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Working Out After COVID

Millions of people have now been infected with and recovered from the coronavirus. The lucky ones return to normal within weeks. But for some survivors, symptoms can last for months.

Penn State College of Medicine researchers found more than half of the people diagnosed with COVID-19 worldwide will experience post-COVID symptoms. The survivors are referred to as long-haulers, and what they're experiencing is called "long COVID" or post-acute COVID-19 syndrome.

The symptoms tend to be similar but less severe than what people experienced during their initial infection. Long-haulers report breathing problems, chest pain, cognitive impairment (known as brain fog), depression, fatigue, sleep problems, and taste or smell loss.

One study of German COVID-19 patients found that 60% had heart inflammation two to three months after their initial infection. People who experienced mild cases weren't immune. A survey done by the Centers for Disease Control and Prevention found that "35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health."

Early intervention is critical for improving the quality of life for long-haulers. The longer you skip exercising, the longer it will take to recover what you've lost. To help people recover, research organizations have put together guidelines for how you can safely return to exercise. Here's what they recommend.

ANYONE who experienced severe symptoms or was hospitalized should have their doctor or cardiologist perform an ECG.

For ATHLETES that had symptoms but weren't hospitalized, "two weeks of rest after resolution of symptoms followed by evaluation with troponin testing, ECG, and echocardiography."

RECREATIONAL ATHLETES who had mild to moderate symptoms and weren't hospitalized can resume moderate-intensity activity within 1-2 weeks. However, if there was a history of pre-existing cardiac conditions, three weeks of rest was recommended. If the patient had "myocarditis associated with COVID-19, they recommend rest from exercise for 3 to 6 months followed by testing with biomarkers, echocardiography, rhythm monitoring, and exercise testing."

For ANYONE ELSE who was infected but didn't have symptoms or only experienced minor problems, start exercising as soon as you're cleared. Many people can resume 3-5 days after a second negative test.

Follow the 50/30/20/10 rule. That means cut your routine exercise by 50% for the first week. If you usually exercise for an hour, cut it to 30 minutes. If you normally squat 100 pounds, reduce it to 50 pounds that first week.

For the second week, reduce the intensity of your exercise and the weights you lift by 30%. The week after that reduce by 20%, then for the final week drop everything by just 10%.

The average person takes a month to get back to where they were before COVID, but don't be disappointed if it takes you longer. If you're having problems at one level, drop it back until you're strong enough to move on.

The first four weeks should be about getting back into the exercise habit. Don't "power through" pain because that's your body letting you know something is wrong.

STOP and call your healthcare provider if you feel dizzy, lightheaded, nauseous or have any sharp pains during this slow return. STOP if you feel tightness in your chest or tingling in your arms or legs. Call emergency services if the pain increases or doesn't go away.

Make a healthy eating plan. The virus and the medicines used to fight it can take a significant toll on your body. You might not feel hungry or want to eat convenient junk food. Remember that low-quality food will slow down your recovery.

Plan meals with at least half the plate covered in vegetables. Choose lean meats and dairy products if you eat them. There are hundreds of healthy recipes on our website at WeEatFit.com.

Reference Links:

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

The PHOSP-COVID Collaborative Group
The Lancet - Respiratory Medicine, April 23, 2022DOI:https://doi.org/10.1016/S2213-2600(22)00127-8

Click Here for the Study


Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection

Destin Groff, BA; Ashley Sun, BA; Anna E. Ssentongo, DrPH, MPH, et al
JAMA Network Open, October 13, 2021;4(10):e2128568. doi:10.1001/jamanetworkopen.2021.28568

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Prolonged Symptoms After COVID-19 Infection in Outpatients

Aditi Ramakrishnan, Jennifer Zreloff, Miranda A Moore, Sharon H Bergquist, Michele Cellai, Jason Higdon, James B O’Keefe, David Roberts, Henry M Wu
Open Forum Infectious Diseases - Oxford Academic, Volume 8, Issue 3, March 2021, ofab060,

