Safely Resuming Exercise After COVID-19

Have you recovered from COVID-19 and struggled with knowing when and how to safely return to exercise? This is a common challenge for many because symptoms such as post-COVID fatigue and breathlessness can lower your tolerance and cause concern with exercise.

Physical activity is generally good for everyone and too much rest can make joint and muscle problems worse. However, be aware that exercise is a form of stress that can bring on symptoms so taking a smart and informed approach when returning to exercise is best.

General Guidelines for Return to Exercise After COVID-19

• Set realistic expectations. Do not expect to resume pre-illness activities and intensities right away
• Resuming physical activity should be slow and gradual
• Start with shorter sessions of exercise and allow for more rest initially
• Listen to your body and let your symptoms guide your plan
• Plan to exercise when you have the most energy
• Watch for post exertion symptom exacerbation which tells you that you have pushed yourself too far – scale back on duration, repetition or intensity if needed
• Monitor your exertion – try a heart rate monitor, a safe place to start is to use your resting heart rate, add 15 and gradually increase as tolerated
• Include a light warm up before you start exercise and monitor your symptoms before you move on to more strenuous activity
• Include rest time after exercise and continue to monitor your body’s reaction to the activity to determine next steps

Why is Exercise Important After You’ve Recovered from COVID-19?

Movement and exercise are important components of returning to your pre-illness function and addressing any lingering post-COVID symptoms. Exercise trains and strengthens the heart, lung and brain function, restores muscle strength and endurance, promotes mental wellbeing and improves cognitive function and performance, such as memory, concentration and decision making. Exercise does this by promoting blood flow throughout the body and brain, strengthening the heart muscle and improving oxygen transfer and uptake in the lungs.

Who Needs A Medical Evaluation Before Returning To Exercise?

There are multiple individual factors that determine your recommended approach to returning to exercise including pre-illness factors and illness severity. The American College of Sports Medicine outlines levels of risk to guide specific recommendations for those who require medical evaluation prior to resuming exercise, as follows:

Low Risk: Individuals under the age of 50, who had an asymptomatic infection or mild respiratory symptoms that resolved within seven days and would like to resume recreational exercise. *This group can follow a gradual return to exercise without further evaluation.

Intermediate Risk: Those with symptoms or fatigue lasting for more than seven days, or prolonged shortness of breath or chest pain that did not require hospitalization. *Requires medical evaluation

High Risk: High risk patients are defined as those who required hospitalization or who experienced shortness of breath or chest pain at rest or while performing activities of daily living. *Requires medical evaluation.

In addition, we recommend you consult with your doctor if you have cardiovascular disease or a respiratory condition, have symptoms such as chest pain, palpitations, severe shortness of breath, dizziness at rest or during activity, or have been mostly inactive prior to your illness.

What Approach Should I Take With Resuming Exercise?

Please note these recommendations are specifically for low-risk individuals who have recovered from mild cases of COVID–19 and are not intended to replace consultation with a medical professional.

Resuming activity should be slow and gradual. This applies to cardiovascular exercise, such as running, cycling, rowing, resistance or weight training and sports activities. A gradual approach helps promote the right balance between re-integrating exercise and allowing the time for sufficient rest and recovery between training sessions. For many, this means shifting expectations as fatigue is one of the primary symptoms that makes it difficult to pick up where you left off with exercise – and fatigue is not something you want to push through. By approaching exercise in the right way, most symptoms should improve with continued training, although the timeline for getting back to a level similar to before illness may vary from person to person.

Low risk individuals who have had a mild case of COVID-19 should consider the following progressions. Wait at least 7 days after symptoms have resolved before starting a gradual return to exercise. Begin with low impact activities such as short walks, easy biking or gentle yoga. Progress through the following, as tolerated: (1) Try resistance exercise with very light weights or simply stick to body weight exercises and gradually build your strength capacity from there. (2) Then, as tolerated, gradually increase the intensity and duration of cardiovascular and resistance exercises. (3) Finally, consider sport specific training and return to sport.

A specific example for runners, from Dr. Jonathan Hooper in Ottawa, suggests resuming training at around 50% of pre-COVID level and gradually increasing by 10% until fully back to your normal exercise tolerance.

Exercise should not resume if you have a persistent fever, shortness of breath at rest, cough, chest pain or palpitations.  Please contact us if you require any assistance from our team resuming exercise after COVID-19.

References:

1. Salman D, Vishnubala D, Le Feuvre P, Beaney T, Korgaonkar J, Majeed A et al. Returning to physical activity after COVID-19 BMJ 2021; 372 :m4721
2. Safe Return to Physical Activity After COVID-19. Dec 20, 2021.
3. For Runners Recovering from COVID-19 Slow and Steady Wins the Race. April 13, 2022.