Returning to exercise after Covid-19

The majority of people who contract Covid-19 will feel a lot better in a few weeks.  However, it is thought that 1 in 10 people will go on to develop Long Covid.  Long COVID is the presence of signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for 12 weeks or more and are not explained by an alternative diagnosis (NICE, 2020).

A study published in 2021, found that 92% of people who went on to develop long covid were not admitted to hospital (Davis et al, 2021).  While they tended to have milder symptoms, they also tended to have more of them- most had more than 14 symptoms.  It was more prevalent in women and in people aged between 30-49 years old.  The majority were moderately to very physically active before Covid 19. 

Almost 90% of people with long covid had symptoms that were fluctuating in nature and the top 3 symptoms that people were experiencing were fatigue, post exertional symptom exacerbation (PESE) and cognitive dysfunction (Davis et al, 2021). 

PESE is different to fatigue.  Somebody suffering from PESE will experience a marked, rapid physical or cognitive exhaustion in response to exertion. This can be immediately after the exertion, or it can be delayed by up to a few days and recovery from this exhaustion is prolonged.  The sort of exertion that would cause these symptoms is not just physical exertion.  It can be mental or cognitive, emotional or sensory exertion.  This could be as simple as taking a shower, reading or writing, or holding an intense conversation with a friend.  If this is something you feel you may be experiencing, seek help. 

Your physiotherapist can help you use pacing as an activity management tool to avoid PESE.  When pacing you will be doing less activity than you have energy for.  These activities should be short in duration, and you will need to rest often.  As symptoms improve, you will experience less fatigue and weakness and you will very gradually be able to increase your activity levels under the guidance of your physiotherapist.

The World Confederation for Physical Therapy has advised that using a cautious approach to physical activity will likely support long term recovery. 

So, what does all this mean in terms of returning to exercise after covid-19? 

Once you are feeling well enough to return to exercise, start slowly.  Monitor how you are feeling at the time, but also over the next couple of days.  If you are still feeling good, gradually progress this.  This could be done by increasing the distance or increasing your speed.  Keep an eye on any breathlessness – you should be able to hold a conversation at all times through the activity and not feel out of breath.

Be aware that a trip to the shops or doing a lot of work around the house may take a lot more out of you than before and you may not be able to do as much exercise afterwards. If you are feeling tired- rest. 

Be realistic with your goals and allow your plans to be flexible and make sure you are getting adequate rest.

It is great to keep an activity symptom diary to help you keep an eye on your response to exertion and measure the progress towards your goals over time.

Do not compare yourself to others.  Everyone’s recovery will be different so concentrate on your progress and how activity affects your symptoms
If your symptoms are persisting for 12 weeks or more, speak to your GP.  There are a number of Long Covid clinics that have been set up to assist in recovery from long covid.

A gradual return to regular exercise is one of the best ways to prevent injury and aide your recovery. If you do notice any pain or reduced range of motion contact one of our physios at PMC Physiotherapy Dunboyne and get it checked out.

For more resources on this topic, please visit the Irish Society of Chartered Physiotherapists website at Ask the Physio | Physiotherapy Advice, Guides, Information | ISCP