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Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

Valentina O. Puntmann, MD, PhD1; M. Ludovica Carerj, MD; Imke Wieters, MD; et al
JAMA Cardiology, July 27, 2020; 5(11):1265-1273. doi:10.1001/jamacardio.2020.3557

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Persistent Symptoms in Patients After Acute COVID-19

Angelo Carfì, MD; Roberto Bernabei, MD; Francesco Landi, MD, PhD; et al
JAMA Network, July 9, 2020;324(6):603-605. doi:10.1001/jama.2020.12603

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Estimates of Americans with long COVID-19, per state

Gabrielle Masson
Becker's Hospital Review, Tuesday, August 24th, 2021

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Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

Mark W. Tenforde, MD, PhD1; Sara S. Kim, MPH1,2; Christopher J. Lindsell, PhD3; Erica Billig Rose, PhD1; Nathan I. Shapiro, MD4; D. Clark Files, MD5; Kevin W. Gibbs, MD5; Heidi L. Erickson, MD6; Jay S. Steingrub, MD7; Howard A. Smithline, MD7; Michelle N. Gong, MD8; Michael S. Aboodi, MD8; Matthew C. Exline, MD9; Daniel J. Henning, MD10; Jennifer G. Wilson, MD11; Akram Khan, MD12; Nida Qadir, MD13; Samuel M. Brown, MD14; Ithan D. Peltan, MD14; Todd W. Rice, MD3; David N. Hager, MD, PhD15; Adit A. Ginde, MD16; William B. Stubblefield, MD3; Manish M. Patel, MD1; Wesley H. Self, MD3; Leora R. Feldstein, PhD1; IVY Network Investigators; CDC COVID-19 Response Team
Morbidity and Mortality Weekly Report (MMWR) - CDC, Weekly / July 31, 2020 / 69(30);993-998

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Considerations for Return to Exercise Following Mild-to-Moderate COVID-19 in the Recreational Athlete

Jordan D. Metzl, MD,corresponding author Kathryn McElheny, MD, James N. Robinson, MD, Daphne A. Scott, MD, Karen M. Sutton, MD, and Brett G. Toresdahl, MD
HSS Journal - National Library of Medicine - National Center for Biotechnology Information, Published online 2020 Aug 10. doi: 10.1007/s11420-020-09777-1

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CSCCa and NSCA Joint Consensus Guidelines for Transition Periods: Safe Return to Training Following Inactivity

Caterisano, Anthony Co-Chair; Decker, Donald Co-Chair; Snyder, Ben Co-Chair; Feigenbaum, Matt; Glass, Rob; House, Paul; Sharp, Carwyn; Waller, Michael; Witherspoon, Zach
Strength and Conditioning Journal, June 2019 - Volume 41 - Issue 3 - p 1-23 doi: 10.1519/SSC.0000000000000477

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COVID-19 and the Athletic Heart: Key Updates from the American College of Cardiology Sports & Exercise Leadership Council

Jonathan H. Kim, MD, MSc, FACC; Aaron L. Baggish, MD, FACC; Eugene H. Chung, MD, FACC; Kimberly G Harmon, MD; Matthew W. Martinez, MD, FACC; Dermot M. J. Phelan, BAOMBBCH, PhD, FACC; Benjamin D. Levine, MD, FACC
American College of Cardiology, January 24, 2022

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Post-COVID-19 Syndrome and the Potential Benefits of Exercise

Amaya Jimeno-Almazán, Jesús G Pallarés, Ángel Buendía-Romero, Alejandro Martínez-Cava, Francisco Franco-López, Bernardino J Sánchez-Alcaraz Martínez, Enrique Bernal-Morel, Javier Courel-Ibáñez
International Journal of Environmental Research and Public Health, 2021 May 17;18(10):5329. doi: 10.3390/ijerph18105329.

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