Exercise & Covid-19

It’s no question that the Covid-19 pandemic has changed everyone’s lives. Up until this Omicron variant, if you were young and reasonable healthy it was a safe assumption that you wouldn’t catch it (provided you followed public health guidelines, of course). 

As much as we still don’t know about this virus, there has been some interesting research surfacing with regards to exercise & Covid-19. Which of course I find super interesting so I have summarized it here for you! This information is accurate at time of writing. The situation is ever evolving and I will update this blog as more information is made available.

🦠Exercising whilst you have Covid-19:

If you have an active Covid-19 infection, it is strongly recommended that you avoid exercise.

Exercising whilst you are symptomatic with Covid-19 carries the same risk of regular respiratory infections in that it may prolong illness; but it also carries a more serious risk of exacerbating Covid-19 related myocarditis.

Myocarditis is inflammation of your heart muscle that can reduce your heart’s ability to pump, or cause arrhythmias. If your heart’s pumping ability is reduced, the rest of your body is not getting enough blood or fresh oxygen. You may experience chest pain, shortness of breath, fatigue, or palpitations. If the myocarditis is severe, clots may be formed which could lead to a stroke or myocardial infarction (MI). You can learn more about myocarditis here.  

You are at more risk of myocarditis if you develop a severe Covid-19 infection, however it has been found in even asymptomatic Covid-19 cases. There have been studies on college athletes that found myocarditis in 0.7-2.0% of cases on Cardiac MRI. Other studies are showing up to 15%. 

One study performed cardiac MRI’s on 100 patients who had recovered from Covid-19. The median age of patients was 49 years. They found evidence of cardiac involvement in 78% of the patients, and ongoing myocardial inflammation in 60%, and this was independent of any preexisting conditions, severity of illness, and time from originally being diagnosed. The median time of these cardiac MRI’s was 71 days post infection.

Let me sum that up. Over half, to three quarters of patients still showed signs of stress to their heart almost 2.5 months after they had recovered from Covid-19.

BUT! There is a caveat here. Much like musculoskeletal imaging, apparently healthy and asymptomatic individuals can show signs of stress on MRI. This study had no baseline data, so we don’t know what was there before they contracted Covid.

The current recommendations for return to exercise are to wait for 10 days from onset of symptoms, AND be symptom free for 7 days. If you were on any form of treatment of Covid-19, you should be off these also. 

Experts recommend a graduated return to exercise post Covid-19 infection, and to use a ‘level of risk’ system. 

High Risk individuals 

• Those who required hospitalization
• Those who experienced shortness of breath or chest pain at rest or whilst performing activities of daily living (ADL’s)
• These individuals ideally should be evaluated by a team of specialists (cardiology, pulmonology, sports medicine) before returning to physical activity

Intermediate risk individuals 

• Those with symptoms of fatigue lasting more than 7 days, or prolonged shortness of breath
• Did not require hospitalization
• A history of asthma or chronic fatigue
• Elite or endurance athletes
• These individuals ideally should also be evaluated by a team of specialists (cardiology, pulmonology, sports medicine) before returning to physical activity. This may include an ECG, bloodwork, and a chest x-ray.

Low risk individuals 

• Those under the age of 50, and who had asymptomatic infections, or mild respiratory symptoms that resolved within 7 days
• These individuals should follow a graduated return to exercise, but do not need specialist evaluation.
• Low risk individuals should rest for at least 10 days after diagnoses, and should wait until they have been symptom free for 7 days before they follow a graduated return to exercise

Graduated return to exercise

• Experts recommend that individuals return to their regular ADL’s first. Eg work, school.
• Individuals should be able to walk 500m on the flat, with no symptoms of shortness of breath or fatigue.
• Start with 15 minute increments and assess fatigue levels. If that is tolerable, then a gradual increase is recommended starting off with light physical activity.

You can find a nice infographic from the British Journal of Sports Medicine here.