Take it slow when returning to exercise after COVID

Dear Doctors: I’m a healthy 61-year-old woman, still tired and a bit sick after five days with a moderate bout of COVID. I want to exercise again when I’m symptom-free. Would a 20-minute walk a few times a week, and a few gentle sessions of more vigorous exercise, be a good way to start?

Dear Reader: We’re getting versions of your question from quite a few readers these days. And no wonder. In April, the Centers for Disease Control and Prevention estimated at least 60% of adults and 75% of children in the U.S. had been infected with the coronavirus. These numbers are driven, in large part, by the emergence of a series of highly contagious variants. This includes omicron, as well as its many subvariants.

It’s important to realize that a post-COVID return to exercise and other daily activities may be different than when coming back from a cold or the flu. This is due to the toll the coronavirus takes on the lungs, and to the prevalence of fatigue and exhaustion in so many COVID cases. Even after a relatively brief or mild illness, people who have recently recovered from COVID often find they have lost strength and stamina. For that reason, it’s best not to base your expectations and decisions on past experience with a cold or the flu. Instead, treat this reentry to becoming active again as something completely new.

Guidance from the American College of Cardiology addresses exercise in relation to several levels of coronavirus infection. Individuals who test positive and do not develop any symptoms for the next three or four days can safely resume exercise. However -- and this is just common sense -- they should take all precautions not to spread the virus to others. People with COVID who had mild symptoms that didn’t involve the heart or lungs can safely resume exercise when they are free of symptoms and the illness has run its course.

Elizabeth Ko, MD and Eve Glazier, MD

Individuals whose heart or lungs were significantly affected by COVID are urged to check with their doctor before attempting to exercise. And those diagnosed with inflammation of the heart muscle, a condition known as myocarditis, are recommended to wait three to six months before resuming exercise, preferably under a doctor’s guidance.

In your own case, you have described a moderate case of COVID without serious complications. Once your symptoms have cleared and you’re feeling stronger, it is considered safe for you to resume exercising. But make it a gradual return. Rather than carry out a specific plan, begin by exploring what your body can do. Start with a short walk. If that goes well, try a brief workout. Still good? Then build on these starting points, but incrementally.

Overdoing exercise after any type of illness can lead to a setback. And remember, you’re assessing not only how much you can exert yourself, but also how well and how quickly you recover. This includes resting heart rate, respiration, fatigue and general well-being. If, as often happens, you experience lingering COVID symptoms, you’ll have to take things slowly. A return to your previous level of fitness and exertion may be a longer journey that you expect.

UCLA Health experts collaborate across departments to offer comprehensive care for people with long-haul COVID symptoms. We draw on our knowledge and expertise to help you recover from long COVID. Learn more and download the form into the UCLA Health Long COVID Program.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)


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