COVID-19 recovery

In New Zealand we are now seeing high numbers of community cases of COVID-19, which means that many people reading this may have already had COVID, some may be suffering from ongoing post-COVID symptoms, and others may have concerns or anxieties around catching the virus.

First and foremost we must continue to try and minimise the spread of COVID-19 in the community. We are now well aware of the primary measures that should be taken to reduce transmission. However, should you find yourself in the unfortunate circumstance where you or someone you know ends up unwell with COVID, this article may help to give you some of the knowledge and tools to look after yourself during this time and after.

As this is a new, ever changing virus research is continually evolving to keep up with it. The information in this article is based off what we currently know, but there is still a lot that is not yet fully understood.  Please bear in mind that COVID recovery is different for each individual and this information may not be applicable to everybody.

During infection with Covid-19

Rest

Rest is very important as your body fights off infection, and is the key to a faster recovery with less complications. This includes not only rest from exercise and physical activity, but mental activity (such as work and study), as well as social and emotional activity as well.

Make sure to take plenty of time for yourself, techniques such as meditation may be useful in achieving quality rest during this time.

Sleep

You may find you feel the need to sleep more during infection with COVID. Even though it can be difficult when you are off work and out of your usual routine, make sure to try and maintain your usual sleep hours and habits.

Nutrition

Try to keep your normal routine for eating and drinking. Being ill with a temperature can make you dehydrated so make sure you drink fluid when you’re thirsty and enough so that you pass urine with normal frequency and volume.

Maintaining a normal amount of food intake will help with your recovery after infection, as it will minimise deconditioning during this time.

Allow time and be kind to yourself

You may feel pressure to resume your usual activities quickly, but don’t rush. Give yourself adequate time to recover, as fatigue is very common following COVID regardless of the severity of infection, and needs to be managed cautiously.

Reduce pressure and expectations on yourself to be back at your previous level of fitness or exercise, and focus on smaller, easier tasks or ways of moving your body which are achievable during this time.

Returning to exercise after Covid-19

Risk Reduction

The main risks associated with returning to exercise after a COVID infection are cardio-respiratory events and complications, most commonly myocarditis, as well as psychological sequelae in some people.

If you were hospitalised or completely bed-bound at home during COVID, medical clearance is required before returning to exercise. This may involve ECG testing and blood tests to ensure a safe return to activity without the risk of doing further damage.

In cases of milder symptoms, you don’t need medical clearance but still need to take it slowly due to the risk of myocarditis.

It is recommended to be seen by a doctor if you are feeling any cardiac signs or symptoms: chest pain, palpitations or unusually high heart rate, severe breathlessness, drop in blood pressure or anything else of significant concern that may require medical attention.

Phased return to exercise

In the natural course of COVID-19, deterioration signifying severe infection often occurs at around a week from symptom onset. Therefore, it is recommended that a return to exercise or sporting activity should only occur after you have been asymptomatic for at least seven days.

The following infographic is an example of a phased return to exercise. A minimum of seven days is recommended at each phase to prevent sudden increases in training load. However, you should stay at the phase you feel comfortable with for as long as necessary.

Symptom monitoring

This is a very important part of ensuring a safe and effective return to exercise, especially as every individual will progress at different rates and with varying symptoms.

In the case of a return or development of symptoms with exercise (cough, abnormal breathlessness, palpitations, fever) this means stop, seek medical advice if required - otherwise restart at the same phase when symptom-free or step back to the previous phase.

Other ways to monitor for over-exertion during and after exercise include assessing breathlessness, use of the Borg Scale (as referenced in the above diagram), heart rate monitoring, and measuring recovery time – ideally you should feel recovered within one hour of exercising, anything longer than this indicates you may be doing too much.

The bottom line

COVID can result in serious complications regardless of your age, health, fitness or severity of infection. Returning to work and exercise following COVID infection needs to be taken seriously and should be approached with caution.

If you are having difficulty with symptoms or any post-COVID sequelae, or are simply feeling any uncertainty around returning to exercise, we recommend seeing your doctor for further advice.

References and useful links

• Salman D, Vishnubala D, Le Feuvre P, Beaney T, Korgaonkar J, Majeed A, McGregor A. Returning to physical activity after covid-19. BMJ 2021; 372.

• Vasiliadis AV, Boka V. Safe Return to Exercise after COVID-19 Infection. Sultan Qaboos Univ Med J. 2021;21(3):373-377.

• https://www.renews.co.nz/rushing-back-to-exercise-can-cause-long-covid/

• https://www.healthnavigator.org.nz/health-a-z/c/covid-19-positive-exercise/

• https://www.rcot.co.uk/how-manage-post-viral-fatigue-after-covid-19-0