Exercise remains a key component of rehabilitation for patients recovering from COVID-19. However, there is limited guidance on how to start and progress exercise in non-athlete populations in the post-acute period of infection. Getting back into training after recovering from a COVID infection is not as clear cut as it is after other viral infections. In this case, regardless of your activity level, with walking, running, cycling or gardening we advise you to be extremely cautious as you return to activity.

We discuss if specific “return to exercise” protocols could help to solve this problem and return patients in the general population back to normal function.

There are a couple of reasons and I’m only going to highlight a few:

• It is possible for someone with mild coronavirus symptoms to get worse on around day 7 post infection
• Cardiologists are seeing a higher incidence of heart issues in people infected with the virus.
• The nephrologists are seeing that post COVID patients returning to early start to complain of muscle pain and when investigated, present with renal dysfunction.

Our patients post COVID is struggling with the following symptoms:

• Elevated resting heart rates more than 6 weeks post COVID
• Poor saturation
• Heart rate recovery slower than usual
• Chronic headaches
• Muscle pains
• Shortness of breath – more so than you normally would be during or after a training session.
• Dizziness
• Chest pain
• Palpitations

If you are experience any of these symptoms while or after your workout, it is best to stop. Review these symptoms with your treating doctor.  The best way to go about getting going again, is to start with a very low intensity session and gradually build yourself up over a 3 – 4-week period while monitoring your heart rate and perceived levels of exertion (how tired you feel).

COVID-19 POSITIVE & Asymptomatic
Wait 2 weeks before resuming training.

COVID-19 POSITIVE & Mild Symptoms
Wait for all symptoms to clear, then rest for a further 14 days before you try a workout.

COVID-19 POSITIVE & Severe Symptoms/Hospitalised WITHOUT heart issues
Wait for all symptoms to clear, rest for 2 weeks then be evaluated by your doctor.

COVID-19 POSITIVE & Severe Symptoms/Hospitalised WITH heart issue
Evaluation and clearance from a cardiologist once the 2-week rest period has been completed, is necessary.

The more high-level athlete you are, the more it is advised to go for a formal check-up which would include an ECG and cardiac enzyme level checks.

Knowing that the virus can cause complications in many systems of the body, the best practice is to resume training in a slow and steady way. You need to pay attention to both the physical and psychological effects of a workout.

 

Dirkie Coomans – physiotherapist