When you're fighting COVID-19, you need to baby your body. That means getting plenty of R&R — and temporarily giving up exercise.
After all, your body needs time to recoup before you begin stressing it with exercise. That said, you also don't want to take too much time away from your workouts. Working out after COVID, when done the right way, can improve your recovery and help you get back on your feet, says Rachel Volkl, DPT, a doctor of physical therapy at Rush University Medical Center in Chicago.
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Feeling antsy (or even a little nervous) to get back to your regular workouts? Don't worry. We consulted rehab professionals to figure out exactly how to approach exercise after COVID-19. Start with these eight crucial strategies.
Get tips on how to stay healthy, safe and sane during the novel coronavirus pandemic.
1. Follow the 50/30/20/10 Rule
If you had mild to moderate COVID-19, you may be able to slowly return to exercise after you've been symptom-free (aside from loss of taste and smell) for at least five to seven days, according to August 2020 HSS Journal guidelines. Stay quarantined for 10 days after your diagnosis, per the Centers for Disease Control and Prevention (CDC).
When starting out, the HSS Journal guidelines suggest slashing the length of your typical fitness routine by about 50 percent for one week, followed by 30 percent, 20 percent and 10 percent for the next three weeks — as long as it feels good.
Let's say you usually jog for an hour a day. After your first zero-symptom week, you may be able to do 30 minutes of mild exercise like walking every day for one week. If all goes well, you might bump that up to 40 minutes the next week, and then 50 the third week. If you're feeling fine, you might be back to doing an hour (of light exercise) at a time by the fourth week. If this pace leaves you feeling drained, increase your workout time even more gradually.
Once you're back to your usual workout length, you can start to think about increasing your intensity, says Jordan Metzl, MD, a sports medicine physician at HSS. You might speed up your walk on week five, add some short jogs during week six; and do more continuous jogging or running on week seven.
2. Talk to Your Doctor
Still, many people need to wait longer to exercise, says physical therapist Sharlynn Tuohy, PT, senior director of Acute Care Rehabilitation at HSS and coauthor of the HSS Journal recommendations. Some also need to more ramp up their workouts more slowly.
Check with your doctor about when to begin working out again if you were hospitalized, received supplemental oxygen, had blood clots or you have underlying heart or lung conditions. They may run tests like an electrocardiogram (EKG) or X-ray to make sure exercise is safe for you.
Also, even if you had a mild or moderate case, understand that chronic fatigue can leave you dragging for weeks or months, especially if you happen to be a long-hauler.
Do normal activities — like carrying grocery bags or going up stairs — feel harder or different than usual? Don't brush it aside. "You may need physical therapy or occupational therapy to safely progress back into activity," Volk says. Be patient with your body and talk through any concerns or frustrations with your healthcare team.
3. Do Breathing Exercises
Deep belly breathing can help rebuild the muscles that support your lungs, Tuohy says. It can also reduce anxiety, boost oxygen levels and slow down rapid breathing, a common COVID-19 symptom.
To try breathing exercises, lie on your back with pillows under your knees. Place one hand on your chest and the other on your abdomen. Take calm, gentle breaths. Try to inflate your abdomen, then your chest. Pause, then deflate your chest, then your abdomen.
Next, try paired breathing to improve rib mobility. Inhale as you raise your arms overhead; exhale as you lower them back down to your sides.
4. Break Up Your Workouts
There's no such thing as a workout that's "too short" to count — especially after COVID. "When recovering from illness, it's best to do short amounts of exercise throughout the day," Tuohy says.
If your goal is to exercise for 30 minutes per day, try splitting things up into three 10-minute sessions or even six 5-minute ones. Getting up and moving frequently throughout the day can boost your COVID-19 recovery.
To keep track of your activity levels and how you feel during and after your workouts, try using a fitness tracker or exercise log.
5. Set a Base of Light Cardio
When you're bouncing back from COVID-19, low-intensity cardio activities like mellow walks, bike rides or elliptical sessions can help you build back your heart and lung strength without over-stressing your symptoms, Tuohy says.
To make sure you're actually keeping things light, listen to your body. You should have plenty of energy and feel capable of carrying on a brief conversation while working out. Stop if you're uncomfortable or short of breath.
If you have a heart rate monitor, don't go above 75 percent of your max heart rate (220 minus your age), Metzl says. It is normal to have a higher than usual heart rate after a period of inactivity.
6. Strengthen Your Biggest Muscles
"Your large muscle groups [back, chest, core, shoulders, glutes] take the biggest hit when you're sick," Tuohy says. "You start to lose muscle mass in them right away."
That's too bad because they happen to be the muscles you use to do essential everyday activities such as going up stairs, lunging down to tie your shoe, picking up a bag and pulling open a door.
To restore stamina and power to these muscles, focus on functional exercises like lunges, step-ups and squat variations that resemble your typical activities, Volkl says.
After days or weeks of inactivity, your muscles can do more than lose strength. They can also tense up.
"For example, the muscles in your shoulders and chest might shorten and tighten if you have been curled up in bed," Tuohy says. Spending a lot of time sitting or lying in bed can also lead to tight lower-body muscles. "Stretching and lengthening them will help you stay injury-free," she says.
Try doing full-body moves like the hip flexor stretch and the windshield wiper with reach stretch at least once (but preferably a few times) per day.
8. Watch for Symptoms
If, during exercise, you notice any of these red flags, the Cleveland Clinic recommends you immediately stop what you're doing. If the symptoms don't quickly let up, call your doctor or go to the hospital. If they do improve, continue resting for at least 24 hours. Then, for your next workout, ease up on the length and intensity.
- Chest pain or heart palpitations
- High heart rate that exceeds your level of exertion or prolonged heart rate recovery
- Dizziness or lightheadedness
- Shortness of breath, difficulty catching breath or abnormal, rapid breathing
- Excessive fatigue
- Limb swelling
- Passing out
- Tunnel vision or vision loss
Read more stories to help you navigate the novel coronavirus pandemic:
- HSS: "HSS Experts Release Evidence-Based Guidelines for Returning to Recreational Exercise After COVID-19"
- PLOS ONE: "Change in skeletal muscle associated with unplanned hospital admissions in adult patients: A systematic review and meta-analysis"
- Scientific Reports: "How to prevent the detrimental effects of two months of bed-rest on muscle, bone and cardiovascular system: an RCT"
- Journal of Rehabilitation Medicine: "Six weeks' aerobic retraining after two weeks' immobilization restores leg lean mass and aerobic capacity but does not fully rehabilitate leg strength in young and older men"
- CDC: "When You Can be Around Others After You Had or Likely Had COVID-19"
- HSS Journal: "HSS Beyond: Moving Forward After COVID-19"
- JAMA Internal Medicine: "Diaphragm Pathology in Critically Ill Patients With COVID-19 and Postmortem Findings From 3 Medical Centers"
- HSS Journal: "Considerations for Return to Exercise Following Mild-to-Moderate COVID-19 in the Recreational Athlete"
- CDC: "Perceived Exertion (Borg Rating of Perceived Exertion Scale)"
- Cleveland Clinic: "Returning to Sports or Exercise After Recovering From COVID-19"