Getting moving again after recovering from COVID-19 is no walk in the park for some people and experts warn that pushing yourself too hard, too soon, can be detrimental to your recovery.
Even those with peak levels of fitness who only suffer mild COVID-19 symptoms can be overcome with exhaustion and struggle to get moving after their infection.
For Sydney personal trainer Matt Hunt, getting back to the gym after days of fevers, aches, headaches and night sweats from COVID-19 was more tiring than he imagined.
“It’s just the energy levels, it really knocks you … they take a while to come back and there’s no easy fix,” he said.
“I’ve never lied down on the couch for five days in a row, so that was a novelty for me.”
Mr Hunt — who owns the Un1t gym in Sydney’s Alexandria — felt well enough to resume exercise about five days after his symptoms began but was only up to doing some gentle exercises such as stretching and yoga.
“I certainly wouldn’t recommend a one-rep max deadlift.”
Unless you have severe COVID-19, or experience any chest pain while positive, experts say a cautious re-entry into exercise is appropriate.
Here’s what they advise:
When can I start exercising again?
The general consensus among exercise physicians is to wait at least seven days after you first experience symptoms to resume any form of exercise.
But don’t jump back in like you’re qualifying for the Olympics. Instead, start with low- or light-intensity activities.
“This might be things like everyday activities — for example, housework, light garden tasks or gentle walking — for the first couple of weeks,” says Selina Parry, senior lecturer at University of Melbourne’s department of physiotherapy.
You should be able to do tasks such as these while holding a full conversation.
From there, gradually increase the time you’re doing these tasks, perhaps by 10 to 15 minutes per day, until you get to the point where you can complete a 30-minute walk at a light intensity, suggests Dr Parry, who specialises in intensive care patient recovery.
Mr Hunt said his first step on the road to recovery was some simple yoga.
“Just getting the muscles firing that I hadn’t used for three or four days because I’d been lying down.
“I wasn’t up to anything huge … just doing really functional movements, concentrating on hips, shoulders and lower back to get the body flowing again.”
David Salman, who has specialised in intensive care medicine in the UK, conducted research that found two weeks of minimal exertion was the best way to restart your exercise routine.
What if I am completely asymptomatic?
There’s no evidence to definitively say you should or should not exercise before day seven of your infection if you’re experience no symptoms.
But, Dr Parry says, even if you feel perfectly well after testing positive, monitor how you are feeling very closely if you engage in exercise.
“Be alert to any signs of intolerance.”
How do I progress?
The most important thing to remember is implementing a gradual, slow return to physical activity.
After a week or more of gentle movement, you can progress to moderate exercise — such as brisk walking or swimming — for a week.
“You might be breathing a bit harder than normal, but you shouldn’t be out of breath and you should be able to hold a conversation,” Dr Parry says.
Following this, Dr Salman advises levelling up to some more complex movements that use coordination, strength and balance, such as running with changes in direction or circuits of body weight exercises.
“Again, without it feeling hard,” Dr Salman says.
When you’re able to complete these activities, you should be ready to return to your pre-COVID level of activity or more.
Mr Hunt recommends doing some group exercise classes so you’re around other people and telling a trainer or instructor that you’ve just recovered from COVID-19.
“Having an honest conversation about how you’re feeling and what you went through post-Omicron will be the best thing … coaches will give you the right direction.”
Mr Hunt says some of his clients have struggled greatly with fatigue levels post-COVID but he says some light strength training can be hugely beneficial in the initial recovery phase.
“Nothing heavy, obviously, just something to get the muscle fibres moving again,” Mr Hunt says.
“Work on your breathing and opening the rib cage again.”
When to stop
It’s likely you may be more breathless than usual when restarting your regime but be alert to the return of or development of COVID-19 symptoms.
“Things I’d be looking out for — abnormal levels of fatigue or exhaustion, breathlessness, racing heart, dizziness, cough … any increased signs of symptoms or new symptoms,” Dr Parry says.
Chest pain should also ring alarm bells and at least a visit to a doctor because some people with COVID-19 can develop myocarditis (heart inflammation), however this is thought to be rare in those with mild to moderate COVID-19.
Monitor how you feel one hour after exercise and the day after.
“It’s just about making sure you’re not flaring up your symptoms,” Dr Parry advises.
“You should be able to feel recovered an hour later and the next day you shouldn’t be going, ‘Oh my goodness I can’t even think about doing what I did yesterday’.”
Research is still evolving but, Dr Parry says, it is critical to minimise something called “post-exertion symptom exacerbation”, which could cause prolonged symptoms, commonly referred to as “long COVID“.
And, if you are struggling getting back into some physical activity due to weeks of fatigue, seek individualised support from a GP, physiotherapist or exercise physiologist.
What to expect
Dr Parry says that, for some people, it will take weeks to get back to their pre-COVID level off fitness but others will bounce back a lot quicker.
“If you have a more prolonged time when you’re not active, you will lose some of your fitness. Recognise what you have been through.”
Mr Hunt says do not be hard on yourself and compete with your pre-COVID self.
“Ease yourself into it and watch how much you’re labouring and how long it takes for your heart rate to come down again,” he says.
“If you feel like you’re labouring, take it back 10 or 20 per cent until the next day or the next week or the next month.”
And, of course, be realistic with your goals.
“If you trained five days a week, just try getting up to twice a week for a while and, remember, some people might not get back to their normal routine … everyone’s different,” Mr Hunt says.
Will exercise help me?
As long as you slowly, gently build up your routine, yes.
The physical and health benefits from being physically active significantly outweigh the risks of not engaging in exercise, post-COVID, for many people.
If you’re not feeling motivated though, the smallest of steps can help.
“If you are lying down and feeling like you have no energy, if you just get up and move a little bit … reach down and touch your toes, or any sort of mobility moves, even just five minutes of a yoga flow, you will feel so much better,” Mr Hunt says.
“If you’re moving the body and breathing, then the blood flow and oxygen rushes through your whole entire body, which makes you feel a lot better, so your endorphins are flying.”