Is It Safe to Work Out If You've Had COVID-19?

- How long after recovery can you start to exercise?

If you’ve had a mild case of COVID-19, you should start exercise as soon as you feel ready – but be sure to ramp up by starting at a lower level of exertion than you normally do, perhaps for a shorter time, give yourself time to rest, and stay well-hydrated. Don’t be nervous if you’ve done maybe 3 or 4 days in a row and just feel tired the next day – make that your day of rest and start up again. If you don’t feel better after that day of rest, please call your doctor and make sure you haven’t uncovered any significant health problem.

If you’ve had a severe case, especially with lung issues like pneumonia or bronchitis, or with cardiac (heart) issues, do not start an exercise regimen until you’ve been cleared by your doctor. They will likely have you start out very slowly and work up slowly as well. They may have you start with the supervision of a trained physical therapist, who can spot signs of trouble before you yourself may be able to.

Remember that this virus has an insidious course in a lot of people – even after the infection is gone. Listen to your own body and don’t push beyond a reasonable level. Even elite athletes have found that it takes them a longer time to get back up to their usual exercise level. If you push too hard, you may regret it.

- Should you start low-impact, or is it OK to jump right back into your high intensity workouts?

As above, start with low-impact, walking instead of running, cycling instead of intense sprints. Get your lungs, heart, and muscles back into the groove of working out. Then increase your walking speed, then jog, THEN run. Likewise, increase your incline and then your ups and downs. Likewise, increase your cycling speed, then resistance, then do some hills. Get to the sprints when your body is ready.

For weights, start much lower than you’re used to. Maybe even at half the weights. Lower weights with same number of reps will restore your tone. When you are ready, increase the weights. Do not do free weights of any consequence (like free bench press) without a spotter. This is an important time to remember safety protocols in the gym.

- Anything you should avoid?

If it hurts, stop. If you are severely out of breath during or after exercise (not just the usual amount), stop. It is healthier to dial it all down and rebuild your capacity. This will help avoid both musculoskeletal injury and any heart and lung complications. If resting does not lead to a feeling of recovery, please see your doctor.

- Any concerns around breathing, VO2 max, or blood oxygen saturation?

VO2 max refers to the maximum amount of oxygen you can utilize during exercise. It's commonly used to test the aerobic endurance or cardiovascular fitness of athletes before and at the end of a training cycle. It is not an at-home test.

Blood oxygen levels are easily measured at home – with a pulse oximeter that goes on your finger, and also via some smart watches. The lung issues with acute COVID-19 infection can be insidious – that is, people are walking, driving, etc. with oxygen levels on pulse oximetry, normally 98-99%, down to 80% or less. There are many reports of people driving themselves to the ER only to be found to have dangerously low oxygen levels needing emergency intervention.

So it is very reasonable to have a pulse oximeter at home and check yourself every so often – and certainly if you feel like you’re having trouble catching your breath or taking deep breaths.

COVID-19 long haulers are people who had acute COVID-19 infection and instead of having a full recovery where they can be back to normal, they have ongoing lung issues, heart issues, foggy head feeling, headaches, aches and pains. They have to be very deliberate when they think of what types of exercise they can do safely, and should discuss this with their doctor or a physiatrist – a physical medicine and rehabilitation physician – who can counsel them.

Dr. Jonathan Aviv, Dr. Byron Thomashow, and I (Dr. Sujana Chandrasekhar) have identified a group of these long-haulers who exercise okay but report trouble catching their breath after trying to speak on a conference call, say. Their lung x-rays are normal. When their voice box is examined – awake, comfortably seated in the ENT office – we find that the nerve that controls the vocal cord movement is damaged. This is called post-viral vagal neuropathy, because it’s the vagus nerve. When we identify this problem, instead of saying there’s nothing that can be done, the ENT (ear-nose-throat) doctor can institute a low acid diet and speech therapy exercises and the patient can regain their breathing quality of life.

The more we learn about COVID-19, the better we can take care of patients. The bottom line is – start slowly, push yourself in a logical and controlled manner, stop if it’s too much, check your pulse ox, and see your doctor if you can’t recover or get back to your ideal level of activity.

And of course, wear a mask, watch your distance, wash your hands. Here’s to our health.

Sujana S. Chandrasekhar, MD, FACS
Partner, ENT & Allergy Associates, LLP
Co-host, @ShesOnCall

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