It is looking increasingly likely that the majority of Kiwis will experience a COVID infection at some stage. We are increasingly being asked about when it is safe for patients to return to their normal physical activities, including sport. Fortunately, the majority of us will have only very mild symptoms that may not impact our lives too much. As a result, the majority of patients can start to return to activity when they feel physically able. A small number of patients however do need further evaluation. Patients with a number of other comorbidities, those who have not exercised before and those who have experienced chest pain, significant shortness of breath or other more significant symptoms should see a doctor and may need other tests, for example blood tests or an ECG. This is to rule out complications like myocarditis (inflammation of the heart muscle) that may make exercising unsafe.

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Slow and steady

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Generally, COVID infection symptoms settle over 3-7 days within the infectious period. When a patient feels that their illness has resolved, most are safe to start returning to some physical activity. Given that the SARS-CoV-2 virus can  involve a number of systems, including the heart, kidney, blood, brain and wider nervous system, the resumption of activity should be slow and steady. The duration and intensity of activity should be guided by both physical and psychological factors. Increasing the volume and intensity of activity too quickly can prolong fatigue and other symptoms, making getting back to even the most basic activities of daily living difficult and frustratingly slow. It should be highlighted that prolonged rest can also be counterproductive. This can lead to significant morbidity including persisting fatigue, weakness and other symptoms.

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Fortunately, here in Aotearoa, we have the experience of clinicians managing return to activity, exercise and sport in other countries where COVID has been around for two years. Their experience, and those of their patients, has helped shaped best practice and safe management.

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Recovery can take 3 - 6 weeks. Pace yourself

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Returning to a normal level of activity or sport generally takes about 3 weeks but can often take much longer for those who have had a more severe illness, especially those who have been hospitalized. As a rule you should wait 7 days after being symptom free before starting to ‘exercise’ again. The important message is that returning to activity and exercise is important for recovery of physical and psychological wellbeing, but must be in a step wise fashion, ensuring you are able to recover well from each exercise bout without ongoing symptoms before progressing to the next level. Adequate sleep, good nutrition, hydration and social connection are also vital to help you recover well. Some practical tips are to:

1. Try to remain active while you are isolating at home (if your symptoms allow)
2. Start with small volume of low-intensity aerobic exercise, walking is an excellent option
3. Avoid returning to more intense exercise, for example heavy resistance training or running, for at least seven days after your symptoms resolve
4. Plan a graded return to activity, for example start by increasing your walking distance and intensity, progress to include some bouts of running within your walk, then increase the amount of running
5. You may feel more tired than normal, listen to your body and make sure that you get enough rest

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Help is available

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To learn more about how to be more active, including some return to play programmes, there are a number of good resources. The Moving Medicine website has a number of excellent resources that have been designed for both patients and clinicians. Included in these is an easy to follow set of COVID Recovery Tips detailing how to get back to the activities you enjoy. For those wishing to push themselves a bit more and get back to high performance endurance sports and activities, there is an excellent Infographic in the British Journal of Sports Medicine outlining “Graduated Return to Play after COVID-19 infection”.

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If you feel that you need help resuming activity after your COVID infection please feel free to get in touch. Our team of doctors, physiotherapists and exercise physiologists can help ensure that you get the best and safest advice on getting back to the activities you love.

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Be kind to yourself, don’t be afraid to ask for help and be patient with your recovery.

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