ABC | Volume 115, Nº2, August 2020

Statement Grossman et al. Position Statement of the Brazilian Society of Cardiology Department of Exercise Testing, Sports Exercise, Nuclear Cardiology, and Cardiovascular Rehabilitation (DERC/SBC) on Activities Within its Scope of Practice During the COVID-19 Pandemic Arq Bras Cardiol. 2020; 115(2):284-291 Content 1. General Rules ................................................................................ 286 2. Treadmill Exercise Test and Cardiopulmonary Exercise Test .. 286 3. Cardiopulmonary and Metabolic Rehabilitation ...................... 287 4. Nuclear Cardiology ........................................................................ 288 4.1. Adaptation of Nuclear Cardiology Practices During the COVID-19 Pandemic .............................................................................................. 288 4.1.1. General Considerations When Scheduling a Nuclear Cardiology Scan .......................................................................... 288 4.1.2. Considerations Upon Patient Arrival at the Facility .................... 288 4.1.3. Considerations During the Scan 24 ............................................... 288 5. Sports Cardiology .......................................................................... 289 5.1. Physical Activity and Sports During the COVID-19 Pandemic .......... 289 5.2. Physical Activity at Home ................................................................ 289 5.3. Outdoor Physical Activity ................................................................. 289 5.4. Physical Activity in Gyms and Fitness Clubs .................................... 289 5.5. I’ve Been Diagnosed with COVID-19 – When Can I Resume Physical Activities? .............................................................................................. 290 5.6. Assessment of Athletes Who Have Contracted COVID-19 ................ 290 References .......................................................................................... 290 1. General Rules • The Brazilian Society of Cardiology Department of Exercise Testing, Sports Exercise, Nuclear Cardiology, and Cardiovascular Rehabilitation (DERC) is closely monitoring the COVID-19 pandemic and its consequences, and is aligned with the Brazilian Medical Association (AMB) regarding the position statements issued by its specialized departments and affiliate societies. • It recognizes that containment of the pandemic is a core strategy. • This document provides an up-to-date overview of recommendations to minimize risks to both patients and clinicians during this pandemic period. • Given the dynamics of the pandemic, any of these recommendations may be updated if and as new facts and scientific evidence arise. • All preventive measures advised by the Ministry of Health and the World Health Organization (WHO) should be systematically incorporated into high-quality care for patients with cardiovascular diseases, as they are considered to be at high risk. • Any and all procedures must follow recommended standards for disinfection, use of personal protective equipment (PPE), and contact precautions. • Any discontinuation, continuation, or interruption of activities inherent to the SBC/DERC scope of practice must comply with the provisions of local health authorities or the bylaws of the health facilities where they are conducted. • At this time, compensation for treadmill exercise tests (TMETs), cardiopulmonary exercise tests (CPETs), nuclear cardiology procedures, and cardiopulmonary rehabilitation cannot be reduced as a result of any measures taken in the fight against the pandemic, unless otherwise instructed by the AMB Permanent Technical Committee on the Hierarchical Brazilian Classification of Medical Procedures. 2. Treadmill Exercise Test and Cardiopulmonary Exercise Test • Careful assessment of respiratory symptoms and complaints and other acute infectious conditions should begin when the patient calls to schedule the test. The appointment may then be confirmed or discouraged, so as to avoid unnecessary movement of patients where social distancing measures are in place. Patients should come alone, except for children (under 18) and those otherwise incapable. 1,2 • Patient who have already contracted COVID-19 and have recovered, if asymptomatic and clinically stable, should postpone TMET and CPET for at least 30 days after recovery. Even patients recovered from COVID-19 must follow the recommendations and procedures described herein. • Considering the potential risk for generation of contaminants during TMET and CPET, we recommend that the number of tests be reduced as much as possible—optimally, one test per hour per ergometer. • Once the appointment has been confirmed, instruct patients to come already wearing appropriate clothing and footwear, as they will not be allowed to use changing rooms at the clinic or hospital. • Upon arrival, reassess the patient for signs and symptoms of COVID-19 by interview or completion of a specific epidemiological questionnaire. Measure body temperature and provide a surgical mask at the entrance to the facility. Receptionists and other secretarial staff must wear a face mask and gloves at all times, as well as maintain a safe distance from patients. 3,4 • As usual, all patients must sign an informed consent form. This is mandatory. However, it is suggested that additional considerations be included in the form due to the ongoing pandemic, namely: it is impossible to accurately specify the quantitative risk of contracting the coronavirus during a TMET or CPET, but: • All possible preventive measures will be undertaken to minimize contamination. • The risk of contracting an infection during a TMET or CPET is probably higher compared to that of the same test performed once the pandemic is over. • The physician in charge of the test must adequately contextualize the indications for the test and, in case COVID-19 or any other acute respiratory syndrome is suspected (history of fever, cough, nasal discharge, weakness, tachycardia, cyanosis, abnormal pulmonary auscultation), inform the attending physician and discontinue the test. 286