A-Z Health Information | Te hāpori (Ngā kaupapa hauora) COVID-19 Returning to Exercise After Covid-19 Infection

Returning to Exercise After Covid-19 Infection

Exercise will help most people feel better after COVID-19 infection. Socialising and getting back to doing things you enjoy is important for your mental health. Exercise is medicine! But before you jump back in, there are some things you need to know.

This information is for people returning to exercise after an acute COVID 19 infection, not for those who may be experiencing symptoms of Long COVID.

If you have Long COVID

Anyone with Long COVID symptoms is advised to seek advice from a medical professional prior to completing any physical activity.

Exercising after COVID

Exercise is important for recovery from COVID-19 and a graduated return to physical activity has been shown to be safe and important.

Fortunately, most people will have a relatively mild illness and an uneventful recovery especially if fully vaccinated. As a result, the majority of people can start to return to activity after a 7-10 day period without symptoms and when they feel physically able. A small number of people however do need further evaluation.

When to see a doctor first

People with other health conditions, those who have not exercised before, and those who have experienced chest pain, significant shortness of breath or other more significant symptoms, should see a doctor. They may need other tests, for example, blood tests or an electrocardiogram (ECG). This is to rule out complications like myocarditis (inflammation of the heart muscle) that may make exercising unsafe.

 

What to expect during recovery

Ups and downs

It appears that people of all ages, backgrounds, irrespective of the severity of initial infection, can experience ongoing symptoms of COVID-19. There can be ups and downs but gradually you should have more ups, less downs. If you feel that your recovery is not following that pattern or you are experiencing new symptoms, you may require further assistance to manage your return to exercise.

Fatigue

It is also normal for your body to feel fatigued while you are fighting a viral infection, as your body uses up more energy during this period. We often do not feel back to our normal selves for at least a month after a virus like influenza or COVID-19.

Loss of strength and fitness

Being unwell with COVID-19 and the rest you need to take when unwell, can cause your muscles to become weaker and your cardiovascular fitness to reduce. Exercise is important for re-gaining strength and endurance. Muscles take time to adapt and recover. Regular strength and balance exercises can help you regain your normal function quicker.

 

Advice

There is currently limited research evidence and advice is based on “expert opinion”. A wide range of advice is available, from extremely conservative to more cavalier approaches. Links to some of the major sporting codes are listed below.

Rest

Initially rest is important. Sleep is magic, this allows repair.

Start with gentle exercise

Generally, COVID-19 infection symptoms settle over 3-7 days within the infectious period. When you feel your illness has resolved, the recommendation is resumption of gentle exercise after 7-10 days of being symptom free. You should have managed to fully resume other aspects of life e.g. day to day activities, school etc.

Pace yourself

Given that the COVID-19 virus can involve a number of systems, including the heart, kidney, blood, brain and wider nervous system, the resumption of activity should be slow and steady. Adopt a phased/graduated return to physical activity. Make it progressive, graduated and monitored. Don’t overdo or overexert yourself. A cautious approach is recommended.

Listen to your body

Only progress intensity of exercise in length and exercise duration if you did not experience any new or returning symptoms during or after exercise (this can be up to a few days later), and if you have fully recovered from the previous bout of exercise.

Be patient, focus on small achievements

Try not to compare yourself to how you were feeling before you were ill, instead compare yourself to how you were last week.

Watch out for symptoms that suggest there may be an issue

Recognise any relevant symptoms: chest pain, dizziness, difficulty with breathing, nausea, feeling faint or lightheaded, unexpected shortness of breath, heart racing. If you have any questions or concerns your first point of call should involve your GP.

Know that medication can mask symptoms

If you are taking any medication be mindful that it may mask symptoms (e.g. Paracetamol or Ibuprofen will reduce muscle aches) which would make it difficult to effectively monitor symptoms.

Communicate

Communication is very important whether this be with your coach, staff at gym or people around you. Let others know that you have recently had COVID-19.

 

Post-exertional malaise (PEM)

When you start exercising again, your symptoms can get worse, or you can get very tired even after a small amount of activity (physical or mental). This is known as post-exertional malaise (PEM).

PEM can be experienced by people resuming exercise after COVID-19 infection. It occurs when an individual feels well at the start of the exercise and experiences severe fatigue afterwards (this can be days after).

In addition to fatigue people with PEM can also experience pain, emotional distress, anxiety and interrupted sleep after exercise.

Regular rest and spreading tasks throughout the day is recommended to avoid triggering PEM.

 

Key Messages

  • Adequate sleep, good nutrition, hydration and social connection are also vital to help you recover well.
  • Returning to physical activity and exercise is important for recovery of physical and psychological wellbeing. Ensure you can recover well from each exercise bout without ongoing symptoms before progressing to the next level.
  • Communication is key - let others around you know that you are returning to physical activity after a recent COVID-19 infection.
  • There are still a lot of unknowns - if you are unsure of how best to return to physical activity after COVID-19 or have any concerns, contact your GP in the first instance.
  • Be kind to yourself, don’t be afraid to ask for help and be patient with your recovery.

 

Useful links and resources

More information on COVID-19 can be found at the following websites:

 

References

Updated 10 Aug, 2022