16 Feb Returning to Exercise after COVID-19
The risk of Covid-19 remains not only in the severity of the disease but also in returning to normal daily activities after infection. In a study, several people reported that they are physically inactive and experienced a prolonged recovery rate particularly when trying to return to exercise after Covid-19. People also experienced an uncertainty of how, when, and whether it is safe to return to exercise after Covid-19. Furthermore, the consequences of Covid-19 may result in potential long term complications including heart disease, lung problems, and adverse psychological effects which could further impact the return to normal daily activities.
What are the risks associated with exercise after Covid-19?
Current understanding of recovery from Covid-19 is limited, but preliminary research has identified several key concerns. Firstly, exercising in the presence of myocarditis (inflammation of the heart muscle) is associated with increased risk for morbidity and mortality. Recent evidence shows continuing myocarditis in 60% of the infected for an average period of 71 days from diagnosis. The risk of exercising with myocarditis immediately after Covid-19 without medical supervision could potentially lead to sudden death. Secondly, thromboembolic (obstruction of a blood vessel by a blood clot) complications, particularly in the lungs are also associated with Covid-19. Lastly, psychological sequelae including anxiety, depression, and post-traumatic stress disorder (PTSD) have been highlighted after infection. Severe caution should be exercised when considering returning to physical activity after Covid-19.
Key factors to consider before returning to exercise activities!
A risk-stratification approach can be used to manage the complications after Covid-19. Several factors need to be considered before returning to exercise:
- Are you physically and mentally ready to return to exercise?
- Have you been asymptomatic for a period of 7 days?
- If you could walk 500 m before Covid-19, would you currently be able to walk at least 500 m on flat surface without feeling excessive fatigue or breathlessness?
- Avoid exercise if you have ongoing symptoms.
- Avoid exercise for 3 to 6 months if you have confirmed myocarditis.
What guidelines should I be following to safely return to exercise after Covid-19?
Individuals who have had Covid-19 should obtain a medical clearance certificate from their physician before engaging in any form of exercise. Returning to exercise should be gradual, individualized, and based on subjective tolerance to the activity. A phasic approach is recommended to gradually increase the exercise volume and intensity from low to baseline level or beyond. These phases should be followed for a minimum of 7 days each and should be progressed to the next phase only if the criteria are met. The Borg Rating of Perceived Exertion (RPE) is a good subjective measuring tool to measure how hard someone feels when they are exercising and can be a helpful guide in choosing what exercises to do as you progress through the phases of increasing physical activity. Exercises should be performed at an RPE of 6-8 for about 30 min in the initial phases and then progressed to an RPE of 11-15 at the regular exercise pattern in the progressive phases.
Performing exercises such as stretching, balancing, aerobic, and strengthening are a good base to work from. Household, gardening, and active traveling to work etc. are also good activities to incorporate into the phases. Following a structured exercise regime with clear established goals of how they will be achieved will bring about the best outcome to return to normal daily activities. Keeping a diary to monitor progress of exercise, along with measurements such as RPE, heart rate, and mood changes are essential. Please consult your physician if you experience any abnormal breathlessness and/or abnormal heart rate for a given activity, or return of symptoms including temperature, lethargy, or chest pain after one hour after exercise. Alternatively consult with your local biokineticist to guide and prescribe a scientific exercise regime to safely return to normal daily activities.
In conclusion, a medical clearance certificate should be obtained, and a health assessment should be performed to determine vitals in people prior to exercise who have had Covid-19. Return to exercise after at least 7 days free of symptoms and stop exercising should new symptoms develop, or current symptoms persist. Initially start with at least two weeks of minimal exertion and aim to reach 30 min of exercise. Progress to next phase only if criteria is met. Use daily monitoring to track progress, even when to seek further help.
References:
- American College of Sports Medicine (2017). Acsm’s guidelines for exercise testing and prescription. Wolters Kluwer.
- Salman, D., Vishnubala, D., Le Feuvre, P., Beaney, T., Korgaonkar, J., Majeed, A., McGregor A.H., 2021. Returning to physical activity after covid-19. Brit Med Jour;372, (m4721).
- RPE Scale (Perceived Exertion Rate) (topendsports.com)