All Your Questions About Exercise and COVID-19, Answered

Flashback to early March 2020: Working out might have meant dropping into a crowded, sweaty SoulCycle class, meeting up with friends for a jog in the park or enjoying a pickup game of flag football on the weekend.

Exercise has obviously changed a lot since then. But beyond strapping on a mask or booting up your Apple TV for a workout, the fundamental role of exercise in our lives has undergone a shift.

We reached out to experts on the front lines to answer the most common questions about exercise and COVID-19. Learn how to work out safely, whether it's OK to keep exercising if you have a positive diagnosis and the best moves to get your lungs and muscles healthy again.

While it's possible that exercise may lower the risk of infection (unless, of course, you're sweating it out in a busy gym or studio), a May 2020 study in ​Redox Biology​ shows that regular exercise significantly reduces the risk of acute respiratory distress syndrome (ARDS), one of the main causes of death in people with COVID-19

"The best defense you have is making yourself as healthy as possible — and part of that equation is exercising every single day," says Jordan Metzl, MD, sports medicine physician at the Hospital for Special Surgery (HSS).

That doesn't mean pushing yourself to the max on a daily basis, which could lead to injury or run down your immune system — but carving out time each day to get moving in some fashion. "Maybe it's a jog one morning, a bike ride another and yoga or a walk the next," he says.

Not if it involves boosting your heart rate or exerting energy. "We recommend that you back off any kind of exercise, especially if you are feeling ill," Dr. Metzl says.

Whether you're seriously sick or just have mild symptoms, you need to conserve your resources when fighting COVID.

"Working out during an active infection forces you to use muscles that should be supporting your cardio-pulmonary system," says Brianne Mooney, PT, DPT, a physical therapist at the HSS who has researched exercise and COVID-19 rehabilitation.

Instead of trying to get in "workouts" during your illness, make a point to simply get up and move every hour. Walk around your house. Do some stretches. These are the things your body needs.

Guidelines from the Hospital on Special Surgery state that most people with mild or moderate COVID-19 can gradually begin exercising after they've had no symptoms for 5 to 7 days.

If you had complications from COVID, spent any time in the hospital or have any other existing health conditions, talk to your doctor before resuming a training routine. Learn more about when you can start working out here.

Focus on functional training, which is designed to make your daily tasks easier to perform.

"This includes walking and taking the stairs to improve cardiopulmonary function and, subsequently, endurance," says Rachel Volkl, PT, a physical therapist at Rush University Medical Center. "It also involves exercises that target large muscle groups — such as slow, controlled sit-to-stand transitions from a chair; and rows, shoulder presses or wall push-ups to strengthen your upper extremities."

The idea behind functional fitness is that it mimics movements you naturally do, like getting up from the couch, carrying a bag of groceries, putting on a sweater, or pulling a box out from the closet.

By working the muscles involved in these everyday tasks, you can do them more safely and comfortably, which is super important when you're recovering from a taxing illness.

To improve your breathing post-COVID, you need to give your body a chance to rest so that the inflammation will decrease.

"If you experienced any pulmonary issues during your illness, such as chest pain or trouble breathing, seek clinical guidance," Mooney says. "You should work with a rehabilitation professional to help you maintain your baseline function and introduce higher-level respiratory muscle training exercises if appropriate."

If you are able to breathe easily and didn't have lung-related complications while you were sick, then focus on posture as a starting place. "Good posture gives your lungs room to expand and take big, full breaths," Volkl says. "Slouching with your shoulders hunched forward impairs your ability to breathe deeply."

Check in on your posture throughout the day, especially if you're spending a lot of time in front of a computer or sitting. "Think about bringing your shoulders down and back and maintaining a tall spine, stretching up towards the ceiling," Volkl says.

Breathing exercises can also lead to better airflow. "They restore the strength and function of the diaphragm, a key muscle for healthy respiration," Volkl says. "They also help to improve oxygen levels and control rapid breathing and shortness of breath."

(Bonus: Deep breathing also lessens anxiety.)

Eventually, you can add a cardio and endurance program.

