Exercising After COVID—How the Virus Affects Your Body and How to Adjust Your Workout

Exercising after COVID and resuming your normal routine after recovering from the virus can be a challenge. While some may find their fitness level has declined due to the debilitating effects of the disease, it's not impossible to get your fitness back to where it was before your COVID-19 infection.

Katie Kollath, an ACE-CPT (American Council on Exercise-Certified Personal Trainer) told Newsweek: "In general, the virus will significantly reduce your capacity to train intensely, at least during the actual infection and the recovery process from it. Most of the cases we've seen cause some trouble breathing and significant fatigue."

However, it is possible to get active again, albeit with a few adjustments. Newsweek asked the experts about exercising after COVID-19 and how to tweak your workout.

Exercise With COVID

For most people, the impact of COVID-19 on the body can be seen in three phases, Dr. Sandeep R. Das, a COVID-19 CVD (cardiovascular disease) an expert for the American Heart Association (AHA) told Newsweek.

1. The period where you're infected and symptomatic.
2. The period immediately after you're no longer having symptoms.
3. The longer term, weeks or months after the infection.

During the first symptomatic phase, your body is directing all of its energy to fighting off the infection and you're likely not going to be up for any kind of exercise.

Once the symptoms subside, "there's a quite variable period where many people feel residual fatigue" and this typically lasts a couple weeks but can go on for much longer, even months in a smaller subset of people, according to Das.

In the long term, there are some who have quite prolonged symptoms that can last many months. "Data on this population is lacking, and there's a lot of academic interest in better defining this population, but this is definitely a major debilitating effect in those people," the expert said.

How Does COVID-19 Affect the Body?

COVID-19 primarily exerts an inflammatory reaction in our body, which "can affect many body systems, including the heart, lungs and musculoskeletal system—all of which are important for optimal fitness," Dr. Keri Denay, a fellow with the American College of Sports Medicine (ACSM), told Newsweek.

The severity and impact of this inflammation varies by person. Although we know some of the risk factors that put certain people at greater risk for severe illness from COVID-19, "we still cannot easily predict who will suffer severe symptoms and who will not," Denay noted.

Some people experience "post-COVID syndrome," also referred to as "long COVID," which see patients who no longer have the virus in their bodies have lingering health problems even after they have recovered from the initial acute phase of the illness, explains the Johns Hopkins University School of Medicine.

Dr. Tae Chung, assistant professor of physical medicine, rehabilitation and neurology at the Johns Hopkins University School of Medicine, told Newsweek: "For post-COVID syndrome, autonomic dysregulation is thought to be the cause of reduced fitness."

Autonomic dysregulation refers to any abnormality of the autonomic nervous system (ANS), which is a subcomponent of the peripheral nervous system that regulates involuntary physiologic processes, such as blood pressure, heart rate and respiration.

This presents abnormalities in different parts of the sympathetic and parasympathetic nervous system, explains a July 2018 study in the Orphanet Journal of Rare Diseases.

"This leads to imbalances in cardiac, enteric [intestine-related], motor and respiratory systems resulting in an autonomic crisis," the study said.

How Does COVID Affect the Lungs?

Speaking about the impact of COVID-19 on the lungs, Dr. Panagis Galiatsatos, an assistant professor at the Johns Hopkins University School of Medicine, told Newsweek it can be compared with a person breaking their leg.

"If someone breaks their leg, you can see that visually because there is a cast, and they are limited because they can't use their leg. For the lungs, you need to use the same point of view. Although you visually can't see those lung scars, they are there," said Galiatsatos.

While your mind may be ready to use your body in the way you've always been accustomed, your lungs may not be. "That scar and the healing process robs you of your endurance until that healing is complete," he said.

Patients who may be at risk of lung scarring are advised to talk to their doctor as they may require supplemental oxygen to help them recover, Galiatsatos said.

"For the patients who have permanent damage, we would recommend pulmonary rehabilitation, where they can monitor your heart rate and oxygen, to make sure your recovery is going appropriately," the ALA expert said. Those who are advised to undergo pulmonary rehabilitation will be made sure to exercise both arms and legs equally.

When Can I Exercise After COVID?

How soon you can return to exercising following COVID-19 infection will depend on your symptoms, said the ACSM's Denay.

• Those who are asymptomatic with a positive test or have mild symptoms, are advised to not to engage in exercise for three days and then start a gradual return, depending on how they feel.
• Anyone with moderate symptoms is advised to refrain from exercising for five days and have a discussion with their physician about "additional testing that may be warranted before a return to exercise," she said.
• Those who experience severe COVID-19 symptoms or were hospitalized due to the infection should consult with their doctor before resuming any exercise.

