Having trouble handling exercise after COVID?
Here are expert tips
Before Amy Lipnicki tested positive for the coronavirus in January, she spent hours exercising every week, alternating between lifting weights and logging between 3 and 10 miles with her running group along the Brooklyn waterfront.
But after she received her positive result, there was only one way to describe her condition, she said: “Extreme lethargy.”
She waited two weeks before trying to run again. When she did, managing 2 miles was difficult: “I would jog a little bit and then walk most of it,” she said. Her chest felt tight and her legs felt heavy.
A little more than a month later, Ms. Lipnicki, 43, a two-time marathoner who works as a veterinarian and lives in New Jersey, said that she’s “still trying to run, which I’m doing very, very slowly.”
According to experts, Ms. Lipnicki’s experience is common. Many people have a tough time resuming exercise or reaching their previous level of fitness after contracting COVID-19, said Dr. Jordan Metzl, a sports medicine physician at the Sports Medicine Institute at the Hospital for Special Surgery in New York City.
“The biggest mistake people make is they try to get back out and do too much, too quickly.”
That is a factor in the guidelines for recreational athletes returning to exercise after mild-to-moderate cases of COVID-19 that Dr. Metzl and his colleagues published in August 2020. Since then, researchers in Canada and Europe have also released return-to-exercise guidance, as have members of the American College of Cardiology’s Sports & Exercise Cardiology Council, which released its most recent guidelines in January.
All the guidance emphasizes the importance of a gradual return to exercise for people with asymptomatic or mild cases of COVID-19. Here are other tips..
Listen to your body
Both when to resume exercise and how hard to push once you do depend on the severity of the virus and your pre-COVID fitness levels, experts said.
The recently updated American College of Cardiology guidelines recommend people with asymptomatic cases of COVID-19 take three days off exercise following a positive test result to ensure they remain symptom-free.
People with mild symptoms not related to the heart or lungs should rest until their symptoms resolve, those guidelines note.
Once you do start exercising again, “you want to be very slow and gradual in your ramp-up to activity,” Dr. Metzl said. “The adage of ‘listening to your body’ is really appropriate . . . if you feel fatigue, don’t push.”
Dr. Metzl and his colleagues recommend that people recovering from mild cases of COVID-19 follow the 50/30/20/10 rule: Start out by reducing your normal exercise by at least 50% for a week — so a typical 4-mile run would be reduced to 2, at most, or an hourlong yoga class should be cut to 30 minutes max — followed by gradual weekly increases to limiting it by 30%, 20% and 10% of your preCOVID routine, provided you continue to feel comfortable.
Lingering issues
Most people don’t need to get cleared by a doctor to resume exercise after COVID-19, provided they were asymptomatic or had mild symptoms and are otherwise healthy, according to Dr. Jonathan Kim, one of the co-authors of the American College of Cardiology return-to-exercise guidelines.
“If you want to get back to exercise, you don’t need to see your cardiologist, you don’t need to have all these cardiac tests. ... You just need to be smart and careful,” said Dr. Kim, who is also an associate professor of medicine at Emory University.
But people with “chest pains or chest tightness, shortness of breath during exertional activities that’s beyond what we consider normal, getting lightheaded, fainting, clearly feeling irregular heartbeats” during their bouts with COVID-19 or during exercise afterward should see a cardiologist to ensure they’re keeping their hearts and lungs safe while exercising, Dr. Kim said.