Making a Return to Exercise Following Recovery from COVID-19

• There are no clear guidelines regarding patients making a return to exercise or running following recovery from a COVID-19 infection. However, The American College of Sports Medicine has provided some information about regular exercise or running, which they say is dependent on the severity of the initial infection. 
• Patients who have recovered from COVID-19 who are already planning an endurance event such as a marathon should begin with light training over short distances alongside suitable lung exercises. Crucially, a medical specialist should be consulted, and a physical assessment carried out, to ensure the patients do not place themselves in danger. 

In addition to those who have recovered from COVID-19, anyone who has avoided fitness centers and public spaces due to the risk of infection during the COVID-19 pandemic are advised to start with light and careful training when planning a return to fitness or an athletic event. Additionally, those who have recovered from COVID-19 should seek out information about returning to exercise or consult a doctor who will be able to offer them suitable advice on appropriate training programs. 

There are no clear guidelines regarding making a return to exercise or running following recovery from a COVID-19 infection. However, The American College of Sports Medicine has provided the following information about regular exercise or running, which they advise is dependent on the severity of the initial infection: 

Patients who tested positive for COVID-19 but were asymptomatic or only experienced slight symptoms, such as a cough that went away after around a week, and who experienced no myocarditis or cardiovascular issues, should adhere to the following advice: 

• Rest and avoid moderate and heavy exercise for at least 5 days following the initial positive result. 
• Light exercise, such as walking or household chores, can be undertaken as normal after 2-3 days after self-isolation (after 7 -10 days). 
• Training load can be increased once no symptoms are present, which may involve walking briskly or cycling. However, the heart rate should not exceed 70% of its maximum and the exercise should not last longer than 15 minutes at a time. 
• Training time can gradually be increased to 30 minutes, 45 minutes, and then 60 minutes as long as the heart rate doesn’t exceed 80% of its maximum and patients pay special attention to how their body is reacting. 
• If two weeks have passed from the initial date of infection and no irregular symptoms or breathing difficulties are present, patients can make a full return to their previous exercise regime. 
• Two weeks after the initial infection is the minimum time that should be allowed to pass before patients make a full return to running. However, running a marathon – which is an intensely difficult feat – without the proper amount of training would be considered a risk. If patients wish to run such a distance, they should wait at least 1 month following their initial infection to ensure they remain safe while racing. 

Moderate COVID-19 infections with symptoms that last no less than 7 days, and which do not require hospital treatment, but could involve breathlessness when resting, palpitations, or chest tightness, are all potential indicators of cardiovascular issues. 

Recovery from severe COVID-19 infections that result in direct damage to the lungs can be classified into the following 2 stages: the first two weeks of recovery when white spots can still be found in chest X-rays but are gradually disappearing, and weeks 3–4 of recovery when the body is rehabilitating itself, although patients may still feel fatigued and lacking in energy. 

Patients in these groups should adhere to the following advice: 

• Prior to any exercise, undergo an EKG test as well as a troponin test, which measures the levels of this protein that is released when heart muscle has been damaged. 
• Moderate cases who have undergone the above tests without issue may return to light exercise and gradually increase intensity over time. 
• Severe cases who have undergone the above tests without issue should still rest for at least 3 months and only make a return to exercise after consulting a cardiologist and a pulmonary specialist. 

The Center for Disease Control and Prevention (CDC) currently recommends that high-risk groups or those who have had contact with an infected person no longer need to self-isolate but should wear a mask at all times when leaving the house. 

• Exercise as normal but do so inside. 
• Self-isolate and monitor for symptoms 5–7 days. 

Patients recovering from COVID-19 generally experience some level of impact on the lungs, which may have been partially damaged by the infection. Additionally, COVID-19 can affect the cardiovascular system, as well as other areas of the body. 

During an infection, the body’s immune system response to the virus can unintentionally damage healthy cells. This effect is known as multisystem inflammatory syndrome (MIS), a condition capable of continuing long after the patient has recovered from their initial symptoms. 

Moreover, the side effects caused by certain medication used to treat COVID-19 alongside prolonged stays in hospital can result in patients not feeling 100% for a long time after they’ve recovered from the initial infection, which is why they must focus on a comprehensive approach to rehabilitation. 

Pneumonia resulting from a COVID-19 infection generally occurs in more than one location or in both lungs. However, with adequate and timely treatment, a full recovery of the lungs is entirely possible. Nevertheless, even after recovery, there may still be residual lung lesions which can cause patients to feel breathless, fatigued, and easy to tire. Restoring function to the lungs in recently recovered COVID-19 patients who experience pneumonia symptoms can be achieved using the following techniques: 

• Breathing exercises: These are essential during the first 2 weeks of recovery and involve inhaling forcefully and fully in through the nose before slowly releasing that breath through the mouth until the lungs are empty. The exercise should be repeated 10-15 times, once a day as a way of gradually restoring flexibility to the lung tissue. 
• Tissue paper breathing exercise: This involves inhaling to fill the lungs before exhaling slowly through pursed lips to keep a piece of tissue paper moving for as long as possible. 
• Lung exercises: Another technique that is essential during the first 2 weeks of recovery, this lung exercise involves the use of a Triflow (tri-ball incentive spirometer) device, which helps keep the lungs active and free of fluid by encouraging patients to exhale fully for as long as possible to keep the balls inside elevated. 
• Light exercise: During weeks 3–4 of recovery, patients should attempt some light exercise to rehabilitate the lungs despite their body still feeling the fatigue associated with a moderate to severe COVID-19 infection. Such exercise should begin with slight movements at low intensity, such as standing up to walk around frequently, before graduating over time to a brisk walk and eventually a light jog. 

The COVID-19 virus entering the heart muscle, combined with the immune system response which also affects cardiovascular function, could result in heart failure, arrhythmia, and other associated heart conditions. Patients experiencing palpitations or pain and tightness in the chest, despite having recovered from a COVID-19 infection, should seek medical attention at the earliest opportunity. A cardiologist will be able to inquire into the patient’s medical history and seek out the information necessary to plan effective treatment and recommend related diagnostic techniques, such as chest X-ray, breathing examination, blood test, and EKG assessment. 

The effects of COVID-19 continue to impact our daily lives, from asymptomatic infections and moderate cases to severe infections requiring emergency medical attention and those resulting in loss of life. 

Patients who experienced moderate to severe symptoms may continue to suffer with dangerous aftereffects despite having recovered from the initial infection, including residual lung lesions or lung fibrosis that causes rigidity and an inability to exchange oxygen as effectively as before the infection. Unfortunately, such symptoms may not be apparent when resting, instead only becoming obvious when the patient exerts effort through exercise, at which point they will feel extremely fatigued and tire much faster than usual. 

Runners are therefore advised to return to training gradually, starting with light jogging over short distances combined with breathing exercises before slowly increasing intensity over time. Crucially, they should first consult with a specialist and undergo screening to ensure they do not place themselves in danger while exercising.