There have been 113 million confirmed covid-19 cases worldwide, with this set to continue to rise for quite a while. By its very nature as a respiratory virus, covid-19 can knock down even the fittest individuals and leave them feeling fatigued and out of the habit of regularly exercising. However, it is well known that being active can improve our mental health, as well as help to protect us from other viruses or potential reinfection from covid-19. In light of this, many have been left wondering how to safely return to regular exercise.
The British Medical Journal (BMJ) has put together a set of guidelines to advise both patients and healthcare professionals. First, it’s important to appropriately risk stratify individuals into their respective categories based on how severe their covid-19 illness was and the presence of any persistent symptoms. If you had severe covid-19, including if you required hospitalisation, or have any lingering symptoms, you should go to your doctor for advice. They will likely refer you on to post-covid rehabilitation services, where your increased risk for adverse side-effects from physical activity.
If you had mild to moderate illness with covid-19 and have been asymptomatic for at least 7 days, the BMJ has set out a strategy to get you back to regular exercise. They suggest 5 gradual phases through which post-covid patients can move to return to their pre-covid activity levels. It’s recommended you spend at least 7 days in each phase, only moving up a phase when certain criteria are met. If you’re finding a phase too difficult, such as not feeling recovered from previous exercise sessions, you can back off slightly by moving back down a phase.
The initial phase aims to prepare you for your return to exercise. This involves breathing exercises, stretching and working on mobility, and gentle walking, making sure to also incorporate plenty of rest. During this phase, any activity should be at a low enough intensity that lets you maintain a full conversation at the same time without any difficulty. Once 7 days have passed at this phase, and if you feel ready, you can progress to phase 2.
In this phase, some low intensity activity can be reintroduced, such as walking and light yoga, as well as household and garden tasks. These should still be at a low enough intensity that you can maintain a conversation throughout, and the duration can be gradually increased each day by 10-15 minutes. Balance and yoga exercises can act as gentle strengthening activities at this phase. After 7 days, and once you can walk for 30 minutes with minimal exertion, you can move on to the next phase.
Now you can progress to moderate intensity aerobic activity! Examples include brisk walking, jogging, cycling, and swimming. While the intensity of activity is higher in this phase, you should still have enough breath to be able to hold a conversation. Use intervals to introduce this new level of activity, with the BMJ suggesting starting with 2 intervals of 5 minutes of exercise with a block of recovery in between. If achievable, you can increase by an interval each day. After 7 days, if you can complete a 30-minute session and feel recovered an hour later, you can progress to phase 4.
This phase incorporates the moderate intensity activity from phase 3 with the addition of more complex movements that work on skills such as co-ordination and balance. Examples of these movements include side steps, running with changes in direction, and body weight exercise circuits. For every 2 days of training at this phase, there should be a day of rest and recovery. After sufficient time at this phase, at least 7 days, you should feel capable and ready to return to your baseline level of exercise.
While everyone’s baseline level of activity will be different, if you’re unsure about what to aim for, current UK guidelines suggest 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity per week for adult health. Muscle strengthening activities should also be included on at least two days per week.
A Few Things to Bear in Mind
It’s important to note you may not feel as strong as you did pre-covid and some days will be harder than others – try not to be discouraged! Keeping a diary recording your progress can help as you can then look back and see how far you’ve come along. Daily monitoring can also help flag up when you may need to seek medical advice, such as a recurrence of covid symptoms including fatigue or raised temperature. You should also seek medical guidance if you experience abnormal shortness of breath, dizziness or chest pains.
Also, it’s important to be aware that your fitness levels may not neatly align with the 5 phases above. For example, your pre-covid baseline fitness may be similar to the levels suggested in phase 3. If this is the case, rather than pushing through the remaining phases, you should see phase 3 as the final goal as this would constitute a return to pre-covid fitness.
Finally, the advice put forward by the BMJ is, by nature, general, as it aims to guide the post-covid population as a whole. As a result, it cannot replace individualised advice from your medical professional. If at any time you feel you need personal guidance, you should consult this professional rather than rely on the general advice above.