Exercise plays a vital role in our physical, mental, and emotional wellbeing so understandably, many who are recovering from COVID-19 are itching to get back into their usual exercise routine.
It is important to note that everyone’s post COVID-19 recovery will look and feel different and depends on a range of factors such as:
Prior fitness and health levels
Severity of illness and symptoms
Isolation period/length
Type of medical intervention needed
Positive routine activity and regular exercise may help protect people who get COVID-19 from becoming seriously ill. Currently, there is not a lot of research and evidence on exercising safely post COVID. Nor do we know the potential long-term effects for those who’ve contracted the virus. However, there is increasing recognition of potential long-term effects of COVID 19, including enduring illness (long COVID), cardiopulmonary disease, and psychological sequelae in some people.
What is clear from the research is that rest and recovery should be your number 1 priority – especially whilst you have the virus, even if you are asymptomatic.
Rest and Recover Period
It is important to rest for 10 days from when you started to get symptoms or tested positive if you’re asymptomatic.
In this period, rest is your best ally as the body needs rest for your immune system to combat the virus. This is NOT the period to “sweat it out”. COVID-19 is not just a mild respiratory illness, even if you had no/minimal symptoms, and hence return to exercise recommendations are more conservative.
If you are a mover, don’t feel guilty for resting. Give your body the rest to recover, use gentle breath and mindfulness techniques to nurture your body, and remind yourself this is the best way to return to exercise safely and gently.
Only return to gradual exercise when you have been free of symptoms for 7 days.
The reason for the recommendation to wait 7 days post symptoms prior to returning to exercise is:
To avoid potentially prolonging the illness
Increasing the cardiac output may increase viral load transfer to other parts of the body.
Concerns regarding the risk of exacerbating COVID associated myocarditis.
Concerns regarding the risk of thromboembolic complications (The risk of above 2 is unknown but thought to be low. Risk factors for long COVID are still being researched)
Myocarditis is an inflammation of the heart muscle. It can be associated with even asymptomatic COVID-19 infections (more likely with severe disease though). Reassuringly, most people make a full recovery from myocarditis. However, it’s important that a return to physical activity is done slowly and with rest days in between.
5 Phased Return to Exercise
Important points:
Only start when you’ve been symptom free for 7 days
Spend a minimum of 7 days in each phase
Only move to the next phase when progression criteria are met
Listen to your body
Stop when something doesn’t feel right
Seek medical advice if you note abnormal shortness of breath, chest pain or fever.
Drop back a phase if you are finding it too difficult or symptoms return
Monitor how you recover post exercise in terms of symptoms, energy levels, sleep, need for medications and mood.
If you feel down, low or anxious speak to someone and seek medical advice if you are concerned.
Spend a few minutes to warm up/cool down in each session
Phase 1: Preparation to return to exercise
Preparation time for your body to return to exercise gently and safely is the goal of phase 1.
After 10 days or more of rest, sleep, and likely reading/watching Netflix your body needs time to adequately prepare for exercise.
Recommended: gentle breathing exercises, easy walk, light stretches and gentle Pilates/yoga flows, gentle balance exercises.
Remember to allow yourself rest periods mid walk and between exercises.
Start with 10-15 minutes, and gradually increase by adding 5 minutes until you are at 30 minutes comfortably.
RPE (rate perceived exertion): 6-8 extremely light.
Remember to be patient and spend a minimum of 7 days in this phase before moving on.
Phase 2: Introduce low-intensity exercise/activity
Commence low intensity, low impact activity.
Recommended: Walking, gentle Pilates/yoga, light housework/gardening tasks.
Start with 10-15 minutes, and gradually increase by adding 10-15 minutes each day.
RPE: 6-11 light exertion
You can move to the next phase when you have done phase 2 for 7 days and you can walk for 30 minutes at a pace you can easily hold a conversation.
It is important to monitor how you’re recovering too in terms of breathing, return of symptoms, energy levels and sleep.
Phase 3: Moderate intensity aerobic and strength challenge
Intervals are recommended in this phase.
Eg. 2 intervals of five minutes with a block of 2-5 minute recovery between.
Add one interval a day as tolerated.
Recommended: Pilates, body weight or light weight strength training, gentle circuit training, brisk walking, light cycling/swimming/running/stairs.
RPE: 12-14 somewhat hard (moderate intensity, not out of breath, could hold a conversation).
You can progress to the next phase when you have completed seven days at phase 3, and you can complete a 30-minute session (including your rest intervals) and feel recovered within one hour.
Phase 4: Moderate intensity aerobic and strength plus coordination and functional skills
Increase exercise intensity, resistance and frequency but remember the key is listening to your body and monitoring your recovery and fatigue levels.
Allow yourself rest days between exercise days.
It can also be beneficial to split your aerobic and strength training to different days to get the most out of each and reduce fatigue.
Recommended: moderate interval jogging/swimming/cycling, light HIIT training, moderate circuit training, increase weights and range/challenges in strength training, increase balance challenges.
RPE: 12-14 somewhat hard (moderate intensity, not out of breath, could hold a conversation).
You can progress to the final phase when you have completed seven days at phase 4, and when your fatigue levels are normal.
Phase 5: Baseline Exercise
This stage is when you are feeling more like your usual self so can return to your regular exercise.
RPE: > 15 as tolerated very hard to maximum exertion.
Remember how important it is to listen to your body, modify exercise, build in rest periods during exercise intervals and general rest for your whole body. Continue to monitor how you’re feeling during exercise but perhaps even more importantly how you’re recovering as you increase/decrease your activity and fitness levels.
Sarah advises breath and mindfulness in all phases and to consider using phases 3 and 4 to build targeted strength, range, and balance to return to your regular sport/exercise with better outcomes.
The guidelines are conservative but with good reason and will challenge a lot of usually fit and active people to adhere to. They recommend taking 6 weeks to return to normal activity, longer if you need to stay in a phase for extra time. Don’t be too hard on yourself and don’t compete with your pre COVID self.
The physical and health benefits from being physically active significantly outweigh the risks of not engaging in exercise, post-COVID, for many people. However, pushing too hard too soon might slow your recovery.
Please note the above recommendations are for low-risk population recovering from COVID.
Check in with your GP/Physio/specialist if you are intermediate or high risk
Low Risk
No or mild upper respiratory symptoms
Younger client
Recreational exercise goals.
Intermediate Risk
Symptoms for more than 7 days
Chest pain during illness
Elite/endurance athlete
History of asthma or chronic fatigue
High Risk
Hospitalisation and/or ICU
Prolonged chest pain with rest/minimal exertion
History of cardiac disease
TOP FIVE TAKEAWAY TIPS
Go slow and gently despite nil/mild symptoms
Listen to your body and respond/don’t ignore
Give yourself permission to rest
Set a different health goal: mindfulness, flexibility, strength, manage pain
Pushing too hard too soon might slow your recovery and return to exercise
If you need more advice on your return to exercise speak to our team of Physios for a personalised plan. Featherstone has a wide variety of exercise rehab individual appointments and classes to assist your graded return to exercise post COVID in a supportive and informed studio.
We offer a free 10 min chat with a Physio service.
References
David Salman and colleagues at BMJ published 8/1/21
Royal College of General Practitioners AJGP Editorial Jewson Life After Covid published 11/20
APA choose.physio
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