As we come to grips with COVID-19 infections as a mainstay like the seasonal flu, many athletes and patients with recent diagnoses ask, "Can I exercise, and if not, when can I return to exercise?"

These are excellent questions because of some staggering statistics: 78% of COVID-19 patients have cardiac issues, and 60% have inflammation of the heart following infection. The virus can affect the lining of your blood vessels, impacting the blood flow to all the parts and systems of your body, which is why we see lung, heart, and nervous system complications.

Rest

If you test positive for COVID-19 and are asymptomatic, rest from exercise for about ten days as you monitor closely for symptoms.

Rest is crucial when symptomatic (even when mild); this means refraining from exercise until ten days after symptom resolution, from day (1) of no symptoms. Your body needs all its resources to fight and recover from the infection. See the return to exercise steps outlined below.

Heart Testing

For mild cases, the American Academy of Cardiologists recommends a 12-lead electrocardiogram and other medical testing before resuming cardiovascularly challenging exercise to ensure no heart damage (see flow chart above). If tests are clear, a slow resumption of exercise is permitted as tolerated. See the return to exercise steps outlined below.

Return to Exercise Steps

Asymptomatic or Mild Symptom COVID-19 with Negative Heart Test Results:

• start small, for short bouts, with frequent rest

• monitor your heart rate

• keep rate of perceived exertion (RPE) to a 3-4 at max

• build gradually

• keep resistance lower than 70-80% of one rep max

When to See a Cardiologist

Before returning to activity, see a cardiologist if:

• you experience heart-related symptoms such as shortness of breath or heart palpitations.

• you have abnormal heart test results

• you experienced moderate-severe symptoms

A cardiologist will help test for myocarditis and ensure you follow the correct Myocarditis Return-to-play Guidelines. 

The best defense against complications from COVID-19 is to stay up to date on your vaccination against the mutating strains. If you do get COVID-19, refer back to this post to help you follow the steps to return to activity. Remember, your very first step is to REST!