Currently, 1 in every 15 people in the US has tested positive for COVID-19; and that number is rising daily. Chances are good that many of you reading this article are included in that group. As you recover and begin to return to activity and exercise, it is important to go slowly; not push yourself and seek medical evaluation if you are not improving. This article will focus on return to activity guidelines for those that have had mild COVID symptoms or have had a positive test but have been asymptomatic.
This article is not intended to provide guidelines for anyone that was hospitalized with COVID, especially if you have been in the ICU. Anyone hospitalized should work closely with their medical providers on return to exercise and activity. In addition, if you have pre-existing conditions such as obesity, diabetes, or heart disease you should talk to your doctor before returning to exercise.
Following are general guidelines for return to exercise:
- In general, healthy adults can begin to exercise 10 days to 2 weeks after symptoms subside.
- Start with short bouts of exercise with frequent rest breaks.
- Start by building muscular endurance with higher reps and lower weights.
- Set small goals. Aim to do a little more every day but avoid overdoing.
- Don’t push it: Regardless of the type of exercise you did before coronavirus, you should begin with very light workouts that aren’t taxing on your heart and lungs such as slow walking, short stints on the bike or treadmill .
- Whatever activity you choose it should not raise the heart rate too much and you should stop and consult your doctor if you experience chest pain, heart palpitations or other unusual symptoms.
- Increase the intensity gradually. Increase intensity every five to seven days, and only advance to the next stage if your heart and lungs can tolerate it.
- Be patient: Returning to normal workouts should be gradual and could take weeks or months.
Guidelines Based on the intensity of symptoms during COVID:
- If COVID positive w/no symptoms:
- Rest and no exercise for 10 days following a positive Covid test, followed by slow and gradual return to activity.
- If new cardiovascular symptoms develop – return to MD
- Mild COVID symptoms:
- Rest and no exercise for 10 days following symptom onset
- Must have full symptom resolution before slow and gradual return to activity
- If symptoms persist, new cardiovascular symptoms develop, or you are having difficulty with activity tolerance – return to MD
- Moderate symptoms:
- For those with or without cardiovascular symptoms, not-hospitalized, 65 years or older, or with cardiovascular disease risk factors:
- No exercise 10 days or greater from full symptom resolution
- Recommend evaluation by MD for consideration of return to exercise
- Once cleared by MD to exercise – slow and gradual return to activity
- If new cardiovascular symptoms develop – return to MD
- For those with or without cardiovascular symptoms, not-hospitalized, 65 years or older, or with cardiovascular disease risk factors:
The Coronavirus attacks the lungs, blood vessels and can even leave lasting neurological problems. Acute myocardial injury is the most common described cardiovascular complication following COVID-19 occurring in 8-12% of discharged patients. Therefore, it is essential to consult your MD if you are trying to return to exercise and experience ongoing cardiovascular symptoms.
It is not uncommon for people who have had COVID-19 to report extreme fatigue. It is imperative that you use pacing strategies and avoid pushing yourself to fatigue. It is important to get adequate sleep, eat well, and gradually increase activity level and exercise. Early management of fatigue could limit the impact of fatigue and the possibility of fatigue developing into a chronic condition.
Many people recover quickly from COVID-19, but some have ongoing symptoms. COVID is currently categorized into the following stages:
- Acute COVID-19
- Signs and symptoms of COVID‑19 for up to 4 weeks.
- Ongoing symptomatic COVID-19
- Signs and symptoms of COVID‑19 from 4 weeks up to 12 weeks
- Post-COVID-19 syndrome
- Signs and symptoms that develop during or after an infection of COVID‑ These symptoms continue for more than 12 weeks and are not explained by another issue. Typically presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.
- Long COVID
- The term ‘long COVID’ is used to describe signs and symptoms that continue or develop after acute COVID. It includes both ongoing symptomatic COVID‑19 (from 4 to 12 weeks) and post‑COVID‑19 syndrome (12 weeks or more).
- Estimated to occur in 10-20% of people who have had COVID-19.
- Affects even those that were previously healthy and fit individuals who had experienced only mild illness and never required hospitalization for Covid-19.
- May include the following symptoms:
- Mental fog, memory issues, difficulty finding words
- Positional drops in blood pressure
- Racing heart rate with any exertion
- Severe fatigue and activity intolerance
- Chest pain
- Ongoing shortness of breath, sore throat, cough, or heart palpitations
- Visual changes
- Vertigo
- Skin lesions
- Tremors
- Difficulty sleeping
- Headaches
- Numbness or tingling in the extremities
- Joint pain
- Anxiety, PTSD, depression
- GI Issues
- Continued recurrence of original symptoms, often in a cyclical manner
If you are having symptoms of extreme ongoing fatigue or other symptoms of Long COVID, it is essential to catch this early and do not try to push yourself. Pushing yourself or doing too much can cause you to have a major setback. Even trying to just push yourself to walk farther can be too much. Remember to use energy management strategies. Plan your day and activities. Take frequent rests and breaks. Listen to your body and rest when you are tired. Working on management of fatigue early on can improve your timeline of recovery. While pushing yourself too hard, too fast, may in fact, set you back.
A full recovery from coronavirus can be a long process and everyone, regardless if you were healthy before coronavirus or not, should begin with very light activities. Proceeding to more strenuous exercise should happen gradually and slowly. If you are experiencing continued respiratory symptoms past 12 weeks, it is recommended you return to your doctor.
A BIG THANK YOU to Amira Ranney, Physical Therapist, Pivot PT for writing this article for us.
References: https://jamanetwork.com/journals/jamacardiology/fullarticle/2772399; https://www.nice.org.uk/guidance/ng188