Have you had COVID-19? Or do you have it right now and wonder when you can get back to regular exercise?
Several of my coaching clients have contracted and recovered from COVID, and none of them needed an extended break from personal training… and that’s because we followed the current prescribed recommendations for returning to exercise.
Spoiler alert: it takes about five weeks to approach your personal “normal” level of exercise after COVID.
Cautions about Returning to Exercise After COVID
Why does it take so long to get back to normal?
What many people do not know about COVID-19 is that, even if you have a mild case, it’s not like getting the flu. When most people recover from an average cold or flu virus, they may feel a little worn out but can resume vigorous exercise fairly quickly after the flu has passed. In fact, exercise can boost your energy and help you feel better more quickly after a normal cold or flu virus.
COVID, on the other hand, warrants caution and slowness even after the symptoms have passed, because it can have unusual long-term effects on the cardiovascular system in particular. An association has been observed between COVID-19 and conditions like myocarditis (inflammation of the heart muscle), lung issues, arrhythmia, and blood clots. Because of the seriousness of these conditions, it’s smart to follow the current recommendations for gradually returning to exercise… and not to let your ego take charge. This applies even for young, fit people!
But amidst these cautions, there’s not a ton of clear and specific guidance for how to proceed. It reminds me vividly of my postpartum recovery from having Gabriella – the well-worn advice was along the lines of, “Take it easy, listen to your body, and don’t push yourself.”
For someone who enjoys exercise and for whom “pushing yourself” is a big part of fitness, that leaves a huge gap of information (not to mention a lack of timeline) between not exercising at all and jumping back into your regular routine.
If you have (or have recently had) the virus, here are concrete, specific recommendations for returning to exercise after COVID, summarized from sources like the British Medical Journal, Weill Cornell Medicine, and sports physician Jordan Metzl.
As always, consult your doctor before beginning any new program of exercise. If you have or have had COVID-19, only begin this self-supervised return to exercise if you were not hospitalized and if you did not have cardiac symptoms during your illness. Consult your doctor immediately if – at any point in this 5-week return to exercise – you experience heart palpitations, arrhythmia, chest pain, dizziness, or any other cardiac symptoms.
Returning to Exercise After COVID
The British Medical Journal‘s position on returning to exercise after COVID is that you should start exercising, but you should start with assessing the severity of your case.
Did you require hospitalization? Did you have cardiac symptoms during or after your illness? Do you have ongoing health issues after COVID-19? If so, it would be smart to return to exercise under the supervision of a physician. You may need additional monitoring as you become active again, like ongoing blood panels and cardiopulmonary exercise testing.
But if you had a mild case that didn’t require hospitalization and involved no cardiac symptoms, it is recommended that you pursue a graded return to exercise on your own, monitoring your own symptoms and getting help if you feel you need it.
A “graded return” simply means that you start below your pre-COVID level of fitness and gradually increase the intensity of your exercise.
Physician Jordan Metzl and his colleagues recommended in The Musculoskeletal Journal of Hospital for Special Surgery a “50/30/20/10 rule” for returning to exercise. This means “reduce the normal exercise load by at least 50% for the first week, then by 30%, 20%, and 10% in the following three weeks if comfortable at the end of each period. That would mean taking at least a month to return to a pre-COVID-19 exercise routine.”
Here is how it could look, and how I’ve approached it with my clients:
Week 0 (First Week Symptom-Free)
This means you had the virus last week, and this week you’re not sick anymore. But don’t do any exercise/activity at all. Focus exclusively on hydrating, getting your sleep back on track, resting, attending to any medical needs, and feeling better. Take it easy around the house in terms of housework and errands. Ask for help from others to make life easier. Wait to start Week 1 until you have been symptom-free for seven days.
Basically, Week 0 is doing nothing.
To be clear, this is your first week after you have been symptom-free for seven days. This is not your first week without symptoms.
