If you’re recovering from long COVID – when you get persistent symptoms after having COVID-19 – you may be wondering if you should be exercising. Will working out help or harm your recovery?
After all, tiredness (fatigue), breathlessness and muscle or joint pain are some of the most common long COVID symptoms – all of which can make it difficult to stay active.
So read on to learn how to rebuild your strength and stamina if you have long COVID, whether you’re struggling to get up the stairs or walk the kids to school, or you want to get back to the gym or that regular 5K run.
Should I exercise if I have long COVID?
Exercise can support your long COVID recovery by helping to build up your energy levels and strength in your muscles, heart and lungs. This is especially true if you’ve been ill for a long time – if you were in hospital, for example – and your muscles need strengthening again. It can improve your wellbeing, too, as you’ll feel like you’re getting your life back on track.
Keeping active can also have more general benefits, including helping you sleep better, lowering your blood pressure, improving your circulation and reducing feelings of stress or anxiety.
However, the big thing to remember is that you need to be realistic about what you can do, at least to start with. For example, going out for a long run when you’re breathless and have joint pain may well end up delaying your recovery.
Also bear in mind that you may need different recommendations from a doctor, depending on your long COVID symptoms. For example, if you have chest pain or a racing heart when you exercise, you may be advised not to exercise until these have been checked out.
How much exercise should I do?
Experts recommend a safe, ‘phased’ return to exercise, to help you avoid a condition called post-exertional malaise (PEM). This is when you feel exhausted after any physical or mental activity – either straight away or a few days later – and your long COVID symptoms can get worse (relapse).
There are 4 basic rules to keep in mind:
- start slowly
- set yourself realistic goals
- gradually introduce new activities
- rest when you need to
Experts advise splitting exercise into 5 phases as you recover, spending at least 1 week in each phase. Try following the 5 phases below.
- Your first activities could include simple breathing exercises, stretching and flexibility exercises around your house.
- Next, try a low-intensity walk (not too fast or too far) and some gentle yoga exercises.
- In phase 3, build up your walks outdoors, gradually increasing the distance and maybe adding some gentle hills. But be careful not to push yourself too hard, to avoid PEM.
- In phase 4, try introducing some moderate-intensity aerobic and strength exercise, such as cycling, swimming, racquet sports, Zumba or dance classes.
- In the final phase, you can return to your usual, pre-COVID-19 activity levels.
Remember, if you move on to a new phase and you find that you feel exhausted, go back to the previous phase. And if you’re still tired from the day before, you should rest – it’s important not to overdo it.
Use the Healthily app to track your progress, so you can see how much you’re improving.
Is women’s exercise tolerance affected by long COVID?
There’s growing evidence that women are more affected by long COVID than men (read more about women and long COVID). And exercise tolerance in women after COVID-19 is another area being researched.
So far, we don't know exactly why and how COVID-19 affects your ability to exercise. However, a small US study that compared women who’d had COVID-19 with women who hadn’t tested positive found some differences in their way heart rates responded to exercise. And the differences were greater in women who also had symptoms of long COVID.
The researchers suggest these findings could potentially have an impact on women’s ability to carry out daily activities – although bigger studies are needed to confirm this and find out more. But it could be another reason to make sure you pace your activity and exercise during your long COVID recovery.
Exercising safely with long COVID
Follow the Borg scale
The Borg scale can help you measure how easy or hard your breathing feels when you’re at rest and when you’re active, to help you exercise safely.
It ranges from 1 to 10, with 1 being really easy to breathe and 10 being maximum effort – such as how you’d be breathing after running really hard in a race. It’s recommended that you aim for the midway point, at 4 to 5 (‘sort of hard’ or ‘hard’), to safely challenge yourself during exercise.
Check your heart rate
Your heart rate is the number of times your heart beats per minute (bpm). You can monitor your heart rate using a smart watch or phone, or by taking your pulse. Read about how to measure your heart rate.
When you exercise with long COVID, it’s recommended that you keep your heart rate at less than 60% of what’s known as your ‘maximal’ heart rate. You can work out what this should be by subtracting your age from 220, then multiplying the answer by 0.6.
For example, if you’re 35 years old, you should keep your heart rate below 111 beats per minute (220 - 35 x 0.6 = 111).
Know when to see a doctor – or get urgent medical help
If you had COVID-19 more than 4 weeks ago and you’re worried about long COVID or you have new symptoms, see a doctor. It might be affecting your ability to exercise, but it’s also important to see a doctor if it’s affecting your quality of life.
Your doctor can get your symptoms checked to diagnose or rule out other health conditions and see if you have long COVID. They can also give you advice about how and when to start exercising again, and refer you to a specialist clinic or a physiotherapist for more advice if necessary.
Read more about how long COVID is diagnosed and treated.
There are also certain ‘red flags’ to watch out for when exercising. You should go to the emergency department if:
- you get new or severe chest pain
- you have severe breathlessness
- you feel faint
If you have new, persistent or frequent heart palpitations, you should also see a doctor. And you should get emergency medical help if:
- you feel your heart is beating very fast
- your palpitations are associated with breathlessness, dizziness, faintness or chest pain
- your palpitations come on when you exercise
Where to find out more about exercise and long COVID
- find more tips for coping with fatigue and muscle pain in our long COVID treatment and recovery plan
- check out UK charity Covid:aid for more information about long COVID and post-exertional malaise
- if you want to keep active indoors, try these exercises if you can’t leave your home from the Health and Safety Executive (HSE)
Your health questions answered
I’m an athlete – why can’t I run as fast any more?
“Previously fit people can also find it difficult to get back to their pre-COVID-19 standard of fitness. This can be frustrating if you’re used to regularly exercising at a high level, and it may be tempting to try to make up for lost time. But like anyone else, you may need to start slowly and gradually build up your distance and pace. One study that looked at injury rates in runners found those who’d tested positive for COVID-19 were about 1.6 times more likely to be injured. You may want to watch this video from the Institute of Sport Exercise & Health (ISEH), about its Long-COVID Syndrome Pathway to help athletes who’ve had COVID-19 get back to fitness.”