Several of my friends have already said that returning to exercise after COVID-19 has been more difficult than usual. A former classmate of mine, a keen athlete, was among the first to be diagnosed with COVID-19 back in March 2020, when a coronavirus diagnosis in Estonia was considerably rarer than nihilissimus acutus, the illness that sent the colonel’s widow from Smuul’s play to hospital.
When we went for a run together in Otepää at the beginning of June that year, it became clear that his fitness had still not returned after several months. Even at a pace of around 6:00–6:30, which would not normally be particularly demanding for him, he had to take several walking breaks during the 12 km loop around Lake Pühajärv. At the time, I remember thinking that I really did not want to catch the virus myself. Fortunately, I have managed to stay healthy so far—touch wood. By now, I have heard plenty about how other people’s recoveries have gone and how restarting exercise has been more difficult than after other illnesses. The days are well and truly over when someone could rant among fellow conspiracy theorists that COVID-19 is like the Abominable Snowman—if you have not seen it, it must not exist.
Has Your Strength Disappeared?
For now, let us set aside renowned Estonian weightlifter Mart Seim, who may have lost not only his strength but also an Olympic medal because of COVID-19. Ordinary people among us have lost their strength and fitness too. The “commission” for this article came from my cousin Diana. After we launched FitQ, she began working out diligently at home using our videos. Her physical performance improved rapidly: having previously scored 240 points on the Estonian Defence Forces’ general fitness test, she soon raised her score to 280 out of a possible 300. But after having COVID-19, she suddenly asked me how she could return to exercise, as she could not find suitable workouts and was struggling even to do downward-facing dog in yoga.
While someone is ill with COVID-19, doctors recommend breathing exercises as a form of training: pursed-lip breathing, blowing soap bubbles, blowing bubbles into a bottle of water through a wide straw, or inflating a balloon. Read the advice from family doctors in more detail here.
However, these exercises are too easy for someone who already feels healthy and ready to return to everyday life and a regular exercise routine. So how should you get started, and what should you keep in mind? I asked people with more experience of COVID-19 and/or exercise for their advice.
A Doctor’s Thoughts
Mari Arak is a doctor at Tartu University Hospital who has unfortunately had a great deal of contact with COVID-19 patients recently. She is also an athlete herself, playing volleyball for the University of Tartu Bigbank women’s team, and serves as the doctor for the Estonian women’s national volleyball team. She begins by pointing out that although she has seen more patients than she would like, she does not monitor their recovery or return to exercise after they leave hospital. Her comments are therefore her personal opinion rather than a scientific perspective.
Mari Arak: “Most of my experience is with adults who have been hospitalised because of COVID-19. The majority are unvaccinated, have required prolonged intensive care and consequently have multiple complications. Recovery takes several months for these patients, and simply walking along a hospital corridor without supplemental oxygen is a major step. It is difficult to say how long it will take them to return fully to their normal everyday routines, because we do not monitor them for that long.
For athletes, it is now clear that COVID-19 generally causes mild to moderate symptoms. A study conducted among Estonian athletes found that COVID-19 keeps them away from training for an average of 2 weeks. In mild cases, I think that is sufficient. Of course, you must pay attention to how you feel. If symptoms persist during training or new problems arise, you should definitely consult a doctor. Many athletes are used to monitoring their heart rate during exercise—it is useful to continue doing so and to adjust the training load according to your heart rate and how you feel.”
A Trainer’s Perspective
Respected trainer and athlete Ott Kiivikas cautions that he is certainly not an expert on recovery after COVID-19 and cannot say when someone can be declared healthy and begin exercising again. Drawing on his personal experience both as a trainer and as someone who has had the illness, he says:
“First of all, it certainly depends on how severe the damage to the person’s lungs is, and there is no single standard that applies to everyone. With any lung damage, you initially have to begin with movement alone—that is, walking—because even a small amount of exertion is tiring. I know this from personal experience. As fitness improves, the proportion of aerobic exercise can gradually be increased, but only week by week. That does not mean weight training is prohibited or ruled out, but the load should be at least 50% lower than it was at the beginning of the training break. You should definitely monitor your heart rate and how you feel; these two things will help you find a suitable training load.”
More Specific Recommendations for Returning to Training
The topic of returning to exercise has also been studied internationally. For anyone looking for much more specific advice, we found the following recommendations, which focus on competitive athletes and therefore on returning to levels of physical exertion that are undoubtedly far above average:
| Phase 1 |
| Diagnosis, illness and recovery Duration: At least 10 days after a positive test or the onset of symptoms. A healthcare provider must clear you to return to training. Symptoms must have resolved, except for loss of smell and taste. |
| Phase 2 |
| Light exercise Duration: At least two days Walking, light jogging, stationary cycling; no endurance training. < 70% of maximum heart rate. Workout duration: < 15 minutes. |
| Phase 3 |
| Light to moderate exercise Duration: At least one day Movement exercises: running drills, bodyweight resistance exercises, circuit training. <80% of maximum heart rate. Workout duration: <30 minutes. |
| Phase 4 |
| Moderate exercise Duration: At least one day More complex training: sport-specific exercises, running, strength training. <80% of maximum heart rate. Workout duration: <45 minutes. |
| Phase 5 |
| Moderate to intense exercise Duration: At least two days Normal sporting activities: non-contact activities, sport-specific exercises, running. <80% of maximum heart rate. Workout duration: <60 minutes |
| Phase 6 |
| Resume normal training Duration: At least one day Complete at least one day of normal training before returning to competitive intensity. |
| Phase 7 |
| You may return to unrestricted competition and training. |
We have heard that some people experience a more severe illness while others have an easier time. My former colleague Evelin, who had COVID-19 in March 2021, is a big fan of CrossFit workouts, which are known to be exceptionally physically demanding. She had a milder case and summed up her experience with COVID-19 and return to training as follows: “At first, I may have tired a little more quickly, but otherwise I was fine and regained my stamina quickly.”
Regardless of whether the illness is mild or severe, the Cleveland Clinic website recommends taking a 10-day break from exercise after diagnosis—even if you are athletic and accustomed to heavier training loads, and your symptoms are mild or virtually non-existent. The main reason is that the illness can be unpredictable and increases the risk of myocarditis.
Recommendations
My cousin Diana also found her own ways to exercise. She describes the training load she chose as follows: “To begin with, I used the first half of Netfit’s Verve 01 programme as a breathing exercise. The tai chi and yoga exercises familiar from BodyBalance are also suitable, followed by gentle stretches like those used in Yin yoga. It made life feel more bearable for me.”
When you feel ready to exercise, we recommend looking for categories such as “mind and body” workouts in FitQ’s training library. If you do not feel quite ready yet but would like to get started, begin with the meditation and mobility categories instead. At first, be sure not to push beyond the point of discomfort.
Wishing everyone a good recovery!
Further Reading:
A family doctor’s guide to recovering from COVID-19
Cleveland Clinic’s guide to returning to exercise
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