Returning to Sports or Exercise After Recovering From COVID-19

Whether you’re a student athlete or active adult who has recovered from COVID-19, you’re likely itching to get back on the field or resume your exercise routine. Or, if you don’t have symptoms or if your illness is mild, you might be wondering what activities you can do while you wait out the infection.

Sports medicine physician Marie Schaefer, MD, discusses the latest recommendations and guidelines for a safe return to fitness after COVID-19.

Many long-term effects are still unknown

We certainly know more now than we did when the pandemic began, but much is still unknown about the long-term effects of COVID-19. We know that the virus can lead to damage of the heart, brain, lungs and kidneys, but there’s no way to pinpoint or predict who exactly these individuals will be. Some people might also experience lingering symptoms, including shortness of breath, muscle aches, loss of stamina and exhaustion – all of which are bad news, but particularly so for athletes and active people.

“The truth is, the disease can affect everyone differently,” says Dr. Schaefer. “Anyone, including young athletes, could experience a severe case or have long-term damage, which is why it’s so important to take this seriously.”

This is especially true with active individuals, as it can be difficult to tell what long-term effects someone is going to have after they recover from the virus. Some people might fare just fine and will be able to jump back into their old training regiment, while others will find that their athletic performance just isn’t what it used to be.

For the majority of athletes and active people, returning to activity will likely be a slow process and will require patience. You should work with a healthcare provider to make sure you’re progressing appropriately and monitoring your symptoms.

Exercise restrictions in isolation and quarantine

If you were exposed to COVID-19

If you were exposed to someone with COVID-19, you’ll need to quarantine. Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. Athletes and active individuals can exercise in quarantine as long as they’re able to maintain the restrictions. Going to the gym or practice is out. Instead, look for at-home workouts. If an athlete in quarantine begins to feel sick, they should immediately stop exercising.

If you’re diagnosed with COVID-19

If you’ve been diagnosed with COVID-19, you will be placed in isolation. Isolation separates sick people with a contagious disease from people who are not sick. People in isolation should not leave their homes for any reason other than an emergency. Isolating a sick member to one room and masking all members of the household is advised to help prevent other members from getting sick. Athletes who are in isolation should refrain from doing any exercise until they are released from isolation and ultimately cleared by a healthcare provider to resume activity.

Timelines for returning back to sport or exercise

While an athlete or active individual is sick with COVID-19, they should not engage in any physical activity and should focus on rest, good hydration, proper nutrition and following the advice of their healthcare providers. The timeline of return back to exercise or sport is determined by how mild, moderate or severe the case was.

All athletes and people that engage in exercise that test positive for COVID-19, regardless of symptoms, must rest for a minimum of 10 days. There should be no physical activity or training in that 10-day time frame. If an athlete tests positive but does not have symptoms, the isolation date starts at the date of the positive test. If they’re symptomatic, this period begins the date the symptoms started.

If an athlete only has a mild illness or tests positive without experiencing any symptoms, they can consider returning to activity after the 10 day isolation period. Once that 10-day window has passed, the athlete may consider a gradual return to physical activity, but must not have symptoms.

If an athlete had a moderate or a severe illness (or if they had to be hospitalized), they should be evaluated by a healthcare provider prior to restarting any type of exercise. These people may need to have additional tests, including ECGs, heart imaging or blood work before they are cleared to start a progression back into activity.

Myocarditis in athletes and active people

Myocarditis is an inflammatory response of the heart due to a viral infection, such as COVID-19. It can cause swelling in the heart muscle making rigorous activity more difficult and sometimes, even deadly.

“Myocarditis is more likely to be found in people who had a moderate or severe case of the virus, but it can happen to anyone who was infected,” says Dr. Schaefer.

Given this increased potential risk for myocarditis, athletes returning after COVID-19 infections need to be cleared by a healthcare provider who will determine if any additional testing is needed. Because of the risk of myocarditis, athletes and anyone that exercises should follow a graduated return to physical activity over the course of a week to monitor for signs and symptoms of this serious complication.

Gradual return to sports for student athletes and active adults

Student athletes (and any active adult) should complete a supervised, graduated return to sports progression as they head back to practice, training or exercise. This progression is often referred to as Return to Play (RTP) and involves seven stages.

Athletes should start at stage one and only progress to the next stages as long as they remain symptom-free. Whenever possible, it’s a good idea for young athletes to have the progression supervised and guided by an athletic trainer. If an athletic trainer is not available, consider having a coach or parent supervise this progression to ensure safety. For active adults, be sure to monitor your symptoms or ask a friend or family member to keep an eye on you.

If the athlete should suffer any of the following red flag symptoms during the attempted progression, they should stop exercising immediately:

• Chest pain or heart palpitations.
• Nauseous.
• Headache.
• High heart rate not proportional to exertion level or prolonged heart rate recovery.
• Feeling lightheaded or dizzy.
• Shortness of breath, difficulty catching breath or abnormal, rapid breathing.
• Excessive level of fatigue.
• Swelling in the extremities
• Syncope (passing out).
• Experiencing tunnel vision or loss of vision.

If symptoms resolve, the athlete should rest for 24 hours and start back at the previous stage. They can continue to progress if they feel well. If any symptoms persist beyond 24 to 48 hours or if they do not resolve after stopping exercise, follow up with your healthcare provider for recommendations regarding additional evaluation and testing.

Follow these seven stages for the safest return to sports or exercise:

Easing back into fitness

Returning back to sports and exercise after recovering from COVID-19 can be a slow (and frustrating) process.

Dr. Schaefer offers additional advice for reintroducing fitness:

• Listen to your body. If you’re experiencing symptoms like chest pain or heart palpitations, stop exercising immediately and consult with your healthcare provider. Exercise and movement is important for overall health, but for COVID-19, things can change overnight as we learn more about the virus. Keep monitoring yourself and if something feels more than just being out of shape, stop exercising and talk to your healthcare provider (red flag symptoms to watch for are listed above).
• Take it easy. Don’t try to “power through” like you used to. Athletes of all ages should follow a gradual progression to get back into exercise. You’ll need to build up the time and intensity of your workouts. Start with a slow walk and if that feels OK, try a brisk walk the next day. Then increase the amount of time you are walking. Gradually build up for about 1 to 2 weeks before you return to the HIIT training or CrossFit you were doing before COVID-19.
• Be patient. Even if you were training for a marathon prior to becoming infected, you’ll likely discover that your body has changed a bit, which warrants extra caution. Don’t push too hard on a body that is still trying to recover.