Returning to Exercise After Covid

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Are there dangers on returning to exercise post Covid? That is still something being studied, but we do know there are long term effects from Covid and because of possible complications there should be guidelines on how to return to physical activity. There is increasing evidence that “long Covid” symptoms can include cough, elevated resting heart rate, and extreme fatigue. Cardiac damage is also a concern, especially in athletes returning to sport post virus. The American College of Sports Medicine is one of the first organizations to provide guidelines based on your level of risk.

Low Risk: If you are under the age of 50 with asymptomatic or mild respiratory symptoms that resolved within seven days.

  • When to return to activity: Rest for at least ten days after being diagnosed. Once asymptomatic for seven days then follow a gradual return to exercise without evaluation.

  • How to return to activity: You should first return to normal daily routine and sleep patterns. You should be able to perform daily activities and be able to walk 500 m (.31 miles) on a flat surface without fatigue or shortness of breath. Your first workout should be light intensity for a duration of 15 minutes. If you feel your energy is as it was post covid, you can increase the duration during your next workout. It’s recommended you begin with bodyweight exercises and then progress to heavier resistance and sports. *Athletes should engage in at least two weeks of minimal exertion activity before resuming sport.

Intermediate risk: If you had symptoms or fatigue lasting for more than one week, or prolonged shortness of breath/chest pain that did not require hospitalization.

  • When to return to activity: it is suggested that you be evaluated with an EKG and troponin test if you have an abnormal EKG. A personalized exercise prescription is recommended.

  • How to return to exercise: a specialist team should create a personalized exercise prescription

High risk: if you were hospitalized or experienced shortness of breath or chest pain at rest or with basic daily activities.

  • When to return to activity: it is suggested that you be evaluated with an EKG and troponin test if you have an abnormal EKG.

  • How to return to exercise: a specialist team should create a personalized exercise prescription

A gradual return to exercise will help mitigate risk. Working with an exercise physiologist and care team is to your benefit as we continue to learn more about Covid-19 and exercise.

Below is an example of a low risk return to exercise progression. You should make sure you recover from each workout and that no new/returning symptoms occur. Contact your doctor if you experience any chest pain, irregular heartbeat or shortness of breath. This progression may take place over a 1-2 month period.

  1. Stage 1: Mobility/Flexibility and light walking

  2. Stage 2: Continue to build up walking intensity and duration

  3. Stage 3: Moderate intensity aerobic exercise and bodyweight resistance training (one day of exercise interspersed with one day of recovery)

  4. Stage 4: Moderate intensity aerobic activity and resistance training (moving up to two days of exercise and one day of recovery)

  5. Stage 5: Attempting your baseline level of activity, ramping up intensity to moderate/vigorous.

This post is an interpretation of an article titled Safe Return to Physical Activity After Covid-19.