Coming Back After COVID-19

A topic unfortunately still close to our everyday lives… COVID. 

At this point in time, most people have either experienced COVID themselves or have had someone they know that has experienced COVID. But a question asked is how to get back to exercise post COVID? It may be feeling more difficult to do your regular exercise routine or get moving again after a period of isolation and illness. 

COVID-19 is a respiratory disease and can cause severe illness. It is a multi-system disease where cardiovascular, immunological, renal, haematological, and neurological systems are often affected. Possible ongoing complications include ongoing fatigue, myocarditis, and airway hypersensitivity. Exercise is important for recovery for patients with COVID-19 but must be done gradually and safely. 

 

When can I start exercising again? 

People with a mild illness are generally considered recovered after 7 days if they have been asymptomatic or have not developed any new symptoms in this time. 

Current recommendations (healthdirect.gov.au):

If your symptoms were mild, you can start exercising again if:

  • You’ve had 10 days of rest since symptoms started 
  • You’ve had at least 7 days with no symptoms, and 
  • You’re no longer taking any medications such as paracetamol 

The general consensus return to exercise or sporting activity should occur after an asymptomatic period of at least 7 days and would be reasonable to apply this to any strenuous physical activity (Barker-Davies et.al 2020). However, if you’re recovering from moderate or severe illness, speak with your healthcare provider before returning to exercise as those who had more severe COVID-19 illness, such as those who were hospitalised, are thought to be at higher risk of cardiac complications and thromboembolic events (Wilson et.al. 2020). 

 

How to get back to activity

Start with 15 min of light activity like walking or cycling and see how you feel. Continue to slowly increase the duration and intensity of your exercise, paying careful attention to your heart rate and breathing rate. This amount of exercise can slowly be increased progressively through duration and intensity. 

This is general advice based on current recommendations and research. Everyone will progress at a different rate and exercise should be tailored accordingly. 

Stop exercising immediately and contact your healthcare provider if you have any: 

  • Chest pain or palpation 
  • Unexpected breathlessness 
  • Signs of blood clotting, such as swollen calves 

If you develop symptoms such as severe shortness of breath or chest pain, call 000 immediately.

Currently there are no official guidelines or systematic reviews for post acute COVID-19 pulmonary rehabilitation (Kyungyeuk et.al. 2021) but an advisable approach for those with mild disease is that return to exercise should be gradual, individualised, and based on subjective tolerance of the activity. People may be expected to be more breathless for a given activity than before illness. The use of a standardised scale such as the Rate of Perceived Exertion (RPE) can be useful to use when returning to activity post illness. 

Start by resuming activity that reaches approximately light-moderate activity and monitor ability to feel recovered 1 hour after exercise and on the day after. Exercise can then be slowly progressed if able to sufficiently recover and manage exercise load. Speak to your health professional (physiotherapist) if you need further assistance progressing your exercise back to pre illness levels. 

The good news is, most people will recover post COVID-19 infection and be able to resume usual activities but the process should be gradual and progressively increased over time. 

References

Barker-Davies, R., O'Sullivan, O., Senaratne, K., Baker, P., Cranley, M., & Dharm-Datta, S. et al. (2020). The Stanford Hall consensus statement for post-COVID-19 rehabilitation. British Journal Of Sports Medicine, 54(16), 949-959. doi: 10.1136/bjsports-2020-102596

Choi, K., Kim, M., Lee, S., & Kim, J. (2021). Exercise-based pulmonary rehabilitation for a post-COVID-19 pulmonary fibrosis patient. Medicine, 100(47), e27980. doi: 10.1097/md.0000000000027980

Wilson, M., Hull, J., Rogers, J., Pollock, N., Dodd, M., & Haines, J. et al. (2020). Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. British Journal Of Sports Medicine, 54(19), 1157-1161. doi: 10.1136/bjsports-2020-102710

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