Written by: Dr Tom Eaton (Accredited Exercise Physiologist)
Exercise and Sport Science Australia (ESSA) recently published updated guidelines for returning to exercise following COVID-19 infection.
Understanding these guidelines and how to safely return to exercise is crucial for managing your health. Your pathway to returning to exercise is determined by whether you managed your symptoms at home, in a medical care facility or in a hospital setting.
For those who have managed at home, return to exercise guidelines are outlined below. For those with co-morbidities, who have suffered a severe episode of COVID-19 requiring medical treatment or hospitalisation, and those with persistent or ongoing symptoms (more than 4 weeks), a medical review with your usual GP is recommend prior to returning to exercise.
Each individual will respond to exercise following COVID-19 infection in a variety of ways, and as such the timelines suggested below should be used to guide your return to exercise within symptoms limits. Any exercise or activity that results in a worsening of COVID-19 symptoms should be avoided.
How quickly you are able to return to your pre-infection levels of physical activity is determined by a range of factors including the severity and duration of COVID-19 infection and symptoms, pre-infection activity levels and exercise history.
Exercise Guidelines: Acute COVID-19
Acute COVID-19 infection and symptoms may last from 0-4 weeks and can include anything from asymptomatic or mild infection (approximately 80% of cases) to moderate to severe symptoms (15%) and critical life-threatening complications (5%). Following a positive diagnosis, it is safe to perform stretching, balance and breathing exercises or some light walking for 15-45 minutes cumulative total per day (Phase 1). You should perform these exercises within symptom limits, and at a Rating of Perceived Exertion (RPE) level of 0-1 on a 10 point scale.
For those with asymptomatic COVID-19 following a positive diagnosis, it is safe to commence Phase 2 of light exercise (e.g. walking, yoga) 7 days after you receive your test result. For those with symptomatic COVID-19, it is advised that you only return to Phase 2 of light exercise (e.g walking, yoga) when you have been free of symptoms for at least 7 days, and are able to complete all of your pre-infection activities of daily living.
Guidelines for returning to Phase 2 of light exercise include; start with approximately 15 minutes of exercise per day and gradually increasing by 10-15 minutes per day, keep exercise intensity low (RPE 1-2/10) and within symptom limits for at least 3 days in a week. Once you are able to walk for 30 minutes at an RPE of 2/10, you are able to progress on to Phase 3.
In Phase 3, you can gradually re-introduce both aerobic and strength exercise at a moderate intensity (RPE 3-4/10). In this phase, you should aim to exercise for 30 minutes per session within symptom limits, including regular rest periods (e.g. rest 1 min every 5 mins) and gradually adding 1 work interval per day. You can progress to Phase 4 once you have exercised for a total of 30 minutes, 3 days in a week, and feel recovered 60 minutes after your session.
In Phase 4 you can begin to train every second day, at a moderate intensity (RPE 3-4/10), and gradually increase the duration of your sessions by 5-10 mins per session within symptom limits and as tolerated. Once you have completed 3 sessions in a week of at least 30 minutes duration with no return of or increase in symptoms and pre-COVID-19 levels of fatigue after sessions, you may return to your usual exercise routine.
Exercise Guidelines: Post-acute and ongoing symptomatic COVID-19 (Long COVID-19)
Post-acute and ongoing symptomatic (long) COVID-19 may last between 4-12 weeks and beyond 12 weeks respectively. These conditions often present with ongoing persistent symptoms or a gradual improvement before a worsening of symptoms.
Exercise is recommended for those in this category and should follow a similar graded or phased approach as outlined above, guided by any ongoing symptoms. If you are in this category, or have been hospitalised for COVID-19, ESSA recommends a specialised, multi-disciplinary approach to COVID-19 rehabilitation depending on each individual situation.
We can work with your medical team to design a program to help gradually return you to your pre-infection levels of activity.
If you have any questions or concerns regarding returning to exercise following COVID-19 recommend you consult with your GP further advice. Returning to exercise following COVID-19 infection should be tailored to your needs, progressed gradually and performed within limits of any ongoing COVID-19 symptoms.
Our Exercise Physiology team are here to support you using clinically relevant guidelines to ensure you return to exercise safely.