"This improves the health of your cardiopulmonary system," Volkl says. "With regular aerobic exercise, your heart will pump more blood in a single beat, which lowers your heart rate and allows your body to extract oxygen more efficiently."

Your lungs aren't the only body part that COVID can hit hard; COVID might also torpedo muscle mass and health, largely due to deconditioning from being sedentary.

"If you've been lying in bed, your muscles will atrophy," Mooney says. A May 2020 study in the ​European Journal of Sports Science​ found that just two days of inactivity caused muscle loss and neuromuscular damage.

The lack of appetite from feeling icky makes matters worse. "Not getting proper nutrition exacerbates muscle loss," says physical therapist Sharlynne Tuohy, PT, senior director of Acute Care Rehabilitation at HSS and coauthor of a COVID-19 exercise rehabilitation program.

On top of that, the treatments sometimes used to help people with severe COVID take a toll on your musculoskeletal system.

"Mechanical ventilation leads to muscle wasting," she says. "Your diaphragm loses power because the machine is breathing for you — as a result, your muscle physiology changes very shortly after being intubated."

Strength-sabotaging steroids may also be given to those with COVID. "Steroids promote the breakdown of protein in your muscles, causing weakness," Tuohy says.

To limit muscle loss in the first place, keep up with as many of your basic activities as you feel able to: brushing your teeth, getting dressed, feeding yourself, taking a shower.

"This will help you maintain your baseline level of muscle mass and mobility," Mooney says.

She recommends that people try to move in some fashion every hour, even if it's just getting up to use the bathroom or sitting up in bed and breathing in different positions.

Once you're well enough to exercise after COVID, begin growing your muscles by doing low weight and high repetition strength training for several weeks to months.

"This can improve motor recruitment—your nervous system's ability to activate more muscle fibers—which can increase muscle endurance and strength," Volkl says.

As for building actual muscle mass? "This is where higher weight with lower repetitions comes into play, but this type of training is usually not appropriate until a few months out," Volkl says.

And remember to make healthy eating a priority. "The importance of good nutrition cannot be overstated," Volkl says. "It's crucial to get enough protein in your diet to support muscle health, whether for maintenance or growth."

According to the U.S. Department of Agriculture (USDA), the average adult should get at least 0.8 grams of protein per kilogram of body mass a day. However, people who are recovering from illness or actively trying to build muscle need more.

Mounting research, including a May 20219 study in ​Nutrients,​ shows that to encourage optimal muscle health, people doing resistance training need closer to 1.6 grams of protein per kilogram of their body mass per day.

For a 150-pound adult, that works out to about 130 grams of protein per day.

During the coronavirus pandemic, unfortunately, all public activities carry a certain risk of exposure and infection. And determining if it's safe to go to the gym is a judgement call only you can make for yourself.

To make the best call for your health, consider all of the factors that play into your ability to have a low risk workout. These include community infection rates, you and your family's vaccination status as well as the gym's mask and physical distancing protocols, says John Segreti, MD, hospital epidemiologist and medical director of infection control and prevention at Rush University Medical Center.

Don't hesitate to call your local gym and ask what its doing to keep exercisers healthy.

Per the CDC, reinfection is possible. And it's becoming more common the longer the pandemic continues and as more powerful variants emerge. "This is currently being studied," Segreti says.

As for the vaccine? Although experts are still exploring how it protects people, you're not off the hook. Sure, vaxxed folks are less likely to contract or transmit COVID than those who are unvaccinated, but the CDC says that breakthrough infections can happen and vaccinated people can pass along different coronavirus variants to others.

Aside from getting your Fauci ouchie, masking up is still one of the best strategies to slow the spread of COVID. According to the Centers for Disease Control (CDC), masks dramatically reduce transmission from infected people and help prevent healthy individuals from getting sick.

In fact, a February 2021 CDC study found that wearing a tightly fitted mask (with the ear loops knotted and the sides tucked in) or doubling up by slipping on two masks decreased viral exposure by 95 percent.

Before entering the gym or participating in an in-person group workout, check to see that everyone there has on an appropriate mask. "No bandanas or masks with valves," Dr. Segreti says. Wearing a mask below the nose or letting it hang loose is also a no-go.