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Having trouble handling exercise after covid? Here are expert tips.

(Washington Post illustration)
7 min

Before Amy Lipnicki tested positive for the coronavirus in January, she spent hours exercising every week, alternating between lifting weights and logging between three and 10 miles with her running group along the Brooklyn waterfront.

“I was in really good shape,” said Lipnicki, 43, a two-time marathoner who works as a veterinarian and lives in New Jersey.

But after she received her positive result, there was only one way to describe her condition, she said: “extreme lethargy.”

“I was out basically on the couch for the first five days. I could barely get myself up and go to urgent care,” Lipnicki said, adding that her symptoms also included chest pains, muscle aches, difficulty breathing, a cough and sore throat. (Lipnicki was fully vaccinated but not boosted at the time.)

She waited two weeks before trying to run again. When she did, managing two miles was difficult: “I would jog a little bit and then walk most of it,” she said. Her chest felt tight and her legs felt heavy, too.

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A little more than a month later, Lipnicki said she’s “still trying to run, which I’m doing very, very slowly.” Her per-mile pace went from around 9½ minutes pre-covid to closer to 13 minutes now, she added.

According to experts, her experience is common. Many people have a tough time resuming exercise or reaching their previous level of fitness after contracting the coronavirus, said Jordan Metzl, a sports medicine physician at the Sports Medicine Institute at the Hospital for Special Surgery in New York.

“In my office, I’ve seen all kinds of issues — people with delayed recovery [after exercise], their times are slower, they’ve got more muscle injuries or they feel like their body’s out of shape,” Metzl said.

But the best bet for eventually getting back into shape, Metzl added, requires taking the long view — and taking it slow: “The biggest mistake people make is they try to get back out and do too much, too quickly.”

That advice features prominently in the guidelines for recreational athletes returning to exercise after mild-to-moderate cases of covid-19 that Metzl and his colleagues published in August 2020. Since then, researchers in Canada and Europe have also released return-to-exercise guidance, as have members of the American College of Cardiology’s Sports & Exercise Cardiology Council, which released its most recent guidelines in January.

All the guidance emphasizes the importance of a gradual return to exercise for people with asymptomatic or mild cases of covid-19. For those who had more severe symptoms related to the lungs or heart, experts recommend seeing a cardiologist before resuming exercise.

Here are other key tips from experts for a safe return to fitness after a bout with covid-19.

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Ease back in — and listen to your body

Both when to resume exercise and how hard to push once you do depend on the severity of the virus and your pre-covid fitness levels, experts said.

The recently updated American College of Cardiology guidelines recommend people with asymptomatic cases of covid-19 take three days off exercise following a positive test result to ensure they remain symptom-free.

People with mild symptoms not related to the heart or lungs should rest until their symptoms resolve, those guidelines note.

Once you do start exercising again, “you want to be very slow and gradual in your ramp-up to activity,” Metzl said. “The adage of ‘listening to your body’ is really appropriate. … If you feel fatigue, don’t push.”

Metzl and his colleagues recommend that people recovering from mild cases of covid-19 follow the 50/30/20/10 rule: Start out by reducing your normal exercise by at least 50 percent for a week — so a typical four-mile run would be reduced to two, at most, or an hour-long yoga class should be cut to 30 minutes max — followed by gradual weekly increases to limiting it by 30 percent, 20 percent and 10 percent of your pre-covid routine, provided you continue to feel comfortable.

Some people may take months to progress to that 10 percent level, while others may be able to do so in weeks, Metzl said.

“There’s not a one-size-fits-all [solution], and every person that gets exposed to this has a different reaction, and their body fights it differently,” he said.

Take care of your mental health, too

Running has long been Lipnicki’s preferred stress reliever — but struggling to log her miles after recovering from covid has brought new challenges, she said, including “frustration.”

Frustration is a common emotion for people to feel when they have to modify or pause their exercise routines, even temporarily, according to Peter Economou, a sports psychologist and associate professor of psychology at Rutgers University.

“Exercise has been proven to be one of, if not the most, effective coping skills to manage stress, … so removing it from one’s daily routine can have a pretty tremendous impact,” said Economou, who co-authored a study showing that student-athletes faced increased feelings of depression and anxiety in fall 2020, when they were no longer able to compete in their sports because of the pandemic.

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To maintain mental and emotional wellness during periods of inactivity or reduced exercise, Economou recommends implementing a “self-care or well-being plan,” he said.

It should include a light exercise regimen when you feel up to it — even if it’s just walking around at home — eating healthy foods and staying hydrated, as well as maintaining a mindfulness routine, which ensures “the brain can respond in a healthier way to adversity,” Economou said.

See a doctor if you have lingering heart or lung issues

Most people don’t need to get cleared by a doctor to resume exercise after covid-19, provided they were asymptomatic or had mild symptoms and are otherwise healthy, said Jonathan Kim, one of the co-authors of the American College of Cardiology return-to-exercise guidelines.

“If you want to get back to exercise, you don’t need to see your cardiologist, you don’t need to have all these cardiac tests … you just need to be smart and careful,” said Kim, who is also an associate professor of medicine at Emory University.

But people with “chest pains or chest tightness, shortness of breath during exertional activities that’s beyond what we consider normal, getting lightheaded, fainting, clearly feeling irregular heartbeats” during their bouts with covid-19 or during exercise afterward should see a cardiologist to ensure they’re keeping their hearts and lungs safe while exercising, Kim said.

Metzl echoed Kim’s advice, adding that the first step people should take before determining whether to see a doctor is tuning in to how they feel: “If they’re really struggling with breathing issues, chest palpitations, … you just want to be a good body listener,” Metzl said. That means paying attention when “things just aren’t exactly as they should be in your own body,” he said, adding that this might manifest as huffing and puffing going up and down stairs or having trouble breathing during exercise.

Lipnicki is taking her return to exercise slowly, opting for yoga and stretching sessions when she doesn’t feel up for running.

“I’m still trying to force myself every day to get up and do something active,” she said. “I don’t want to become sedentary.”

She does have D.C.’s annual Cherry Blossom Ten Mile Run on her calendar for next month — but she expects to be more focused on enjoying the flowers and having fun with friends than on running the race.

“I’m realistic: This is not going to be a great year, but at least I can have something to motivate me to get out and try and train,” she said.