How to Exercise After Covid-19: Lung and Exercise Science Doctors Share Current Wisdom
If you know, you really know: Covid-19 affects your body differently than other illnesses. Lung and heart physicians explain why your workouts might still feel rough, and offer their tips for getting back to 100 percent. (One hint? Be gentle...)
Even the common cold can make a mild run feel like you’re summiting Everest. But if you’ve had Covid-19, you’re probably not shocked to hear that many researchers are spotting differences in how the Covid works in the body compared to other respiratory viruses, like a cold or the flu…including when it comes to exercise after illness recovery.
Tod Olin, MD, a pulmonologist specializing in exercise medicine at the National Jewish Health Exercise and Performance Breathing Center (who authored a 2022 paper on the effects of long Covid on exercise), says those differences mean individuals who have had Covid-19 are more likely to suffer certain complications that can impact their exercise abilities and capacity. “We have people coming into the clinic who were competitive athletes before they got sick and just want to get back to their sport,” Dr. Olin tells The Healthy—confirming that “getting back” is often not that easy. “Recovery [from Covid] can be a lot longer,” which, he says, “can be very frustrating.”
Get answers for your questions about working out in public: “How Can I Avoid Covid-19 at the Gym?“
Why does recovering from Covid-19 feel tougher than from other viruses?
While a lot remains unknown about this relatively new virus, researchers now think that Covid-19 is mainly an “endothelial disease,” which means that it affects the lining of your heart and blood vessels. This gives the virus the ability to cause damage anywhere there are blood vessels—putting every system in your body at risk. This “multisystemic” attack may be one reason for the unpredictable course the virus sometimes takes, even after someone has more or less “recovered.”
“Traditionally, with other viruses, we would only expect to see people with severe cases being at a higher risk for severe effects,” Dr. Olin says. “One of the unique things we’re seeing with Covid is that even people who have had mild infections can go on to have severe and/or chronic complications for weeks and months afterwards.” This is all part of what experts think of as long Covid.
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Covid-19 targets your heart and lungs
Another unique aspect is how Covid affects the heart, says Saurabh Rajpal, MD, a cardiologist at the Ohio State University Wexner Medical Center who authored a 2021 study in the Journal of the American Medical Association (JAMA) that examined the effects of Covid-19 infection on the heart in athletes. “Covid attacks the heart more, and is more likely to cause inflammation in the heart,” Dr. Rajpal says. “It is also likely an independent risk factor for a heart attack, although research is still ongoing into that question.”
The virus has a similar effect on the lungs, increasing inflammation and reducing function, Dr. Olin says. This makes people who’ve had Covid more likely to experience asthma and other types of dysfunctional breathing.
How to exercise after Covid recovery
The good news is that the majority of people will be able to return fully to exercise—eventually, Dr. Olin says. “It’s normal to feel bad about what you’ve lost. But instead of focusing on what you can’t do, focus on what you can,” he suggests.
Here are these experts’ insights for working out wisely after you’ve recovered from Covid.
Rest for a week, minimum
It may feel counterintuitive, particularly if you’re used to pushing through pain in your workouts…but getting enough rest while you’re sick, and even for a period right after, is the best thing you can do to recover and return to the gym or trail faster, Dr. Olin says.
He suggests resting seven to 10 days after your symptoms end. If you still have active Covid symptoms after two weeks, he says it may be time to see your doctor, who may want to run testing on your heart and lungs.
Start slowly and listen to your body
Dr. Rajpal says that if you feel fine, then you’re probably OK to try exercise. Just start slowly and work up to your normal routine.
And if something feels painful or more difficult than usual, scale it back—Dr. Rajpal says you should expect it to take at least a month to get back to your previous exercise routine…so be patient.
How to deal with symptoms of long Covid during exercise
At this point, you may be asking yourself, “So what can I do after recovering from Covid-19?”
