When should you resume your workouts after taking COVID-19, and how should you do so?

Doctors advise patience when it comes to exercising after healing from COVID-19. Rushing the procedure might jeopardize your health.

Returning to your fitness regimen after an accident or sickness might necessitate some constraint in order to attain the best results safely. If you return to your workouts at full pace without giving your body time to rest and recover, it may take you longer to restore your fitness or, even worse, result in a re-injury or relapse

According to Michael Fredericson, MD, professor of physical medicine and rehabilitation in the department of orthopedic surgery at Stanford Medicine in Palo Alto, California, resuming physical activity after having COVID-19 adds an extra layer of complexity because of the risk of complications, such as myocarditis (inflammation of the heart muscle), for those individuals known as long haulers who experience prolonged symptoms of the virus.

"I think the best advice about exercising after having COVID-19 is to be very cautious – this is a difficult condition," Dr. Fredericson says, adding that no matter your age or fitness level, it's a good idea to talk to your doctor about any physical activity plans and continue with caution.

Individualized Exercise Programs Should Be Used When Returning to Exercise

Recreational athletes resuming physical exercise after being infected with COVID-19 should follow the advice of sports medicine doctors at the Hospital for Special Surgery (HSS) in New York City.

The HSS Journal published the list of considerations and suggestions in August 2020. The scientists point out that each COVID-19 patient is different, and there is a wide range of how the virus affects people. The guidelines also state that everyone heals from COVID-19 at their own pace and that there is presently no formula for determining how and when a person should resume normal activities.

"In patients who recover from COVID-19, there isn't a clear, consistent reaction," says James Borchers, MD, a sports medicine doctor at the Ohio State University Wexner Medical Center in Columbus.

According to Dr. Borchers, it's important for everyone — even those with just mild to moderate symptoms or no symptoms at all — to connect with their healthcare practitioner so that they can talk about how to start exercising again and how to increase intensity appropriately.

• If a patient with COVID-19 has a prolonged fever, dyspnea (breathlessness) at rest, cough, chest pain, or palpitations, exercise should be avoided.
• Even if asymptomatic, any COVID-19 patient with an underlying cardiovascular or pulmonary problem should visit a physician before resuming activity.
• After a seven-day asymptomatic period, an otherwise healthy patient with a self-limited course of COVID-19 may resume physical activity at 50% of usual intensity and volume
• If individuals who have had COVID-19 have chest pain, fever, palpitations, or dyspnea after resuming exercise, they should seek medical advice.

"These recommendations make sense and are suitable as long as we remember that each people is unique, as is the activity they're returning to," adds Borchers. "For some people, starting at half of what they accomplished before becoming infected with the virus may be too difficult." It's possible that more tweaking is required.

According to James N. Robinson, MD, a primary sports medicine doctor at HSS in New York City and a co-author of the paper, these guidelines were developed before the emergence of the delta version of COVID-19 (and numerous others), but they still apply to instances caused by the various variants.

"When exercising indoors with others, it's critical to wear masks and exercise social distancing," Dr. Robinson advises. The CDC says that outdoor activities are still safer than indoor activities (especially when it comes to exercising at a gym or in a fitness studio) and that masking in indoor public spaces can help reduce COVID-19 transmission risk.

Tips for Everyone Returning to Exercise After COVID-19 Moderate or Mild

When you do decide to resume your training regimen, keep the following suggestions in mind.

1. Do not exercise if you are still experiencing COVID-19 symptoms.

"The most essential thing for individuals to remember is not to exercise while they are still experiencing symptoms, such as fever, exhaustion, or shortness of breath," Robinson advises. Instead, he advises people to wait 7 to 10 days after they are symptom-free before resuming activity.

"Exercising when you're unwell or symptomatic with an active infection is never a smart idea," Borchers adds. He notes that exercising when you have an active viral illness might make the condition worse, which can lead to more difficulties.

2. Begin slowly and gradually increase the intensity.

According to Fredericson, how you should begin exercising after COVID-19 depends on your previous level of activity. "Most people should begin with merely a walking program and progressively increase their walking tolerance." "After you've done that for a couple of weeks, you can throw in some more intensive cardio, but not too much — just enough to get your heart rate up a bit higher than it was with walking," he says.

According to Fredericson, using a stationary cycle or elliptical machine, or participating in an activity like swimming, is a good way to get started. "If you can gradually increase the intensity over a couple of weeks, tolerate it, and continue to feel good," he says, "you can return to your regular workouts."

The National Strength and Conditioning Association's suggestions may be a good fit (after consulting with your doctor) for more serious fitness enthusiasts who plan out their workouts to specific heart rate zones or perceived effort metrics. It's a four-week program that will get you back to your previous level of fitness.

"During the first week, you should reduce your activities by half of what you were doing previously. If that goes well, you can do a week at a 30% reduction, then a 20% reduction, and finally a 10% reduction," he explains. You'll be able to safely return to your pre-illness workouts after four weeks of progressively increasing your exertion, says Fredericson. However, you should only continue the regimen if you feel good after each increase.

Because each person's rehabilitation and return to exercise is unique, you'll need to keep a careful eye on your progress and pay attention to your symptoms while exercising.

3. Pay attention to your body, especially if you have any heart problems.

"Since the publication of our guidelines, there has been growing concern about the danger of myocarditis following COVID-19. "This is all the more incentive for folks to take it slowly and listen to their bodies," Robinson adds.

Some cases of COVID-19, according to Fredericson, cause widespread inflammation throughout the body, with a portion of the inflammation affecting the heart muscle, resulting in myocarditis. "You can get an arrhythmia, which is when your heart beats irregularly, or you can get a ventricular arrhythmia, which can lead to a heart attack," he explains.

It's been seen in persons with severe and moderate COVID-19 instances, according to Fredericson.

COVID-19 myocarditis may be uncommon, according to research published in the January-February 2021 issue of Cardiovascular Pathology. The authors assessed the rate of myocarditis to be between 1.4 and 7.2 percent based on data from 277 autopsy cases collected in 22 published articles.

The bottom line: "It is critical that individuals visit their physician before returning to heavy employment or activity if they have underlying previous cardiac or lung issues," Robinson says.

Returning to Exercise After a Long COVID-19 Infection

According to Borchers, the safest and best manner to return to exercise for persons with long-term problems will be different.

"So far, what we've noticed is that these folks start to feel better, but they never quite get over the hump; they tend to plateau and don't improve." COVID- "19 long transporters can endure severe weariness, everyday headaches, and find themselves out of breath doing things like getting up and down the stairs or heading to the mailbox," he says.

"It appears that these folks require a long time to get better, and they should not try to exercise again while they're feeling that way," adds Borchers.

According to him, these patients should only resume physical activity once they are symptom-free and under the supervision of their doctor.

STAY POSITIVE AND NEVER GIVE UP