Returning to Physical Activity After COVID

Returning to Physical Activity After COVID

Written by Allison McNamara, PT, DPT

If you are like so many other people right now, you have contracted the Omicron variant of Covid in the past month or two and are (hopefully) on the road to recovery. You are probably itching to get back into your fitness routine (or as it is January, ready to start one as a New Year’s Resolution) and are wondering how you can safely do so in the wake of your Covid diagnosis.

When to Resume Fitness

Since Covid affects everyone differently, there is a spectrum of recovery protocols for return to sport – some people will be able to resume their fitness routines without missing a beat, and some might need a slower and more gradual return to sport. It is not unreasonable to take at least 3 months to return to your pre-infection level of fitness, especially if you had a severe infection. Since Covid affects your heart and lungs, it is therefore going to impact your ability to participate in exercise – both cardiovascular exercise like running, biking, and fitness classes, and lifting weights. However, it is important to return to performing at least 30 minutes of exercise at least 5 days a week when you are able to do so because regular exercise helps support a healthy immune system.

Guidelines to Resume Fitness

Here are some guidelines you can follow to safely and successfully resume your fitness routine while maintaining your overall health.

Even if you were active prior to contracting Covid, and even if you were asymptomatic, it is always a good idea to check in with your physician prior to resuming exercise. However, before resuming or starting a new fitness routine, you should definitely seek clearance by a physician if any of the following apply to you:

  1. You were hospitalized due to your infection.
  2. You have other co-morbidities that affect your cardiovascular system. Myocarditis is inflammation of the heart due to a viral infection (such as Covid). It can lead to other cardiac complications such as arrhythmia – an irregular heartbeat – which can result in a heart attack. It is rare that Covid leads to myocarditis, but prior cardiovascular illness combined with Covid and rapid return to sport can have devastating consequences.
  3. You have lasting Covid symptoms other than loss of taste or smell. Chest pain, excessive shortness of breath with minimal activity, coughing, headaches, fever, elevated heart rate with minimal activity, excessive fatigue – these are all signs that you need to continue to rest and allow your body to heal before returning to exercise.

If none of the previous categories apply to you and/or your doctor has cleared you to begin exercising, keep the following recommendations in mind when resuming your fitness routine.

  1. Don’t exercise while you have symptoms – fever, fatigue, shortness of breath, coughing, etc. – exercising with active viral infection can worsen the infection and lead to additional complications.
  2. Be symptom free for 7-10 days – even if you were symptom-free for the duration of your infection. According to the Cleveland clinic, it is a good idea to rest for 10 days starting at the day of the positive test before returning to exercise.

How-to Structure Your Return to Exercise

Ready to start? You can use the following guidelines to structure your return to exercise. If you want a more detailed flow sheet to guide your return to exercise, the British Medical Journal has created one for people to follow. If you are an athlete or typically used to higher levels of exercise, the National Strength and Conditioning Association has created one for you to follow.

  1. Start with gentle movement – activities such as simply walking around your home, stretching, and performing breathing exercises. At first, even light activity such as household tasks can take a toll on you – so take your time with this stage and only progress if your symptoms do not return with these activities.
  2. Progress to light activity such as walking or riding a stationary bike – 5-15 minutes at a pace where you can have a conversation (if you are gasping for breath, you are working too hard at this level and should back off a bit.) Even if this feels way too easy, it is better to take your time with your progression to prevent excessive fatigue and allow yourself to get back to your previous level of function more quickly. If you experience the following symptoms – irregular or overly elevated heart rate for your level of activity, shortness of breath or the inability to catch your breath, headache, chest pain, feeling lightheaded or dizzy, nausea, swelling in your extremities, tunnel vision or loss of vision, or if you pass out, you should immediately stop exercising. The amount of time you rest before returning to exercise differs based on your previous fitness level, the severity of your infection, and the protocol you use; however, when you do return to exercise, you should return at a lower level of intensity and gradually progress. If the symptoms do not resolve after stopping exercise, you should see a physician before resuming your fitness routine.
  3. After 7-10 days at this level, if you are exercising comfortably without return of symptoms, excessive shortness of breath, or excessive fatigue, you can begin to perform more intense activities like running or exercising at a quicker pace. However, performing intervals at this point is a good way to ease back into more challenging exercise. 30-60 seconds of a more intense pace followed by a 1–2-minute recovery at a slower pace is beneficial. Once you can perform this for 30 minutes and you are not excessively fatigued afterward, you can progress to the next level.
  4. Return to previous fitness routine. If you become excessively fatigued after exercising or you experience any exacerbation in symptoms, return to the previous level of exercise.

Even after contracting Covid, it is possible (and highly recommended) to return to an active lifestyle as well as your previous fitness activities. You need to monitor your symptoms, be patient with yourself and your recovery, and follow up with your physician as needed. You will be back in action in no time!

If you, friend, or family member are recovering from COVID and still not feeling good, one of our therapists specifically trained in the care of post COVID patients can help. Ask about our PACER program (Post-Acute Covid-19 Exercise and Rehabilitation), available at select locations only. To schedule an appointment, contact Professional Physical Therapy.



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