It is understandable to feel eager about getting back to a regular exercise routine after recovering from a COVID-19 infection. Returning to exercise too quickly, or pushing too hard, risks complications like myocarditis, which is inflammation of the heart muscle that can lead to irregular heart rhythms or heart failure. Due to these potential post-viral complications, medical guidance and a slow, structured reintroduction of activity are necessary for a safe recovery.
Initial Waiting Period and Prerequisites
Experts recommend that individuals should be entirely symptom-free for a minimum of seven days before beginning any structured physical activity. This means no fever, no chest pain, and no unusual shortness of breath, even at rest.
If symptoms were mild and did not involve the heart or lungs, a return to light activity can be considered after the seven-day symptom-free window. Individuals who had moderate-to-severe symptoms, or who were hospitalized, must seek medical clearance before resuming any exercise beyond light walking. This medical evaluation may involve cardiac screening, such as an electrocardiogram or echocardiogram, to rule out silent inflammation of the heart.
Step-by-Step Guide to Resuming Activity
Once medically cleared and past the minimum symptom-free period, the process of returning to activity must be gradual and phased. A common structured approach is to start with only 50% of the pre-COVID-19 exercise intensity and duration. This starting point should involve low-intensity activities like gentle stretching, light walking, or stationary cycling for a short duration, such as 15 minutes.
The progression through subsequent phases depends entirely on how the body responds to the current level of activity. A general guideline is to remain in a phase for at least seven days before attempting to increase the intensity or duration. During this time, it is important to monitor your heart rate, keeping it initially below 70% of your maximum predicted heart rate, and to ensure you do not experience excessive fatigue the following day.
If the current level of activity is tolerated for a full week without any adverse effects, the intensity can then be slightly increased, such as moving to light jogging or bodyweight exercises. If any symptoms resurface, the recommendation is to immediately return to the previous, easier phase for another week.
Immediate Warning Signs During Exercise
Certain symptoms during exercise are acute warning signs that require immediate cessation of activity and medical attention. Chest pain or tightness is a serious symptom that could indicate cardiac involvement and should prompt an immediate stop and medical consultation. Similarly, experiencing palpitations, which are sensations of a racing, pounding, or irregular heartbeat, requires urgent evaluation.
Severe shortness of breath that is disproportionate to the effort being exerted is another red flag. If you feel significantly more breathless than you normally would at that level of activity, stop immediately. Other concerning signs include dizziness, lightheadedness, or feeling faint, which can signal issues with blood pressure regulation or heart rhythm.
Special Considerations for Prolonged Symptoms
For some individuals, symptoms of fatigue, brain fog, and reduced exercise tolerance can persist for weeks or months, a condition often referred to as Long COVID. A hallmark of this condition is Post-Exertional Malaise (PEM), which is an abnormal, disproportionate worsening of symptoms 12 to 48 hours after even minor physical, mental, or emotional exertion. For those experiencing PEM, the traditional approach of gradually increasing exercise intensity is often counterproductive and may trigger a severe crash.
Instead, the focus must shift entirely from structured exercise to energy management and “pacing.” This involves staying within a personal energy envelope, which means planning activities to avoid reaching a point that triggers a delayed symptom crash. Pacing strategies include breaking down large tasks into smaller ones, taking mandatory rest breaks before feeling tired, and alternating periods of mental activity with periods of physical rest.
Individuals who suspect they are experiencing PEM should discontinue traditional exercise and seek specialized medical guidance from a professional familiar with post-viral syndromes. Graded exercise therapy, which involves planned increases in activity, is not recommended for people with PEM.