With the continuing threat of COVID-19 world-wide, it seems as if new information is coming out nearly daily. From trying to understand how the virus is transmitted to who is more susceptible to getting the virus and having serious health impacts from it (and everything in between), we are working our hardest to stay up-to-date with the latest information about COVID-19 and how it impacts ourselves, our patients, and the clinic. As we continue to remain open through the pandemic, we continue to use screening and cleaning techniques along with proper hygiene (friendly reminder- face masks required!) from our staff and within the patients as ways to stay safe and healthy during this time.
That being said, it is clear that this virus will be sticking around for a while and many questions will continue to arise as more people in our community are affected by COVID-19. In the physical therapy realm, one of the questions of interest to us is “when is it safe to start exercising again after recovering from COVID-19?”. This question was recently discussed in the open-access article “Exercise and Athletics in the COVID-19 Pandemic Era” on the American College of Cardiology’s website.(1)
The article provides an interesting discussion, from the perspective of cardiologists, regarding COVID-19’s effects on the heart, the inflammatory-reducing effects of exercise, and what the recommendations are for returning to exercise and sport after recovering from COVID-19.(1) Knowing that, based on early data and observations, “COVID-19 infected patients with hypertension, diabetes, cerebrovascular or cardiovascular disease are more likely to require hospitalization, ICU level care, and die from the infection,” these pre-existing conditions must be taken into account when considering a return to exercise after being infected.(1) Ultimately, the current recommendations from the authors were as follows:
- “… the recreational exerciser seeking to resume activity for general physical fitness after COVID-19 who experienced only mild to moderate symptoms, were not hospitalized, and had no concerning cardiac symptoms should be able to resume recreational exercise at moderate intensity once completely recovered.”(1)
- “However, patients with pre-existing cardiac disease who are potentially at higher risk of complications with COVID-19 may require additional testing and risk assessment prior to return to regular exercise levels.”(1)
- Based on two recently published statements quoted by the authors, it is suggested that athletes who tested positive for COVID-19 who were either asymptomatic or had mild symptoms and were not hospitalized take a rest period of 2 weeks from either the time of the positive test for asymptomatic individuals or from the time of symptom resolution for those people who had symptoms before considering return to exercise in a slow, progressive manner with guidance by their doctor.
- Furthermore, for athletes who tested positive for COVID-19 who had significant symptoms and were hospitalized, a recovery period of at least two weeks after symptom resolution followed by further cardiac assessment and monitoring is recommended. Those with known myocardial injury need to wait 3-6 months before re-evaluation by a cardiologist before considering a return to exercise.
The authors of this article are quick to point out that this information is based on expert opinion, due to the fact that there are no higher level research studies performed on this topic because of the novelty of this virus. However, their concern for the impact of COVID-19 on the heart came through in their recommendations. Ultimately, if you have tested positive for COVID-19 (regardless of whether you were asymptomatic or had such significant symptoms that you were hospitalized), you should make sure to discuss how to safely return to exercise with your healthcare time. As information is quickly evolving, these recommendations may change as further research can be performed and observations are made, but the bottom line for now is that you should REST for at least a two week period regardless of how severely you felt impacted by the virus. Stay safe, stay healthy, wash your hands, and wear your mask!
- Emery MS, Phelan DMJ, Martinez MW. Exercise and Athletics in the COVID-19 Pandemic Era. https://www.acc.org/latest-in-cardiology/articles/2020/05/13/12/53/exercise-and-athletics-in-the-covid-19-pandemic-era.