When to Start Exercising After Covid

Close up shot of sporty happy elderly couple running down the stairs with look on each other

This content has been reviewed and approved by Kathy Doubleday DPT, OCS.

 

Returning to Exercise after COVID-19

If you’ve recently suffered from COVID-19, you might be wondering when, and how, you can safely return to exercising. COVID-19 affects everyone differently and it’s difficult to tell what long-term effects an individual might have after they recover from infection and how this might impact returning to exercise. While some people may be able to get right back into their regular training program, others may find that their physical performance has been negatively affected. For most people, getting back into exercising will take time and patience.

Reasons to Get Active

 There are numerous reasons to exercise, and this is especially true after having COVID-19. Returning to exercise after COVID-19 can help to:

  • Improve strength.
  • Improve energy and endurance.
  • Improve balance and co-ordination.
  • Improve memory and thinking.
  • Improve mental health.

 

When to Return to Exercise after COVID-19

Individuals that have COVID-19, should not participate in any type of physical activity. Rather, the focus should be on rest, hydration, and adopting a healthy diet. The timeline for returning to exercise is based on the severity of infection (asymptomatic/mild, moderate, severe).

Asymptomatic/Mild

All individuals that test positive for COVID-19 should rest for a minimum of 10 days, regardless of symptom severity, even those that have no symptoms. For asymptomatic individuals, the 10-day rest period starts from the date of the positive test. For symptomatic individuals, the 10-day rest period starts from the date the symptoms first appeared.

After the 10-day rest period, individuals with asymptomatic or mild infections that are able to return to their normal activities of daily living and able to walk 500 meters without shortness of breath or fatigue can begin a gradual return to exercise, with at least 2 weeks of minimal exertion.

The return to exercise timeline can be broken into 4 phases:

Phase 1 and 2 (initial two-week period) – the focus should be on light activities such as  household and gardening tasks, walking, yoga, breathing exercises, and light stretching and strengthening exercises.

Phase 3 – includes progressing to more challenging activities including intervals of brisk walking, jogging, climbing stairs, swimming, and/or cycling combined with rest intervals. Progress through this phase by adding an interval per day, as tolerated.

Phase 4 – involves more complex movements that challenge strength, balance and co-ordination including running including changes in direction, shuffling, and/or weight lifting circuits.

After completing the 4 phases of return to exercise, the individual should be able to return to their pre-COVID-19 exercise level.

Each return to exercise phase should last a minimum of 7 days; however, each phase may last longer depending on individual comfort level. Individuals should be monitored during exercise and for 1 hour after exercise, as well as the day after exercise for symptoms of abnormal heart rate, abnormal shortness of breath, excessive fatigue, of decreased mental health. If these side effects occur, a step back to the previous phase is recommended. If symptoms are persistent or if the individual isn’t progressing as expected, they should seek medical attention. Keeping an exercise diary can help to keep track of exercise progression through the phases, and any side effects or changes in mood should be noted to monitor progress.

Moderate/Severe

Individuals that have had moderate or severe COVID-19 are thought to be more at risk of cardiac or thromboembolic complications and should be evaluated by a healthcare practitioner prior to resuming any type of exercise. Additional testing, including ECGs, imaging, and/or bloodwork may be necessary before they are cleared to return to exercise.

The long-term effects of COVID-19 are not completely known at this time, however, there is increasing evidence to show that there are potential long-term effects of COVID-19, commonly referred to as “long” or “post-acute” COVID. The symptoms that persist following initial infection include coughing, shortness of breath, muscle aches, increased resting heart rate, and severe fatigue. These symptoms may last for weeks to months following infection with COVID-19. Additionally, the virus can cause damage to the lungs, kidneys, brains, and/or hearth with approximately 25% of patients with severe COVID-19 infection suffering from cardiac damage. The long-term effects of COVID-19 may interfere with an individuals’ ability to return to exercise. Individuals that are suffering with persistent symptoms should be assessed by primary care and possibly post-COVID-19 rehabilitation services prior to returning to exercise.

 

General Tips for Safe Exercising

When you start exercising after COVID-19, keep these safety tips in mind:

  • Warm up before exercise and cool down after exercising.
  • Dress appropriately with comfortable clothing and supportive shoes.
  • Stay hydrated.
  • Avoid exercising outdoors in extreme weather.

 

Key Points to Remember

Getting back into exercise after COVID-19 may be slow and frustrating, especially for individuals that were extremely active prior to infection. Here are some tips to keep in mind:

  • Start slow – you should gradually get back into exercise, slowly building up your time and intensity as your endurance improves.
  • Listen to your body – symptoms including heart palpitations, chest pain, nausea, headache, increased heart rate, dizziness, shortness of breath, extremity swelling, excessive fatigue, vision changes, and/or passing out should never be ignored, stop exercising immediately and speak with your healthcare practitioner and resume exercise once symptoms subside.
  • Patience is key! – it will take some time before your body has recovered from infection, give yourself some time and grace when getting back into exercising.

 

Conclusion

Whether you’re an avid athlete or a casual participant you’re likely anxious to get back to exercising after COVID-19. Keep in mind that it’s often a slow process that will take some patience – take it slow and listen to your body. 

 

Sources

https://www.acsm.org/blog-detail/acsm-certified-blog/2021/12/20/safe-return-to-physical-activity-after-covid-19

https://www.bmj.com/content/372/bmj.m4721

https://health.clevelandclinic.org/returning-to-sports-or-exercise-after-recovering-from-covid-19/

https://myhealth.alberta.ca/after-covid/exercising-and-being-active/exercise-after-covid-19

Physio Ed. Clinical

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