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Returning to Exercise After COVID-19: When is it Safe?


While vaccinations and boosters have lessened the effects of COVID-19, the virus and its symptoms are still present. And if you haven’t already become infected with COVID-19, with its lingering existence comes the risk that you may get it. Symptoms include fever or chills, a cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or a runny nose, nausea or vomiting, and diarrhea. COVID-19 takes a toll on the body, with symptoms sometimes lingering for four or more weeks. The range of symptoms and slow recovery time can make it challenging to return to exercise even after a mild- to moderate- case of COVID-19. Follow accepted guidelines and recommendations when returning to exercise as attempting it too soon can negatively impact your body.

How COVID-19 impacts exercise

COVID-19 affects the body's major systems, including the cardiac, pulmonary, musculoskeletal, hematologic, and gastrointestinal systems.

This brief overview explains how COVID impacts the systems that play an integral role in exercising:

  • Cardiac System: May cause arrhythmias; myocarditis, or inflammation of the heart; heart attack; inflammation; interstitial fibrosis that contributes to ventricular dysfunction and heart failure; and hypoxia, when the body is deprived of oxygen. Since working out places stress on the heart, proceed with caution following COVID-19, particularly if an underlying heart condition was present pre-COVID.
  • Pulmonary System: Negative effects include fever, cough, pneumonia, labored breathing, serious lung infection, and deterioration in respiratory status.
  • Musculoskeletal System: Symptoms include muscle pain, joint stiffness, and fatigue.
  • Hematologic System: Potential effects include hypercoagulability, meaning an increased tendency to develop thrombosis; large vessel strokes; myocardial injury, which reduces the heart’s ability to pump blood; and microvascular thrombosis, which can lead to hypoxia.
  • Gastrointestinal System: Vomiting, nausea, anorexia, diarrhea, and loss of appetite are all potential effects of COVID.

Considerations

Everyone’s experience with and recovery from COVID-19 is unique. Listen to your body and symptoms before resuming exercise. When in doubt, consult your doctor.

Things to keep in mind when assessing whether you’re ready to safely return to a workout routine include:

  • Do you have a pre-existing cardiac condition? If you answered no and had mild-to-moderate symptoms, recommendations suggest resting 2 to 3 weeks after your symptoms have dissipated before resuming moderate activity. If you have a heart condition, wait for 3 to 6 months after symptoms have cleared up. Also, speak to your doctor about getting some testing done, including biomarkers, echocardiography, rhythm monitoring, and exercise testing.
  • Did you suffer from moderate to severe pulmonary issues while sick with COVID? If not, and your general symptoms were mild to moderate, rest 10 or more days from the start of symptoms, plus another 7 days from the symptoms clear up. Upon returning, keep exercise light to begin and gradually ease into it. For those who had more severe pulmonary issues from COVID, the recommendation is that you see a pulmonary specialist before returning to exercise.
  • Did you experience nausea, vomiting, or loss of appetite? If so, don’t begin exercise until your appetite returns, ensuring you're receiving adequate calories. Also, make sure your hydration levels are back to normal.

Risks of exercising too soon after COVID

While it can be hard for exercise-lovers to remain inactive after COVID-19, resuming exercise too soon can result in serious health issues. It’s better to take extra time to rest while all of the body’s systems recover.

Exercising too soon can result in the following:

  • Myocarditis: An inflammatory response of the heart that causes the heart muscles to swell, making exercise extremely dangerous. It is more likely to occur in those with moderate to severe COVID, but anyone infected is at risk.
  • Increased injury risk: From a musculoskeletal perspective, those returning to exercise after COVID should start with low-intensity exercises. The virus is hard on the body, and if you’ve been sick, it’s caused you to be inactive. Jumping into your pre-COVID routine after weeks of inactivity puts you at risk of muscle tears, tendon strains, joint pain, or becoming overly sore.
  • Increased fatigue: Exercising too soon after COVID can create significant fatigue. If during or after exercise you notice significant tiredness, your body is likely not ready yet.

In addition, if you experience any of the following symptoms, stop exercising immediately and contact your doctor:

  • Chest pain or palpitations
  • Nausea
  • Headache
  • Unusually high heart rate
  • A feeling of lightheadedness or dizziness
  • Shortness of breath
  • Extreme fatigue
  • Swelling of the arms or legs
  • Fainting
  • Tunnel vision or loss of vision

Recommendations

Do not resume exercise if you had COVID and still have a lingering fever, difficulty breathing at rest, a cough, chest pain, or heart palpitations.

If you have an underlying heart or pulmonary condition, consult a doctor before restarting your exercise routine.

If you are healthy and had a mild to moderate COVID case, you can resume exercise after being symptom-free for 7 days. Begin at 50% of your normal intensity and volume.

If you resume exercise and develop chest pain, fever, heart palpitations, or difficulty breathing, immediately stop exercising and talk to your doctor.

Safely increasing activity post-COVID

Remember, your body needs time and patience when recovering from COVID, and the same is true for returning to activity. If you’re exercising and notice pain or severe exhaustion, your body is not ready. However, if you return to exercise and low-intensity activity feels good, your body may be ready to take things up a notch.

Some suggestions for safely increasing your activity level post-COVID include:

  • If pre-COVID you enjoyed running, start with a walking program to ease into it. If you feel good during the walks, you can gradually increase the distance. As you continue to feel more comfortable with the routine, you can begin to mix jogging with it. Go slow when re-introducing running to your plan. Start with a minute or two, and build upon that.
  • Those who enjoy strength training should not dive into using their pre-COVID maximum weights. Start with lighter weights, gradually increasing the weight week by week.
  • Engage different body parts during your workouts, so you don't overly stress some muscles while neglecting others.

References:

Centers for Disease Control and Prevention (2021). Post-COVID Conditions.

Cleveland Clinic (2021). Returning to sports or exercise after recovering from COVID-19.

John Hopkins Medicine (2021). Getting back to exercise safely after pandemic lockdown.

John Hopkins Medicine (2022). Coronavirus diagnosis: What should I expect?

Metzl, J. D., McElheny, K., Robinson, J. N., Scott, D. A., Sutton, K. M., & Toresdahl, B. G. (2020). Considerations for return to exercise following mild-to-moderate COVID-19 in the recreational athlete. The musculoskeletal journal of Hospital for Special Surgery.

UCLA Health (n.d.). Is exercise safe after COVID-19?

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