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 • Minimize the number of staff members in contact with the patient. • Minimize patient–staff contact time. • Highlight importance of frequent hand hygiene. • If the patient has suspicious symptoms, all staff members in contact with the patient must wear full PPE (respirator, eye protection, apron, and gloves) and provide a mask to the patient. • In patients with confirmed active COVID-19, scans should be performed only if absolutely necessary. Check local infection control policies and consider scheduling these patients as the last scan of the day. Use a separate scanner if possible. After the scan, complete terminal cleaning of the room and all equipment is to be performed. • The s canne r g an t r y, bed , gu r ney, t r eadmi l l , sphygmomanometer, stethoscope, and infusion pumps are to be cleaned after each scan by personnel wearing appropriate PPE. • Regular cleaning of high-touch surfaces (including door handles, tables and desks, computers, keyboards, telephone receivers, and dictation equipment) by personnel wearing appropriate PPE is mandatory. B) Selection of scan protocol 24 • Choose the shortest protocol. • Consider one-day imaging protocols. C) Selection of stress protocol 24 • As the SARS-CoV-2 virus is spread by droplets, procedures which generate droplets or aerosols are considered to pose the greatest risk. Therefore, pharmacological stress tests are preferred to exercise tests. • If an exercise test is considered absolutely necessary, the staff must wear appropriate PPE (preferably, an N95/FFP2 respirator) and keep their distance from the patient except if providing direct care or while injecting the tracer. Follow the guidelines of this position statement regarding TMET. • Use of automated blood pressure cuffs in lieu of sphygmomanometers requiring operator intervention should be considered. D) Interpretation of test results 24-26 • Avoid the presence of several physicians and/or interns in the same location if possible. • In scans requiring computed tomography (CT)-based attenuation correction, CT images must be interpreted in the context of pulmonary findings possibly indicative of COVID-19. 5. Sports Cardiology 5.1. Physical Activity and Sports During the COVID-19 Pandemic Regular physical activity is essential for the promotion of health and correction of risk factors for cardiovascular diseases. A sedentary lifestyle worsens the natural history of chronic degenerative diseases and increases mortality. Both while lockdown measures are in place and once restrictions on mobility have been lifted, the following guidance applies for physical activity at home, in gyms and health clubs, and outdoors, as well as for participation in sports in general. 27 5.2. Physical Activity at Home Broadly, the following guidelines are to be followed: 27 • Exercise in a well-ventilated place; keep doors and windows open whenever possible. • If more than one person will exercise in the same room, keep a minimum distance of 2 meters between them (i.e., one person per 4 m²). • Preferably, physical activities should be practiced individually. To increase safety, stick to those exercises which you already used to performing. • Wash hands and exercise equipment very well with soap and water or hand sanitizer (70% alcohol-based) during physical activities. • Use disposable towels or individual fabric towels, laundering them after every use. • Do not overexert yourself while training; follow your physician’s advice. • Stop exercising at once if any of the following symptoms appear: fatigue, chest or back pain, dizziness, palpitations, muscle pain, fever, nausea, vomiting, diarrhea, or flu-like symptoms. • Sedentary individuals and those who have not trained for a long time should limit themselves to light physical activity only. 5.3. Outdoor Physical Activity Follow the guidelines of local health authorities regarding restrictions on outdoor physical activity. 27 Even where restrictions have already been lifted, individual, isolated exercise is recommended, as described above. Always bear in mind that, as of yet, there is still no specific treatment for the virus, and some precautionary measures must continue to be followed. There are not many validated standards for specific recommendations regarding the practice of outdoor activities during a pandemic. Only one Belgian–Dutch study suggested that a distance of 2 meters is ineffective in preventing the spread of the virus during such activities. Instead, the authors suggest: 1. A distance of 4 to 5 meters between people walking behind one another. 2. A distance of 10 meters when jogging or cycling slowly. 3. A distance of 20 meters when cycling quickly. It bears stressing that the aforementioned measures and suggested behaviors are subject to constant change as the pandemic evolves. 28-30 5.4. Physical Activity in Gyms and Fitness Clubs • Hand sanitizer (70% alcohol-based) and face masks should be provided for use by members and staff in all areas (front desk, weight rooms, free weights, classrooms, swimming pool, changing rooms, etc.). 289