Safely Returning to Physical Activity after Covid-19

Jarrod Wilson (Exercise Physiologist – Burnie)

With the sheer volume of Covid-19 information presented to us daily, it can be overwhelming to know what to do if you contract the virus and what recovery might look like once the acute infective period is over. Now that the Tasmanian border has re-opened and Covid cases are on the rise, more people will be emerging from isolation and managing their recovery. It is therefore an appropriate time to look at the evidence surrounding what constitutes a safe return to physical activity.

You may be thinking “how long should rest I for after diagnosis?”, and “when is the best time to return to my active hobbies? to exercise? or to sport? Whilst it is natural to feel somewhat reserved and even anxious with the thought of returning to exercise after having had Covid, particularly if you have experienced symptoms, there is now increasing evidence suggesting that this can be done safely, providing several key factors are considered.

It is well established that the SARS-CoV-2 virus impacts on multiple body systems including the respiratory, cardiovascular, renal, and neurological systems. Consequently, the virus can cause a variety of widespread symptoms, and, whilst some people remain asymptomatic, others are impacted with significant health issues and, unfortunately, we have seen millions of deaths worldwide.

So how long should I rest for after diagnosis?A person lying on a couch Description automatically generated with low confidence

It is generally accepted and recommended that people rest for at least 10 days after diagnosis and that, for low-risk people, a gradual return to exercise can take place if they have been asymptomatic for seven days. If you are thinking about getting back into your exercise routine or chosen sport, an important first goal is to ensure that you can manage pre-Covid work/school loads and your own daily routines. Ideally, your sleep patterns should have also returned to how things were before Covid diagnosis. If you feel that you have successfully accomplished these goals without complication, a return to physical activity can then be considered.

Am I considered low risk, intermediate risk, or high risk for physical activity?

The Australasian College of Sport and Exercise Physicians (2020) have proposed a framework that can be used as a guide for low-, intermediate- and high-risk populations when deciding to return to physical activity after Covid-19 infection. Below is a table detailing each risk category and the relative signs and symptoms experienced. Your risk category determines the best approach when returning to physical activity.

Risk Classification

Description of Presentation

Low risk

Individuals who are of a younger age (<50yo), with recreational exercise goals who have had an asymptomatic infection or mild upper respiratory symptoms that have resolved within 7 days.

Intermediate risk

Individuals who have experienced persistent symptoms or fatigue lasting longer than 7 days or ongoing shortness of breath or chest pain which did not require hospitalisation.

High risk

Individuals who required hospitalisation and those who experience/(d) symptoms involving multiple symptoms of the body other than the respiratory system; or symptoms such as chest pain with exertion or at rest, prolonged shortness of breath. Additionally, those who have returned abnormal electrocardiogram (ECG) or troponin findings during the acute phase of the illness.

I am considered high risk for exercise; what does this mean for a return to physical activity?

The good news is that even patients that have spent time in ICU with Covid-19, and thus determined to be “high risk”, have had improvements to their function from exercise that is safe for them to perform. Ideally, however, people who are considered intermediate or high risk are strongly encouraged to consult their GP for advice before starting or resuming an exercise regime after Covid. They may even require further investigation such as tests related to cardiovascular/lung/neurological function (ECG, echocardiogram, blood tests, etc.).

People considered to be in the low-risk category are encouraged to participate in a graded return to physical activity.

Below is a useful flowchart from the Australasian College of Sport and Exercise Physicians (2020) that can be used as a reference:

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When I am exercising, I have started to notice a return of symptoms that I previously had with Covid. What should I do?

It is important to pay attention to your body when you start to become physically active again after Covid-19 infection. Whilst exercise has been shown to be effective as a rehabilitation strategy post-Covid, there are some very important considerations when planning a return to your chosen type of physical activity/exercise.

If symptoms that you previously had with Covid reappear with exercise, or if any new symptoms develop, it is important to stop exercising and seek medical advice. Whilst rare with exercise, symptoms that will require further investigation include a cough, abnormal breathlessness (different to normal shortness of breath that you experience when exercising), chest pain, palpitations, fever, and insomnia. If you have had Covid, you are more likely to have changes in lung function. This is because the SARS-CoV-2 virus causes a reduction in the capacity for oxygen to travel from the lungs to the blood. As a consequence, exercise can induce mild breathlessness which has been found to be a reasonably common complication of exercise in post-Covid patients. It is important to understand that persistent respiratory symptoms, such as abnormal/severe breathlessness, chest pain, or chronic coughing is associated with an increased risk of more serious health outcomes such as pulmonary embolism, interstitial lung disease, and secondary infection. A medical review is absolutely necessary if you are experiencing persistent respiratory symptoms.

Now that the ‘bad stuff’ has been talked about, keep in mind that exercise leads to a multitude of health benefits that have been shown already to be relevant to improving the health outcomes for people that have had Covid-19.

What else do I need to know when returning to exercise after Covid?

When starting or resuming an exercise plan after Covid, it is safest to do so in a progressive manner. This means that you should adopt a gradual approach and slowly return to your pre-diagnosis physical activity levels. Do not think that you can resume with the same frequency, intensity and training loads that made up your exercise regime pre-Covid. It is also essential that you do not ‘push through’ any new or reappearing symptoms when you are exercising.

 

Exhausted squash player resting on floor Free Photo

 

To put it all together…

In summary, exercise has been found, so far, to be safe and useful in large populations as an effective rehabilitation strategy in the recovery from Covid-19 illness, due to the profound physical and mental health benefits associated. There are rare complications that people have experienced from returning to exercise after Covid infection, however the risk of serious complications occurring with exercise is decreased if the plan to return to pre-Covid activity levels is gradual, individualised and determined by tolerance to the activity.

If you have had Covid-19 and need help on your journey to regain fitness/conditioning, or to pursue any other health-related goals, make an appointment with one of our Exercise Physiologists today by calling our Burnie clinic on 64314586.

References

https://www1.racgp.org.au/ajgp/coronavirus/life-after-covid-19

https://link.springer.com/article/10.14283/jfa.2021.1

https://www.bmj.com/content/372/bmj.m4721

https://www.essa.org.au/EventDetail?EventKey=PCCP21