Most people bounce back after an infection, but still feel some subtle effects of having been sick. It’s also important to understand that long Covid can kick in even after a period of feeling better. So, if you’ve ever had a Covid-19 infection, the doctors suggest you should be on the lookout for these ways it can affect your capacity for exercise:
One of the findings of Dr. Olin’s research is that the Covid-19 virus makes muscle cells less efficient in how they produce and use energy. This may be why so many people report feeling incredibly tired when trying to exercise, even when they feel “fine” otherwise. The best thing to do is to go slowly, rest when you need to, don’t push through pain, and be patient with yourself, he says.
Shortness of breath
Dr. Olin says the second most-common symptom is feeling short of breath when you rest, or having more difficulty breathing than you would expect for the level of exercise you’re doing. “If this doesn’t get better or you find yourself constantly gasping or wheezing during exercise, see your doctor,” he says. “We’re seeing people who have never before had asthma, now have asthma. Fortunately that is easy to diagnose and treat.”
The inflammation caused by the virus can cause myocarditis, which in turn can cause chest pain, says Dr. Rajpal. Covid may also increase your risk of a stroke or heart attack, so it’s important to know your family history and personal risk factors, he says. It can also be wise to know the signs of a heart attack (as well as possible silent signs).
Tachycardia is the term to describe when your heart beats very quickly—as if your heart is “racing” or pounding out of your chest. Covid can cause an increased heart rate when resting, or a faster heart rate than you would expect for the level of exercise you’re doing, says Dr. Rajpal.
If this persists no matter what you do, talk to your doctor. It may indicate a dysautonomia, like POTS, or a heart problem caused by the virus.
Coughing during exercise
A mild, persistent cough is fairly common after Covid, and it’s okay to exercise through that—but, if you’re experiencing coughing fits that stop or impede your workout, it’s time to talk to your doc, Dr. Olin says. This may be a sign of asthma, dysfunctional breathing, or lung damage.
Vertigo or dizziness
Another common symptom people report during exercise after Covid is feeling vertigo or dizziness. The lessened ability to balance can prevent you from doing exercises you used to enjoy, like yoga.
This may get better on its own; but in the meantime, stick to safer exercise that might make it less likely to fall. “This isn’t the time to take up rock climbing,” says Dr. Olin. If this lasts more than a week or two, talk to your doctor.
It’s one thing to space out during a workout…it’s another thing to forget your gym bag, and your water bottle, and then lose your keys somewhere between your car and the locker room.
Covid brain fog is real, it can be serious, and it’s common after recovery. There is no known cure, so you may have to adapt your routine to account for it, says Dr. Rajpal. Consider using phone alarms and reminders, sticky notes, and other visual or audio cues.
The Covid headache can feel intense and may even worsen with exercise. It may stem from inflammation in the blood vessels of your brain and head, or it may be due to hyperventilating from feeling short of breath and your heart racing.
Dr. Rajpal says if your Covid headache is mild and you want to exercise with it, you can try…but, he says, if it feels really painful, it’s time to rest.
People who never experienced mental illness before Covid are now reporting symptoms, particularly of depression, and it can feel devastating.
Dr. Olin explains how feeling depressed can make you incredibly unmotivated to exercise, which, in turn, can cause more depression. This can lead to a vicious cycle. “Focus on just doing what you can—baby steps,” he says. “Celebrate every small victory. Ask someone to workout with you. And don’t be afraid to ask for professional help.”
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- Tod Olin, MD, MSCS, pulmonologist, specialist of exercise medicine and Director of the National Jewish Health Exercise and Performance Breathing Center and associate professor in the Department of Medicine at National Jewish. Author of a study examining the effects of Covid-19 infection on lung and muscle function during exercise.
- Saurabh Rajpal, MD, cardiologist and assistant professor at the Ohio State University Wexner Medical Center and author of a study examining the effects of Covid-19 infection on the heart in athletes.
- American Journal of Respiratory and Critical Care Medicine: "Decreased Fatty Acid Oxidation and Altered Lactate Production during Exercise in Patients with Post-acute COVID-19 Syndrome"
- JAMA Cardiology: "Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection; Results From the Big Ten COVID-19 Cardiac Registry"
- European Heart Journal: "COVID-19 is, in the end, an endothelial disease"