Covid Recovery & Return to Exercise

By Noa Deutsch 7 min read
Covid Recovery & Return to Exercise

As a coach, I have a lot of balls in the air when working with my athletes. They all have different goals, they are of different age groups, the ability level range is very varied, etc. I need to plan around everyone’s schedules, goals, events, injuries. I need to make sure I help them balance their training with work, life, school and more… And now there is a new variable to take into consideration.

Covid.

I know what some of you might be thinking. We have vaccines now, so people are not getting admitted to the hospital as often as earlier in the Pandemic. Most people have mild symptoms and their recovery is fairly fast. But there is research in the area that most individuals are not aware of, coaches included, and many considerations to take into account when returning to exercise, especially intense training.

Because I need to navigate ‘return to play’ for the athletes I work with, I started reading more and more to make sure I can provide the most up to date advice and have enough information to know when to refer to health care professionals if needed. I have been working on an article with some general considerations along side links for further reading for the last few weeks and then, ironically, I got covid myself… I somehow managed to dodge it for 2+ years, so I guess it was bound to happen at some point given the current landscape. This means that I am currently stuck at home, and while I am doing everything much slower than normal, I have a bit more time to finish this resource for you. Of course, I will then need to apply the same guidelines to myself as I return to my normal riding and exercise routine once my symptoms are gone.

I am going to keep this fairly simple for two reasons. 1) In an attempt to avoid information overload, and 2) A disclaimer - While I have a certain level of understanding as a sport scientist, I am not a doctor and this should not be taken as medical advice.

I am not providing references throughout as this is not a scientific paper… That said, all the information below is taken from the list of links at the end of this article (Sorry, not proper reference formatting. Also, pro tip: look at the references at the end of each article for even more relevant reading material).

Return to exercise after Covid Considerations

Lets start by saying that illness from covid can lead to complications and long term consequences that might not be obvious, so the prudent approach is to have all the information available so informed decisions can be made when planning return to training and racing.

Of course, as with any illness or injury, you should return to training gradually, depending on how long you did not train for and the severity of the illness. There will be a certain level of detraining and you should not attempt to jump right back to where you stopped, even if it seems fine at the time. It might seem like that in the short term, but trust me when I say that it could come back and bite you in the long run (I have seen the consequences both personally and professionally over the last 2+ decades. One day I’ll share why I stopped racing at an elite level… Spoiler alert - It’s relevant).

The reality is that we don’t really have a consensus for return to play after covid. It should all be case specific depending on severity and if the athlete has an underlying medical condition. We do know that returning to high intensity training while the body is still recovering from a systemic infection is associated with the risk of significant complications, including viral myocarditis, which can lead to predisposition to cardiac arrhythmias and even sudden cardiac death.

The British Journal of Sports Medicine put together an infographic that can be downloaded here). I prefer the chart below, from the British Medical Journal (link 7). You can download it here. And keep reading for more considerations and information to help you navigate return to training!


Action Items

  • Athletes who had moderate or severe illness should be evaluated by a doctor, especially if they experienced cardiopulmonary symptoms.
  • You should be symptom free before returning to training! It seems like all sources suggest 1-2 weeks of minimal exertion before retuning to normal, gradually.
  • What is gradual, you ask? Start with low intensity, and cut the volume by half of your normal for the first week. The following week increase the volume by ~15% and then an additional ~15% the week after… Intensity will need to be introduced after volume is closer to normal, again - gradually!
  • Some symptoms will likely come and go as you recover from the acute illness. Many people (myself included) report that exercise, especially at higher intensity, can trigger headaches, sore throat / swollen lymph nodes, excessively high heart rate and/or breathing difficulties during the recovery phase post covid. Be patient and back off as needed. It's okay to push the limit slightly, but if you are getting headaches or other symptoms during or after exercise, stop and take it easy for a few days before trying again.
  • It’s okay to take your time, and to take a few weeks to progressively return to training. A bit of short term detraining is much better than potential long term health consequences.
  • Monitor heart rate, chest pain, abnormal shortness of breath. Keep exercise heart rate low initially and progress gradually. It could be helpful to monitor HRV also (Heart Rate Variability).
  • Monitor your sleep pattern and make sure you get enough, both in quantity and quality
  • Include plenty of recovery activities, like easy spinning, yoga / gentle stretching, walking, etc.
  • Don’t force it. If you need to back off, do so. Let go of ego. Be patient, flexible and willing to adapt and change based on how you are feeling.
  • Adjust your goals as needed.
  • Eat and hydrate well to support your immune system and to reflect your current level of activity (meaning this should be dynamic)
  • Seek help if needed. It could be medial screening, a consultation with a coach, nutritionist (shameless plug: you can schedule an appointment with me here), working with a therapist, etc. Your health is always worth it!

