Science on Sunday: Exercise and Sports After COVID-19—Guidance from a Clinical Perspective

Putting together a plan to return to sport post-COVID can be a challenging experience, especially with the desire to avoid “long COVID“.

Referrence: Halle M; Reinsberger C; Scherr J et al. Transl Sports Med. 2021;4:310–318

BLUF (Bottom Line Up Front)

For every day of training lost due to the illness, you should take 2-3 days of easy, graded training to return to full training. For an athlete that loses 10 days of training to the virus, they should take 20-30 days to return to full training.

Return to training should be broken into three phases. The first third should focus on building frequency of training using low intensity and short duration training sessions. The second third will build back up the duration of training and the final third will return intensity back into the training sessions. For an athlete taking 20-30 days to return to previous training levels the first 7-10 days will be focusing on the frequency of training. Daily initially then twice a day towards the end of that block if the athlete was training twice per day prior to COVID. The next 7-10 days are focused on building in longer sessions (not every workout but every 2-3 days having a progressively longer session). Then the final 7-10 days the athlete can include higher intensities into their programme returning them to pre-COVID intensities.

Physiological Impact of COVID-19 SARS-CoV-2 / COVID-19

COVID-19 (also known as SARS-CoV-2) is predominantly a pulmonary disease (meaning it has an impact predominantly on the lungs). But it potentially a multi-organ disease impacting

  • Lung,
  • Heart,
  • Vasculature,
  • Brain,
  • Liver,
  • Kidney,
  • or Intestine;
  • Amongst other body tissues.

The clinical research this is based on was written when published in early 2021. Knowledge of COVID-19 has further grown from that point but these recommendations are still valid (other organisations have put out guidelines that are similar and not vastly different). Initial recommendations were based on extrapolations from other virus-induced pathologies.

Any return to exercise plan should be based on the impact of the disease on multiple organ systems and should consider:

  • Severity of disease
  • Age
  • Post-disease exercise performance

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