This week, carefully return to the activities of daily life without formal exercise. This means doing your job (if it is not physically demanding), going about your regular house activities, walking as needed, and doing special post-COVID breathing exercises. Avoid challenging physical work like gardening or heavy housework, and any intentional exercise. Take it easy.
If Week 1 went well well (i.e. you don’t feel over-exerted in the daily activities of life), you can introduce very easy exercise like walking and doing easy mat exercises, like bridges, bird dog, or downward dog. Continue to do breathing exercises.
With walking, start with short walks (5-10 minutes) and add 10-15 minutes per day. Break up walks with rest breaks, and each day try to make the duration of each mini-walk longer. By the end of this week, if you can easily walk 30 minutes, you’re ready to progress to Week 3. If walking still feels difficult by the end of Week 2 (i.e. it takes more than an hour to feel normal again after a 30-minute walk), then I recommend dropping exercise back down to 5-10 minute walks and try to build back up again over several days.
Once you have been doing easy walking for seven days and you can do a 30-minute walk on flat ground with a sub-60-minute recovery, you will begin a daily process of gradually increasing the intensity of your exercise.
Re-introduce aerobic and strength exercise, but at a very easy level. For example, if you formerly did 30-minute runs, start with two five-minute runs with rest in between. As the week goes on, gradually add in more “blocks” of 5-minute exercise until you can do a 30-minute aerobic workout and recover within an hour. I would personally recommend doing the aerobic training every other day and doing an easy 30-minute walk on each day in between.
In terms of strength training, the medical advice is scarce (compared to cardiovascular training), but my advice would be to do short workouts of basic strength exercises at a level lower than your actual strength, and to not incorporate any metabolic conditioning (i.e. high-intensity interval training). Just let your muscles get used to working against resistance again. If you formerly did Bulgarian split squats with 20 pounds in each hand, go back to regular split squats on the floor with just your bodyweight, and then try again with weight a few days later. You will be a little de-conditioned after a few weeks off, but trust me – you will get it back quickly if you start slow.
During Week 3, always back off if you start to feel over-exerted. You can always try again in a day or two. You can always go back to Week 2, as well, if you need another week to build up your cardiovascular endurance by walking.
If Week 3 goes well and you are recovering from 30-minute cardio sessions in under an hour, you can move on to Week 4. This week, do four exercise sessions that total 30 minutes each. Do two moderate-intensity cardio sessions, and two strength training sessions that are only moderately challenging. Do not do metabolic conditioning (i.e. high-intensity interval training). You can do additional easy walks on flat ground if desired.
The goal this week (if Week 4 went well) is to approach your personal baselines of exercise. Take it easy, but push yourself to follow your basic training schedule as you normally would. If you ran three miles three times a week pre-COVID, try running three miles three times, but go slower and take breaks as needed.
In terms of strength training, I would advise resuming regular strength training that’s just slightly easier than what you were doing prior to your illness, but I would hold off on HIIT until your cardiovascular endurance is well-established through moderate-intensity cardio like running, the elliptical, cycling, or swimming.
The key every week, but especially in Week 5, is to listen to your body and respect any symptoms that may come up. If you’re extremely fatigued and aren’t recovering in under an hour, then workouts need to get easier. You can always repeat a week and progress when you’re ready.
Most importantly, if you’re having symptoms like heart palpitations, chest pains, or dizziness at any point in your graded return to exercise after COVID, make a doctor’s appointment and get re-assessed.
Special Tip for Post-COVID Exercise
Something that my post-COVID clients have found helpful is using an inexpensive pulse oximeter to measure oxygen saturation during exercise.
It’s a great tool of external feedback, to let my clients know if they’re pushing themselves too hard and when to back off.
The recommendation from Weill Cornell is that someone recovering from COVID stop and rest if oxygen saturation goes below 88% during exercise. This is the guideline that I have used with my clients.
If you have recently had COVID and want to get back into shape the smart way, you can get personalized recommendations by getting in touch here. Best wishes for a full recovery!