It is no understatement to write that the past two and a bit years have been dominated by the COVID-19 pandemic. Each and everyone of us have experienced significant upheaval to our lives, and suffered the misfortune of missing loved ones, best laid plans changed with a moments notice, and frustrating periods of isolation and quarantine.

At the time of writing, the situation continues to improve. Our usual daily activities are largely back to normal. Many of us have personally contracted the COVID-19 virus. Depending on who you speak to, symptoms can be very different from person to person, irrespective of their health or vaccination status. Having personally had the virus as recent as early April 2022, I can attest to the impact the virus itself and the week of isolation had on my fitness and conditioning levels, as well as my mental well-being. As someone who exercises most if not every day of the week, more than a month after being unwell I am still recovering and restoring my fitness to levels pre-COVID.

To help others through the challenge of best overcoming SARS-CoV-2, I want to highlight the importance of exercise as a strategy to reduce the long-term impacts of the virus. As an Exercise Physiologist and someone who has a strong intuitive connection to my body having exercised regularly for a long period of time, I have been able to independently navigate the weeks post-COVID to safely resume exercise. For many others, I can imagine that facing this challenge will be difficult. Knowing when to resume exercise, when to increase intensity, and how much exercise might be too much too soon, are all keys components to get right.

Throughout this blog, I will be referencing extensively the 2021 journal ‘Post-COVID-19 Syndrome and the Potential Benefits of Exercise‘ written by Jimeno-Almazan and colleagues.

Current State of Play

As of May 2021, research suggests that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Whether it be feeling particularly breathless at rest or upon exertion (which I did resuming AFL training), an ongoing sense of lethargy or low energy levels, a lingering cough or mental fog, I am in agreeance with this research based on conversations with patients and peers alike.

Much focus has been placed on prevention and treatment (social distancing, masks, lockdowns, vaccination), but little discussion is held around how to best recover post-SARS-CoV-2. So let’s look at how regular exercise may improve symptoms and could reduce the long-term effects of COVID-19.

Overwhelming evidence exists that exercise produces short-, middle- and long-term health benefits that prevent, delay, mitigate and even reverse a large number of metabolic, pulmonary, cardiovascular, neurocognitive, inflammatory, rheumatic and musculoskeletal diseases. As EPs, educating our patients on these benefits is our livelihood and passion. Additionally, physical inactivity has been associated with a higher risk for severe COVID-19 outcomes. Those with high levels of cardiorespiratory fitness have reduced likelihood of requiring hospitalisation due to COVID.

The Potential Role of Exercise in Post-COVID-19 Syndrome

As the referenced study highlights, the COVID-19 pandemic has come at a time when population uptake of physical activity is arguably at an all-time low. According to the Australian Bureau of Statistics, during the 2020-2021 financial year only one in four (24.5%) Australians aged 18-64 years met the physical activity guidelines, and only 28.2% undertook strength or toning exercises on two or more days in the last week.

Is this a contributing factor to the widespread world-wide impact of COVID-19?

Perhaps even more concerning, only 27.2% of people aged 15-17 years met the physical activity guidelines. Traditionally this is a time when strong habits towards physical activity are developed and then transitioned into adulthood.

Will we see even greater reductions in exercise uptake in future generations? Perhaps preventing this is our greatest challenge as exercise professionals!

Knowing the many benefits of exercise (see below), and knowing the statement above around physical activity’s association with reducing COVID-19 symptom severity, we can surmise that regular exercise plays an integral role in both the prevention and treatment of Post-COVID-19 Syndrome.

The above diagram adequately highlights the many widely-known and non-specific (to COVID-19) benefits of exercise. Knowing the typical symptoms and multi-organ nature of the disease however shows that physical activity is one of our best strategies to strength our bodies prior to contracting the virus/ during the acute phase of having the virus (depending on symptom severity of course)/ and post-COVID to restore and rebuild our immune, respiratory, cardiovascular and musculoskeletal systems. Graded exercise (starting light and building the intensity as symptoms reduce and sense of wellness improves) will also help restore psychological and neurological health.

My Personal Post-COVID-19 Training Focus

Speaking personally, it was both my physical and mental wellness that took a hit during the two weeks I was most affected with COVID. Being unwell is never nice, and combined with the 7-days of required isolation and ongoing sense of lethargy in week #2, I felt very flat. I steadily re-introduced exercise in week #2 with the focus of simply getting moving again. I focused on the following:

• mobility exercises to reduce stiffness associated with 2-3 days of bed rest and time spent sedentary;
• full-body exercises, to stimulate circulation and the feel-good factor that comes with movement. For example, workouts included 1-2 upper-body push exercise, 1-2 upper-body pull exercise, and a couple of lower body-focused exercises. This also prevented elevated muscle soreness that can come with focusing on one particular muscle group following a period of de-conditioning;
• selecting a weight not based on what I was doing two weeks prior before contracting COVID, simply selecting a weight I could perform adequately with good control for 8 -12 repetitions. Having lost 2kg of body weight (likely lean muscle due to being sedentary and loss of appetite for 2 days), this weight was down on what I usually lift for this rep range. This is always disconcerting when you’ve worked hard to become stronger, but a necessary step when returning to exercise, especially after illness;
• avoided elevating my heart rate to any great extent, and listened to the cues my body was providing me, for instance if I felt more fatigued than usual, or had a sense of requiring longer rest between sets;
• not putting excess pressure on myself to get back to pre-COVID fitness levels anytime soon. Losing strength and conditioning is always a bummer, but it’s important to be kind to yourself and trust that with consistency fitness levels will steadily restore. In the weeks since I have recovered to feel like my old-self, allowing me to elevate my exercise intensity accordingly.

The above exercise-focus was supported with a focus on:

• drinking plenty of filtered water to maintain adequate hydration to support my body’s recovery and detoxification efforts;
• eating well and preparing nutritious meals. This was a challenge as I felt quite de-motivated to proactively go above and beyond to care for myself during week #2, however I recognised the importance of this to aid with recovery;
• rest and sleep. I regularly slept for 8-10 hours overnight in the two week period I was unwell, and saw this as a sign that my body required additional rest to recover and regenerate;
• getting 10 minutes of sun exposure each morning, to help top up important Vitamin D levels and restore a sense of lost vitality.

Outlook

As with any patient or circumstance, there will never be a one size fits all ‘best exercise’. Similarly, in terms of recovering from COVID I do not foresee a ‘best exercise protocol’; it will depend on the individual, disease severity, overriding fitness and health goals, and how quickly the individual wants to achieve these goals.

Some five weeks post-COVID, I am still recouping losses in conditioning, especially in terms of strength. I trust that with training consistency, the right resistance-training workouts for me and my body and ongoing self-care, I will get back to where I was prior to COVID. My focus will then shift to becoming stronger and hitting new milestones.

If you have been hit hard by COVID, have cautiousness around when to resume exercise post-COVID, and what the best strategy could be to safely recoup losses in aerobic and muscle fitness, I understand that tackling this alone could be daunting.

As Exercise Physiologists my team and I can guide and support you with this return to exercise to reduce the impacts of Post-COVID-19 Syndrome and get you back to your vital and lively self as soon as possible.

Luke