Exercise Post-COVID

Posted on behalf of Dr. Bala Munipalli, M.D., from the Post-Acute Sequelae of COVID (PASC) Clinic at Mayo Clinic Jacksonville.

People often want to get back to their routine activities of daily living such as exercise when they recover from COVID-19.  Most people who have mild disease are ready to jump in to get back to previous exercise levels.   Approximately 10% of patients have severe disease and will have lingering symptoms of fatigue, shortness of breath, and decreased exercise tolerance.

As physicians, we continue to learn more about this disease every day, and have realized that the previous advice we gave our patients about getting back to their usual exercise routine after a viral infection does not apply with this virus.  For instance, there is a higher risk of inflammation of the heart muscle (myocarditis) and blood clots that can travel from the extremities to the lungs.  Studies looking at healthy middle-aged men and women without previous chronic conditions such as diabetes, heart disease, or lung disease, and college athletes recovering from COVID-19 had a higher incidence of myocarditis from COVID-19.  Patients who have experienced COVID-19 pneumonia, can have breathing problems for weeks to months.

This virus affects each person differently, and if you have had a severe illness, or required hospitalization, it is best to consult a physician before starting an exercise program.  If you have chest pain, cough, fever, shortness of breath, palpitations (heart flutters), or circulation problems in toes (called COVID toe), it is recommended that you wait until the symptoms are resolved for at least a week and are evaluated by a physician before starting an exercise program. When you do start exercising, a gradual increase in exercise is recommended.

If you have recovered from mild to moderate disease and have not required hospitalization, then start slowly with a week of low level stretching and strengthening.  If this goes well, then try slow walking with gradual increase, or take longer rest periods if the symptoms worsen.  Avoid high-intensity training or prolonged exercise initially.

If you are experiencing residual fatigue, sore throat, back ache, or fever, it is okay to exercise if you only exercise to about 60% of your maximum heart rate (so again no high-intensity exercise), until your symptoms have fully resolved for 2-3 weeks.

Talk with others about living with long-term symptoms in the online Post-COVID support group.

Article by Dr. Bala Munipalli, M.D., from the Post-Acute Sequelae of COVID (PASC) Clinic at Mayo Clinic Jacksonville.