTS outcomes following ARinf in athletes are level of sport participation, illness severity at presentation and the causative pathogen. Clinical assessment of illness severity remains valuable in RTS decision-making, particularly in low-resource settings. However, identifying the causative pathogen may provide additional predictive value and refine RTS clinical decision-making.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bjsports-2025-111446","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T17:20:20Z","timestamp":1781889620000},"page":"1028-1035","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with return-to-sport outcomes following pathogen-confirmed acute respiratory infections in athletes: AWARE X study"],"prefix":"10.1136","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6914-514X","authenticated-orcid":false,"given":"Marcel","family":"Jooste","sequence":"first","affiliation":[{"name":"Sport Exercise Medicine and Lifestyle Institute, University of Pretoria, Pretoria, South Africa"},{"name":"Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1022-4780","authenticated-orcid":false,"given":"Nicola","family":"Sewry","sequence":"additional","affiliation":[{"name":"Sport Exercise Medicine and Lifestyle Institute, University of Pretoria, Pretoria, South Africa"},{"name":"International Olympic Committee Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8883-2255","authenticated-orcid":false,"given":"Maarit","family":"Valtonen","sequence":"additional","affiliation":[{"name":"KIHU, Finnish Institute of High Performance Sport, Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlise","family":"Dyer","sequence":"additional","affiliation":[{"name":"Statistician in Private Practice, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esme","family":"Jordaan","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa"},{"name":"Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3647-0429","authenticated-orcid":false,"given":"Martin","family":"Schwellnus","sequence":"additional","affiliation":[{"name":"International Olympic Committee Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa"},{"name":"School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South 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