The number of people recovering from COVID-19 infection is increasing, along with people's passion for exercising. Can we resume exercise immediately after recovery? How to increase exercise step by step? Zeng Chun, Deputy Director of the Sports Medicine Department of the Third Affiliated Hospital of Southern Medical University, has given his answers.

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People with obvious symptoms should avoid exercise

Q: Why can't we exercise right after recovery?

A: Moderate exercise can enhance our respiratory muscles, strengthen lung function, and improve immunity. However, excessive exercise will make a bad impact on our immunity.

We should have enough rest after the COVID-19 infection. It is recommended to gradually exercise after all the symptoms are eased.

Researchers in Australia published a study about how to return to exercise post-COVID-19 infection, which said that where individuals have significant symptoms, they should rest and avoid exercise. Returning to exercise after COVID-19 infection should happen in a graduated fashion where individuals with no symptoms or minimal symptoms aim to return to their pre-infection exercise habits in approximately 7-14 days.

Q: What are the possible injuries caused by exercising immediately after recovery from COVID-19 infection?

A: The novel coronavirus can cause infectious complications other than to the respiratory system, and viral myocarditis is one of them. But for now, concerns about developing myocarditis after infection in young, healthy people have diminished, as "large registries have proved reassuring with very low rates of clinically meaningful cardiac complications among athlete populations."

However, the above-mentioned researchers emphasized that any cardiac symptoms such as pressure, tightness, squeezing pain in the chest, arms, neck jaw, or back, cold sweat, difficulty breathing, collapse, or sudden dizziness, whether occurring during exercise or at rest, should be treated as a medical emergency.

Gradually increase the amount of exercise on a three-day basi

Q: How can common people resume exercise after being infected with COVID-19?

A: In general, people should resume exercise gradually and step by step after recovery from COVID-19 infection, rather than increasing the amount of exercise at once.

It is advised by those researchers that as a starting point, individuals should attempt 15 to 30 min of exercise at about 50 % of the intensity that they were used to, before infection. If this is well-tolerated, the same should be repeated for the subsequent two days (Days 2 & 3). All goes well, exercise intensity can then be increased to about 75 % of the intensity that the individual was used to, before infection, from Day 4. The duration can also be increased to 30 or more minutes. If well-tolerated, this again should be repeated on the two subsequent days (Days 5 & 6). If there has been absolutely no adverse response to attempted exercise, the individual could consider resumption of normal pre-COVID-19 exercise habits from Day 7.

In my view, most people will still be a little bit lacking in strength between Days 7-14, and it is recommended to slow down a little and aim to fully return to normal after 1 month.

Q: After a thorough recovery, what kind of exercise is appropriate?

A: For common people, it is recommended to conduct 150 minutes of medium intensity exercises in a week, which can be divided into 5 times, 30 minutes each time; high-intensity exercise can also be scheduled for 3 sessions of 25 minutes every time.

Q: How are medium and high intensity exercises defined?

A: Medium intensity exercise can be understood as brisk walking or jogging of more than 6 kilometers per hour, which will make people sweat slightly, but does not affect normal speech. 

More accurate intensity control can be done with the help of heart rate (beats per minute), the maximum heart rate of the common people is 220 minus age, and the exercise that controls the heart rate at 60% to 70% of the maximum heart rate is moderate intensity exercise.

High intensity exercise refers to sports that cause people to sweat a lot and puff, including running, playing basketball, and playing football.

Better exercise after cardiopulmonary function evaluation

Q: Who should pay particular attention to controlling exercise intensity?

A: For people with underlying medical conditions or severe symptoms during infection, it is better to evaluate cardiopulmonary function before starting exercise. Some patients with cardiovascular and cerebrovascular malformations should also pay attention to the risks, especially in autumn and winter.

Q: Should people with chronic diseases such as hypertension or diabetes exercise after recovery?

A: Chronic diseases such as high blood pressure and diabetes should be treated through exercise prescription, and moderate exercise can reduce medication and help control the disease.

The amount of exercise can be relatively small at first, and mainly depends on the body response. After exercise, if you feel comfortable and it is effective , you can appropriately increase the amount of exercise.

Q: Under what conditions should we stop exercise?

A: People should stop the exercise when feeling uncomfortable, such as palpitations, fatigue, and listlessness after training, which cannot be relieved after rest. Simply put, it is the feeling of exhaustion. Some people may experience gastrointestinal symptoms like diarrhea and vomiting. 

When these symptoms occur, people should stop exercise and take rest for 1 to 2 days. Restart the exercise or go back to the previous exercise stage when all the symptoms disappear.