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How to Resume Exercise After Having Covid

This article is from the Wall Street Journal, and is largely based on work by Dr. David Salman, a general practitioner and clinical research fellow in musculoskeletal and sports medicine at Imperial College London. It was shared courtesy of Alex Krisak, Baystate Financial.

Getting back to your exercise routine after having Covid is often difficult and frustrating. But scientists are starting to develop some guidelines.

The best approach, they say, is gentle and gradual—and guided by your doctor. Some people have post-Covid complications that can make exercise higher-risk. And many Covid patients continue to experience symptoms for weeks or even months after their initial diagnosis, making even gentle activity arduous.

“People can feel well and still have a relapse that could be triggered by exertion,” says Dr. Salman. But physical activity is, of course, essential for your overall health, so it’s worthwhile to work on finding the right balance.

Dr. Salman co-authored a paper published in the British Medical Journal in January to help doctors advise patients about resuming physical activity after Covid. It recommends not returning to exercise until you’ve had at least seven days without symptoms and starting with at least two weeks of minimal exertion. “This is not a period of time to be pushing for a personal best,” says Dr. Salman. “You are recovering from an illness that we don’t understand fully.” Take into account your past level of activity: If you were accustomed to walking for exercise, don’t start training for a marathon.

One approach is a four-part phased plan based on a scaled “rate of perceived exertion” or RPE, Dr. Salman says. This is a subjective assessment of how hard someone feels they are working, from a low of 6 (no exertion at all) to a high of 20 (maximum fatigue). Each phase can last at least seven days, and can be adjusted to accommodate different levels of skill. You can stay on a phase for as long as necessary.

The first phase should be focused on extremely low-intensity activity, such as flexibility or breathing exercises, with an RPE of 6 to 8. The next phase can incorporate light-intensity activity such as walking and light yoga, increasing the amount of time 10 to 15 minutes a day, maintaining the RPE if you’re able to.

After these two phases, it may be OK to progress to more challenging movement. One example might be two five-minute blocks of activity such as brisk walking, jogging, swimming or cycling, separated by a block of recovery. You shouldn’t feel that the exercise is hard; the suggested RPE is 12 to 14 or moderate intensity, when you can still hold a conversation. Progress by adding an interval a day, if you can tolerate it.

The fourth phase involves more complex movement, still with moderate intensity, such as running, side steps, shuffles and circuits of body-weight exercises. After completing this phase, and with a doctor’s OK, people should then feel able to return to their pre-Covid level of activity, or more.

Such a gradual approach can be frustrating, especially for people who had previously been very active. But physical therapists say it can be a time to try new things, even if they are gentler than what you’re used to. “It doesn’t have to be a sweating on the floor, soul-crushing workout for it to ‘count,’ ” says Meghan Wieser, a coach and physical therapist in Ellicott City, Md.

If you normally don’t like stretching, this may be a good time to try holding poses to increase mobility. Or if you’re used to lifting a barbell, take the weight off and focus on perfecting form. Dr. Wieser also advises clients in recovery to think about “movement snacks”—a walk between TV shows or a few sit-ups before the kids get out of bed. “You don’t have to set aside a full hour to get a workout,” she says. “Moving throughout the day is a good way to ease back into something in bite sizes and in a way your body can tolerate.”

Write to Anne Marie Chaker at

Dow Jones & Company, Inc.

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