How to exercise safely post COVID
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Recovery from COVID is different for everyone and the most important thing is to listen to your body.
Are you returning to exercise after having COVID? Do you know someone who needs some activity guidelines for getting back into activity after having COVID?
This column is aimed at those Canberrans who experienced mild to moderate symptoms of COVID and were regularly working out before having COVID.
Once you have been asymptomatic for seven to 10 days (for example: no fever, no breathlessness at rest, no chest pain, or palpitations), we can start thinking about a gradated, structured exercise program.
Here are some key points to remember before we get started:
- Consult your doctor before commencing your physical activity program to assess potential complications, e.g: myocarditis (inflammation of the heart muscle) or pulmonary conditions.
- Consult an Allied Health Professional who specialises in exercise prescription, to guide you through the recovery stages, and give you suggestions for alternative activity options.
- Movement can help stimulate the immune system and assist people in their recovery, however, it’s a delicate balance.
- Everyone is unique.
- Be patient. If you feel uncomfortable, that’s a sign to take a break.
- There is no exact algorithm to determine when you can return to activity and at what intensity. It depends on the individual, what level of activity you were doing pre-COVID, and what degree of the viral load you had/have in your system.
- Start with light “physical activity” (e.g. taking out the washing, vacuuming, etc). Once you are recovering from the lighter activities of daily living and have an idea of your tolerance level, then return to structured light “exercise”.
- Monitor your heart rate during and after exercise.
Before we discuss the five phases of active recovery, I wanted to touch on the complexities of fatigue. Fatigue is not the same as “tiredness”. Tiredness is having a busy day and is often relieved by sleep or rest. Fatigue however, is not relieved by sleep, can’t be “pushed through” and is often worsened by simple daily activity.
It’s imperative to recognise the important signals your body is sending you – for fatigue I often refer to the traffic lights analogy:
- RED
- ORANGE
- GREEN
The “stop” is the RED light: e.g.: shortness of breath that leaves you unable to exercise or debilitating fatigue that limits you from taking care of yourself (think: showering).
The “warning” is the ORANGE light: some shortness of breath, however it doesn’t get in the way of doing an activity.
The “go” is the GREEN light: feeling energised and ready for more.
The more green lights we have throughout the week, the better! Here’s a template I use with my patients. The Visible app is also great for managing activity and pacing yourself.
If you are interested, here are the COVID-19 exercise guidelines – however it’s a 43 page document. I am very aware of this barrier, so I’m going to break it down for us.
Once you have been symptom-free for seven to 10 days and able to complete your activities of daily living (hanging out the washing, mowing the lawn for 10 minutes, cleaning the kitchen), then we recommend a five phase “get started” exercise plan (and we only progress through the stages if you are recovering well). In the early stages, think of any movement as a form of “exercise”.
Note: Some people will progress through the stages within 14 days, others will take six to eight weeks (even longer if you are experiencing Long-COVID, but that topic needs a separate article!).
I would recommend not putting a timeline on each stage – go by “feel” and recovery (heart rate, fatigue, muscle soreness, breathlessness at rest, etc). You know your body best. But as a guide, the time at each phase will be minimum of three days, guided by symptoms.
Here are the five phases of recovery we use at Capital Hydrotherapy, for mild to moderate COVID:
PHASE ONE
Goal: Preparation for return to exercise.
Prescription: Rest, breathing exercises, flexibility/ stretching, balance, gentle walking within symptom limits.
PHASE TWO
Goal: Gentle low-intensity exercise (stationary cycling, flat walking, swimming, beginner Hydrolates ™ (Aquatic Pilates), gentle Deep Water Running, gentle online yoga/Pilates focussing on breath and activation). I recommend online/YouTube for the first two stages, so you can stop at any time without the pressure of being in a one hour class.
Prescription: Gradual increases by 10-15 minutes/day.
Progression: Three to seven days, when you can walk 30mins without exacerbating symptoms.
PHASE THREE
Goal: Moderate intensity exercise, with strength-based exercise (walking faster, ralking (run/walk combination), Deep Water Running efforts and intervals, intermediate loaded Hydrolates ™, moderate yoga/Pilates online; cycling on the flat without too many long hills, moderate-intensity body weight/lightweight mobility circuit).
Only exercise if you feel recovered from the previous day, without new onset or worsening of symptoms.
Prescription: Intersperse activity with rest periods (eg: five minutes with a one minute recovery) – adding one interval /day as tolerated.
Progression: three to seven days and 30 min session feeling recovered after one hour.
PHASE FOUR
Goal: Moderate intensity aerobic and strength-based exercise with coordination skills. Complex specific training for 45 minutes (e.g: resistance training, boxing, running, hiking hills, cycling at pace, and/or with hills; complex yoga/Pilates class that has up to a 45min duration).
Prescription: two days training with one day recovery.
Progression: three to seven days – if fatigue levels are normal, then you can progress to Phase Five.
PHASE FIVE
Pre-COVID programming and progressions, 60 min max. At comfortable pre-COVID intensity.
Reminder:
- Pacing yourself.
- Being patient.
- Managing your expectations.
I’d recommend seeing an Allied Health professional who specialises in COVID and fatigue management – someone who can guide and prescribe you through your return-to-exercise-safely plan, and tailor the plan to your individual needs.
Do you have any exercising-after-COVID workout questions? Let me know!
Sharing your concerns will help others within the community. Please email: kirra@capitalhydrotherapy.com.au
Love, Kirra