Das noted there isn't much data at the moment that speaks to the question of when's the best time to get back into exercising after COVID-19.

"But I think an approach that would suit most people would be to take it easy for the first couple weeks, then gradually increase as tolerated.

"A lot of avid exercisers tend to want to push things but just like recovering from a musculoskeletal injury, trying to push it is likely to end up costing you time and slowing your recovery in the long term," the AHA expert said.

ACE-certified personal trainer Kollath advises going by how you're feeling when getting back to exercising after COVID-19 infection. "Make sure you're focusing on adequate sleep and hydration and then from there if you're feeling up to it, add in exercises a couple of times per week and see how you feel."

Returning to Exercise After COVID-19

According to experts, you will most likely need to reduce the volume and intensity of your workout for at least a couple of weeks while you're recovering from the virus.

This will probably entail taking longer rest periods in between sets "due to reduced lung capacity making it harder to breathe," Kollath said. "Don't worry, we find this doesn't last forever. Just be patient and give your body time to heal."

Suggestions from health experts include:

• Longer rest periods between sets.
• Low-intensity exercises (walking or exercise bike).
• Workout at a level where you can still carry on a conversation.
• Resistance training.
• Core strengthening exercises.
• Exercises you were used to pre-COVID-19.

Chung, the specialist in neurology, physical medicine and rehabilitation at Johns Hopkins, said: "We typically use rating of perceived exertion (RPE) to estimate their cardiovascular limit/fitness. Once they reach certain levels of exertion, we usually stop the training and repeat the same amounts of training before they can advance it. There are various other measurements to estimate cardiovascular fitness, which can be used based on individual conditions."

Chung said. "It's also important to avoid overexertion, so we teach them [patients] about energy conservation."

ACE-certified personal trainer Kollath recommends resistance training. "You'll get the most bang for your buck. Plus, you can have as much rest as you need in between sets so your body can adequately recover."

Kollath advised endurance athletes will want to do at least half of the training volume they were doing pre-COVID-19 infection in order to allow your lung capacity to fully recover. The workload can be increased over time as your body heals, she said.

The main key is to "listen to your body," Das advised. Once your COVID-19 symptoms resolve and you start low-intensity exercises, over the following couple weeks you can raise the intensity. But you should still be "keeping the effort at a level that feels pretty easy."

Galiatsatos explained "there isn't going to be an exercise that is better than the other" when it comes to exercising after having COVID-19.

The ALA medical spokesperson recommends sticking to exercises you've been accustomed to but just starting off slower than before.

"The goal is that you want to be able to use your lungs like you used them in the past," Galiatsatos said. If you try an exercise and get short of breath, then that is your limit right now. You can exceed that limit in the future but it takes time.

The expert said: "You have to be conscious that the lungs are organs and if they are injured, they need time to heal. What I always ask patients is 'Where were you before COVID?' and that is where we will try to get to."

For those who have never worked out prior to their COVID-19 infection, "exercise now needs to be a part of the conversation because it is going to expedite the healing," Galiatsatos advised.

Will My Fitness Get Back to Pre-COVID Levels?

COVID-19 patients can recover their pre-COVID-19 fitness level but it will take time.

Denay said: "Most people will be able to regain their previous fitness level." But since each individual's body responds differently, their recovery time frame will need to be adjusted accordingly.

Galiatsatos said that COVID-19 patients will be able to recover their fitness but it can take three to six months before they "get back to normal" and for some, it can take as long as a year.

ACE-certified personal trainer Kollath said that in most cases she's seen so far, people have been able to regain their pre-COVID-19 fitness level, but you need to give your immune system a chance to recover.

Galiatsatos also noted it's important to consider a person's fitness history and level when looking at how and when they'll regain their fitness after having COVID-19. "If you know how much you use your body, then you will be much more aware of how much you need to recover to get back to normal.

The AHA's Das also agreed that "most people will completely recover" their previous fitness level. But some people do face long term COVID-19 effects and "it's not clear what the long term course will end up being" for these people.

How soon a patient will regain their fitness "depends on the causes of reduced fitness, but for post-COVID syndrome, it may be a chronic neurological syndrome that may be there for a long time," Chung said. There are many clinical studies being done on the long-term prognosis of post-COVID syndrome, he added.

Galiatsatos also explained it's vital to avoid getting COVID-19 again when it comes to maintaining your regained fitness.

"If you broke a bone the first thing your doctor is going to say is, 'Don't break it again' during recovery. If you had COVID, the big thing is to not get COVID again. If you do, make sure you are vaccinated so that it doesn't ravage your lungs again. That is so key," the ALA expert warned.