As the world continues to battle Covid-19, there is increasing awareness and recognition of potential long term complications post illness. Dubbed “long Covid”, reports of ongoing illness, cardiopulmonary disease and psychological effects are increasingly prevalent.
Persistent symptoms include but are not limited to cough, fatigue, elevated heart-rate and in 25% of severe Covid cases, cardiac damage. These symptoms are being reported to last for weeks to months following infection (BMJ, 2021).
With respect to exercise and return to sport following viral infections, myocarditis is frequently a potential complication. Myocarditis refers to inflammation within the middle layer of the heart wall. To prevent potential cardiopulmonary complications post Covid infection, it is imperative that we follow return to exercise guidelines (Turner, 2021).
Advice Exercise After COVID
A word on risk…
In order to provide appropriate exercise guidelines, we must first categorize a patient in terms of risk.
Low Risk:
- Under the age of 50
- Asymptomatic or mild respiratory symptoms
- Symptoms resolved within 7 days
Exercise Advice:
- Restore normal daily activity, energy levels & sleep patterns
- Gradual return to exercise
- Must be 7 days asymptomatic prior to returning to exercise
Medium Risk:
- Symptoms lasting for seven or more days but did not require hospitalisation
- Ongoing fatigue, chest pain or shortness of breath
Exercise Advice:
- Seek advice from a primary-care provider (GP) for evaluation of the cardiorespiratory system.
- Investigations & Medical Imaging may be provided if deemed necessary
- Exercise advice can then be provided via a Physiotherapist / multidisciplinary approach
- Exercise will begin gradually, with monitoring
High Risk:
- Covid 19 infection that required hospitalization
- Chest pain / Shortness of breath at rest or while performing activities of daily living
Exercise Advice:
- Seek advice from a primary-care provider (GP) for evaluation of the cardiorespiratory system.
- Investigations & Medical Imaging may be provided if deemed necessary
- Exercise advice can then be provided via a Physiotherapist/ multidisciplinary approach
- Exercise will begin gradually, with monitoring (BMJ, 2021).
Return to Exercise Phases
To facilitate a successful return to exercise and sport, approaches should be gradual, individualized and self-monitored for tolerance to activity. The below table shows 4 phases of exercise to progress through once asymptomatic for 7 days. The phases begin at low intensities, with each phase lasting a minimum of 7 days. It is important throughout these phases to also increase the duration of exercise in small increments.
| Intensity | Type/Example | Duration (minimum) | |
| Phase 1 | Nil exertion | Breathing, stretching | 7 days |
| Phase 2 | Light | Walking, Yoga | 7 days |
| Phase 3 | Moderate | Brisk walk, jogging, swimming, cycling | 7 days |
| Phase 4 | Moderate- sport specific | Running, direction changes, body weight exercises | 7 days |
Am I really ready?
Contracting Covid can be a stressful and scary experience, no matter how mild or severe your symptoms may be. It is vital that when recovering from Covid; we give ourselves time to be both physically and mentally ready to progress. The long-term ramifications of Covid-19 are still being researched and discovered; therefore, it is vital that we treat both the symptoms and the recovery with the respect it deserves. At the end of the day, you should only be returning to exercise and sport when you feel fully recovered, confident and mentally prepared for the tasks ahead.
SIMPLE TIPS:
- Wait until you are completely asymptomatic for at least 7 days prior to returning to any exercise.
- Ensure you can complete your normal work, school and daily essential activities prior to returning to exercise.
- Make a gradual return! Start with gentle aerobic exercise (such as walking), stretching and body weight exercise before exercising at a higher intensity.
- If you experience any symptoms such as chest pain, shortness of breath or irregular heartrate, please cease exercise and seek medical advice.
References
Turner, M. 2021. Safe Return to Physical Activity After COVID-19. https://www.acsm.org/blog-detail/acsm-certified-blog/2021/12/20/safe-return-to-physical-activity-after-covid-19#:~:text=Expert%20panels%20agree%20on%20several,gradual%20return%20to%20physical%20activity.
BMJ, 2021, 372. Returning to physical activity after covid-19. doi: https://doi.org/10.1136/bmj.m4721
