Exercise after COVID – Gradual and Progressive


Hi, and welcome to our first newsletter of 2022! With the ongoing COVID-19 pandemic, we have had quite a number of our clients and many family and friends who have now experienced the COVID-19 infection. We extend our heartfelt regards to those who are battling the after-effects of the infection and deepest condolences to those who have experienced loss. 

We have remained open throughout being an essential service for physiotherapy and massage treatments and have implemented a stringent COVID plan to protect our clients and staff. 

One of the common questions we have been asked when clients have completed their mandatory isolation and have tested negative is, when is it safe for me to resume exercise? And, how can I exercise safely?

As with so many health-related conditions, it isn’t a one size fits all answer. Some have very mild illness or are asymptomatic, while others have experienced more severe symptoms. With the increased prevalence of omicron (estimated to account for 90% of current COVID-19 cases in Australia), there is a trend to milder infection, although this is not necessarily universally the case. 

Common symptoms of COVID-19 infection include fever, breathlessness, headache, muscle aches, sore throat, loss of taste and smell (more commonly alpha and delta strain), fatigue and ‘brain fog.’ 

Whatever the strain of COVID, the research supports a gradual and progressive return to activity. A review article by David Salman et al. (British Medical Journal, Jan 2021) suggests, across the board, a minimum of seven days of rest. The mandatory requirements for isolation take care of the seven days. However, suppose the symptoms are very mild. In that case, it is recommended that absolute bed rest be kept to a maximum of two days. After that period, range of motion exercises may help reduce and prevent ongoing musculoskeletal problems. 

After the mandatory isolation period, it is essential to be gentle with your staging of return to exercise. Post viral fatigue can be a very debilitating problem. Interestingly, research from the UK showed that long COVID was more than twice as prevalent in elite athletes preparing for the Olympic and Paralympic Games. This effect may have been because the athlete was already training to their absolute physical limit before contracting COVID. It may also relate to the pressure to reload the athlete after the acute symptoms have resolved. 

The key message here is that you mustn’t try to make up for lost time by reloading too soon and thinking that you can pick up your exercise plan where you left off. 

So how should you acclimatise to exercise? The research indicates that there should be two weeks of minimal exertion, only progressing when the exercise load is tolerable. Assess signs of breathlessness, palpitations, ongoing cough or a return of fever. In such cases, it is essential to discuss the symptoms with your GP and consider referral to a specialist if ongoing. Exercise programs that increase range of motion and social participation, such as yoga, are beneficial at this stage. If tolerated, you can safely increase your exercise tolerance by ten to fifteen minutes per day – that is, if you aren’t exhibiting any of the side effects listed above.

Having conversations about how you’re feeling also helps. Ensure you have adequate rest, sleep and good nutrition. Keep in mind, and pay special attention to any other medical conditions that may affect your energy levels. If, for example, you have low iron levels or blood sugar levels are high, get those checked by your GP before increasing your exercise load.

After three weeks, and with no setbacks or ongoing symptoms, you should be able to reintegrate into a relatively regular exercise program. If you need any help with exercise tips or techniques, or if muscles are sore and achy, contact us at Excel Physiotherapy and Wellness for one-on-one support. We are with you during these most trying of times.

Written By Tim Ellis, Managing Director and Principal Physiotherapist