Do you want more information? Keep on reading (or just scroll to the end to share, subscribe, comment, etc…)

Respiratory System

Many athletes report a persistent cough after covid, potentially making it harder to return to high intensity exercise in particular, because of the increased demand on the respiratory system, which has been compromised due to covid. This needs to be monitored when setting training intensities, especially if there is an underlying condition like asthma.

Cardiovascular System

I hesitate getting into this here, but there is a potential risk that is being investigated continuously. Of concern is myocarditis or other myocardial injury, which could get worse by exercise during recovery, possibly leading to sudden cardiac arrest. The risk appears to be low in those who had mild covid symptoms, but I think it is important to bring awareness to this, especially if covid symptoms were severe.

Blood clots are another factor to take into consideration, more so in severe covid cases than mild ones

After a period without training, aerobic capacity decreases and heart rate increases. The extent depends on the extent of the illness and recovery duration. This means that taking a few steps back during return to training is necessary, keeping heart and level of perceived effort low initially.

Neurological Factors

Neurological symptoms have been reported, some of them include loss of taste and smell, headaches, ischaemic strokes and fatigue. Autoimmune condition like Miller-Fisher syndrome and Guillain-Barré syndrome have also been observed in covid patients. My suggesting is that if you are experiencing more than mild neurological symptoms while you are sick, you might want to seek medical advice.

Gastrointestinal System

Diarrhea, nausea and vomiting are common Covid symptoms. These symptoms do not last long usually, so the consideration here is to get plenty of fluids and eat easy to digest foods that do not irritate the GI tract.

Hormonal Health

This is an emerging topic that I find interesting, although a lot more research is required. It has also been noted that male hormone profile has been altered in some cases after infection, which could be an issue for both general health and future athlete performance. There are nutritional considerations here, in particular with energy availability. Of course, I would love to see more research done in general, but specifically more research done on women’s hormonal health post covid!

Fatigue

Fatigue is commonly associated with viral infections and we have all seen reports of ‘long covid’, where fatigue (along side additional symptoms) lingers for weeks and months after infection, often leading to Chronic Fatigue Syndrome. Sleep disturbances, abnormal body aches and cognitive issues such as ‘brain fog’ and memory dysfunction are common indicators.

Mental Health

I am a huge believer in the brain-body connection and recovering from illness is not only about recovering physically. Having to stay home while symptoms persist doesn’t help either!

For serious athletes (professional as well as recreational) who are often chasing goals, having to be patient, taking the time to recover properly can be hard mentally. Not being able to get back to normal fast enough, the potential pressure to perform and get back to normal asap (often self inflicted pressure) and increase stress in general can take its tole. Be kind to yourself, let go of ego and seek help if needed.


  1. Exercise-induced Cardiac Troponin T Release in Veteran Athletes Recovered from COVID-19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903455/
  2. COVID-19: Return to sport or strenuous activity following infection. https://www.uptodate.com/contents/covid-19-return-to-sport-or-strenuous-activity-following-infection#H2097903284
  3. Safe Return to Physical Activity After COVID-19. https://www.acsm.org/blog-detail/acsm-certified-blog/2021/12/20/safe-return-to-physical-activity-after-covid-19
  4. Return to Play for Athletes After COVID-19 Infection https://jamanetwork.com/journals/jamacardiology/fullarticle/2780549
  5. Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. https://bjsm.bmj.com/content/54/19/1157.long
  6. Effects and Causes of Detraining in Athletes Due to COVID-19: A Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102934/
  7. Returning to physical activity after covid-19. https://www.bmj.com/content/372/bmj.m4721

Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study.

https://pubmed.ncbi.nlm.nih.gov/35387772/


That is all for this week’s edition of Endurance Collective! I hope you found this article valuable & interesting. If you are not a subscriber yet, hit the button below!


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