How safely resume exercise after COVID-19?

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(alt: Things you need to know before resuming exercise after COVID-19)

Public health recommendations like staying indoors and restricted contact with others in public places during the pandemic disrupted our exercise routines. Coping with COVID-19 can be devastating for many, particularly if they end up stuck in bed for weeks due to severe and multi-organ COVID-19 symptoms. Returning to pre-infection fitness may take a long time. 

Lack of exercise negatively influences your body’s immune response, raising your susceptibility to infections and prolonged recovery.

Moreover, not exercising leads to the loss of skeletal muscle mass and weakens muscle strength. Low activity levels may initiate metabolic alterations, even for two weeks, causing weight gain.

Many studies suggest that tailored and supervised exercise may be an effective multisystemic therapy for the post-COVID-19 syndrome. First, however, check with your doctor before returning to regular physical activity after COVID-19. 

What kind of medical examination should you take before returning to exercise?

COVID-19 infection may affect many organs, so a sound clinical examination is a must. 

Your doctor should consider:

  • the severity of the disease course
  • age
  • post-disease physical performance. 

Besides medical examination, you should also take blood tests measuring:

  • inflammation
  • blood cell count
  • kidney function
  • cardiac biomarkers.

The most important organs to check are the lungs and heart, as they are most affected during infection. Neurological tests also may appear necessary.

Cells covering the airways to your lung may recover very long, even when the virus load has resolved. Therefore, clinicians recommend two to three days of graded return for each training day lost due to infection, regardless of the virus effect. 

Severe cardiac symptoms of COVID-19 disease include: 

  • chest pains breathlessness
  • palpitations
  • or dizziness. 

Even if you experience mild or no symptoms but have tested positive for COVID-19, you should regularly visit your doctor for a heart health checkup. 

When you look for a practical tool to guide your training during recovery, try to monitor oxygen saturation and heart rate.

How do you safely return to exercise after COVID-19?

You should strictly follow clear clinical recommendations on how to exercise after COVID-19 infection. The program should be set individually, starting from less intense training and gradually making it more rigorous based on patients’ possibilities.

With relevant training structure intensity of the exercise should be increased:

  • firstly with frequency (start with one day per week, then increase to three, and end with  five to seven);
  • then with duration (start from 10 minutes, increase to 20 minutes, 30, and so on);
  • and intensity at the end (you should start from the low-intensity training, followed by moderate and intense activity).

After having a COVID-19 infection, you are more prone to injuries as you have likely been inactive for several weeks or longer. To avoid injuries, you should aim to try low-intensity activities for two to three weeks.

Here are examples of possible start programs:

  • exercising on a treadmill one time per week for ten minutes,
  • stationary bike one time per week for ten minutes,
  • and resistance exercise with light weights one time per week for ten minutes.

Tailor the training program depends on disease severity

Returning to your pre-infection fitness level depends on the severity of the symptoms during infection. Most patients with COVID-19 either remain asymptomatic or experience mild symptoms. However, you should comprehensively evaluate your health condition before returning to exercise. 

Here is what international experts proposed to athletes in the post-COVID-19 recovery period:

  • Asymptomatic athletes who have tested positive for COVID-19 should undergo two weeks of self-isolation and rest from exercise, followed by a gradual return to exercise under the guidance of a medical team.
  • Clinicians recommend athletes who experienced mild symptoms but did not require hospitalization two additional weeks of social distancing, followed by a blood test and heart examination – echocardiography. 
  • The situation slightly changes when you are an athlete with moderate to severe symptoms which needed hospitalization. Then you should undergo a comprehensive and multidisciplinary evaluation before returning to exercise. Ideally, if the team of experts compromises a sports physician, cardiologist, pulmonologist, and professional trainer.

Unfortunately, athletes need to take an extensive exercise-abstinence period of three to six months, depending on the reduction of blood pumping by the heart. Also, the rehabilitation plan should include intensive heart and blood system health monitoring. When you have severe breathing symptoms, monitor your recovery progress with specialized pulmonology, even as you return to exercising.

When should you suspend exercise after COVID-19?

Remember that while your body is still experiencing a systemic infection with cough, fever, and short breath, intensive exercise risks serious complications such as heart muscle inflammation, causing a lower ability to pump blood (myocarditis).

Sometimes many athletes report COVID-19-related symptoms after the resolution, particularly during intense training. It can be a recurrence or reactivation of the disease. In such cases, do not downplay it, cease the activity, and contact a sports physician.

Points to remember

  • Before returning to exercise, you should ensure that you are healthy and have had all necessary examinations and diagnostics. 
  • When your doctor gives you the green light, talk to him about gradually increasing the frequency, duration, and intensity of training. 
  • Monitor your heart and lung performance during the recovery period. 
  • Stop your physical activity training and consult a doctor when you observe chest pains, breathlessness, or other symptoms that resemble COVID-19 infection.

Martyna Piotrowska


Safe Return to Exercise after COVID-19 Infection – PMC (nih.gov)

Exercise in the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) era: A Question and Answer session with the experts Endorsed by the section of Sports Cardiology & Exercise of the European Association of Preventive Cardiology (EAPC) – PMC (nih.gov)

Exercise and sports after COVID‐19—Guidance from a clinical perspective – PMC (nih.gov)

IJERPH | Free Full-Text | Post-COVID-19 Syndrome and the Potential Benefits of Exercise (mdpi.com)


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19 października 2022

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