COVID-19 and Return to Exercise

What is COVID-19?

COVID 19 is a caused by the coronavirus, SARS-CoV-2. The coronaviruses are a large family of viruses that cause respiratory infections. These can range from the common cold to more serious diseases.

COVID can present in a variety of different ways including: Fever, cough, tiredness, loss of taste or smell, sore throat, headache, aches, difficulty breathing or chest pain to name a few.

Possible Complications from COVID-19

COVID can effect different parts of the body system. By breaking the body into different sections we can break down where it may have effects. These include cardiac (heart), pulmonary (lungs), musculoskeletal (muscles), and gastrointestinal (stomach).

Cardiac - Various complications that can occur include arrhythmia's, myocarditis and acute myocardial injury. While regular exercise does improve cardiovascular health in the long term, each individual session can stress the heart. Therefore, a graded return to exercise is important.

Pulmonary - As COVID is a respiratory infection pneumonia appears to be the most serious manifestation of the infection which is often characterised by fever, cough and shortness of breath. The current recommendation is prolonged rest after infection, 10 days or more from symptom onset plus 7 days from symptom resolution. A careful monitoring of respiratory symptoms and a gradual return to activity are warranted in recreational exercise.

Musculoskeletal - The most common musculoskeletal complaint is myalgia and arthalgia. Alongside these two, fatigue is often reported and can last for weeks. For those returning to exercise, they should be guided by symptoms and those that are symptomatic to avoid intense exercise. Once symptoms have resolved, gradual return to exercise can begin.

Gastrointestinal - Some complication those diagnosed with COVID can experience include vomiting, nausea, diarrhoea and loss of appetite. The main area of concern is for those returning to exercise post COVID. It is important to ensure that hydration and energy input is enough to reduce the feeling of burnout or dehydration when training.

Returning to Exercise After COVID-19

When returning to exercise post COVID there are modifications that need to take place to prioritise safety of the individual. Recent studies conducted by Elliot et. al (2020) and Salman et. al (2021) have provided a guided approach.

Day 1 - 10

Focus: Recovery and normalising daily activities to protect cardiovascular (CV) system and introducing basic movement

- Symptom free and no issues performing all activities of daily living

- No excessive fatigue, able to walk up to 500m

Day 11 - 14: Light Activity

- Introduction of light resistance training 2-3 sets per body group (5-6 RPE)

- CV training (Heart rate below 75%, start with 15 minutes progress to 30 minutes)

- Monitor symptoms and fatigue

Day 14 - 17: Moderate Activity - Return to normal routine

- Commence usual resistance program with reduced effort (5-7 RPE)

- CV Training (85% of heart rate max, 30 minutes progressing up to 45/60 minutes)

- Monitor symptoms and fatigue

Day 17+

- Return to normal routine

- Continue to monitor symptoms

If you have any questions regarding return to exercise post COVID-19, of if you need some guidance in with the next step call us on 3184 0444 or book in online to see one of our Exercise Physiologists!

Reference List:

  • Metzl, J. D., McElheny, K., Robinson, J. N., Scott, D. A., Sutton, K. M., & Toresdahl, B. G. (2020). Considerations for Return to Exercise Following Mild-to-Moderate COVID-19 in the Recreational Athlete. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 16(Suppl 1), 1–6. Advance online publication. https://doi.org/10.1007/s11420-020-09777-1

  • ELLIOTT N, MARTIN R, HERON N, ET AL. BR J SPORTS MED 2020;54:1174–1175.

  • SALMAN, D. ET AL. (2021) "Returning to Physical Activity After COVID-19", BMJ, P. M4721. DOI: 10.1136/BMJ.M4721

Hannah Kitchen