Exercise and COVID-19

Exercise and physical activity recommendations for older people recovering from COVID-19

Whether you experienced severe, moderate or mild COVID-19 symptoms, your physical activity will have declined whilst unwell. This is normal as the body needs longer periods of rest whilst it is fighting the virus. However, as symptoms begin to resolve, returning to physical activity is important for your general health and wellbeing.

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When can I safely return to exercise and physical activity? 

  • It is advised that you have no symptoms for at least seven days before you return to physical activity.

  • If you have a known heart condition, you should check with your GP before returning to physical activity.

  • If you had severe symptoms or were hospitalised with COVID-19, your path to returning to physical activity  should be more gradual. Follow the individual advice provided by your healthcare team.

How can I safely return to exercise and physical activity? 
The most important thing is to pace yourself. Start by returning to low intensity activities that don’t make your symptoms worse or lead to fatigue. These activities will depend on what you were doing before you got COVID-19, but may include gentle walking, light gardening, or housework. Start for a short period of time (e.g. 10 minutes). For more information refer to the exercise levels on the Safe Exercise at Home website (Level 1 - Foundation, Level 2- Moderate, Level 3 - Advanced). You should begin at least one level below where you were prior to having COVID-19. 

Monitor how you feel during and after activities. If fatigue, pain or shortness of breath  worsen during  activities you should stop exercising immediately. If symptoms such as fatigue, pain or shortness of breath are worse in the 48 hours following the activity, then you have pushed yourself too hard. 

How can I safely progress my physical activity?
Start by gradually increasing the duration of light intensity activities to periods of 30 minutes. Stick to light intensity exercise for at least a week before you consider progressing to more difficult activities. You should only exercise if you feel completely recovered from physical activity on the previous day. You can use the exercise levels on the Safe Exercises at Home website to guide you when increasing your physical activity (Level 1 - Foundation, Level 2- Moderate, Level 3 - Advanced). 

When should I stop exercising? 
If your symptoms worsen during the activity or you experience new symptoms, then you should stop immediately. Seek medical advice if symptoms are concerning and don’t improve with rest.

 

When should I see a health professional? 
Seek medical advice immediately if you experience chest pain, racing heart, dizziness, breathlessness, confusion, difficulty speaking or understanding speech, weakness in the face, arms or legs. These are signs that something more serious may be going on. You should also see a health professional if you have difficulty returning to your usual activities.

 

What if I am having trouble getting motivated or I am anxious about returning to my usual physical activities?

This is not uncommon after an illness. Talk to your GP or a health professional. You can also find some tips to help you stay motivated here

What is ‘Long COVID’? 
For some people it can take several weeks for COVID-19 symptoms to resolve. ‘Long COVID’ is when symptoms continue for 12 weeks or more following infection. Common symptoms of ‘Long COVID’ include fatigue, cognitive dysfunction (or trouble thinking), and shortness of breath. If you think you have ‘Long COVID’ then you should seek medical advice.  

What does ‘Long COVID’ mean for my return to physical activity?
If you have ‘Long COVID’, your return to physical activity will be more gradual. You will also need to progress your physical activity more slowly. This will mean spending more time exercising at a low intensity.

Remember: if you are concerned about ongoing symptoms or finding it difficulty to return to normal daily activities, then it is important to seek medical advice.

References

  • Salman, D., Vishnubala, D., Le Feuvre, P., Beaney, T., Korgaonkar, J., Majeed, A., & McGregor, A. H. (2021). Returning to physical activity after covid-19. Bmj, 372, m4721. https://doi.org/10.1136/bmj.m4721

  • Thomas, P., Baldwin, C., Beach, L., Bissett, B., Boden, I., Cruz, S. M., Gosselink, R., Granger, C. L., Hodgson, C., Holland, A. E., Jones, A. Y., Kho, M. E., van der Lee, L., Moses, R., Ntoumenopoulos, G., Parry, S. M., & Patman, S. (2022). Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations. J Physiother, 68(1), 8-25. https://doi.org/10.1016/j.jphys.2021.12.012

  • World Physiotherapy. (2021). World Physiotherapy Response to COVID-19 Briefing Paper 9. Safe rehabilitation approaches for people living with Long COVID: physical activity and exercise. https://world.physio/sites/default/files/2021-07/Briefing-Paper-9-Long-Covid-FINAL-English-202107.pdf

  • Elliott N, Martin R, Heron N, Elliott J, Grimstead D, Biswas A. Infographic. Graduated return to play guidance following COVID-19 infection. Br J Sports Med. 2020;54(19):1174-1175. doi:10.1136/bjsports-2020-102637  https://bjsm.bmj.com/content/54/19/1174.info.
    This guidance was developed to guide athletes return to play, however the principles can be applied to safely guide other groups to return to usual physical activities.