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  • When Should I Begin Exercise and Racing after COVID?

    With the recent spike in COVID infections, I’ve had several people reach out and ask my opinion on when it is safe to return to exercise after having a COVID infection. I will include some guidelines in the blog, but first I need to include two disclaimers:

    1. I am not a doctor or medical professional, and you need to seek the advice of your personal medical team.
    2. The guidelines presented in the blog are gathered from helping my personally coached athletes, friends, medical professional opinions (from those I know), online research, my family and me (I recently recovered from COVID-19.)

    That written, let’s get on with exercising and racing post-COVID infection. One of the most frustrating aspects of COVID for endurance athletes is there seems to be no rhyme or reason to the severity of illness. There probably are some underlying factors that can predict how sick someone might get when getting this virus and how fast they might recover – but – we do not know those factors now. For example, given two people with the same exercise regimen and vaccination status, one might get very ill and the other has quite mild symptoms. Athletes can feel frustrated and resentful when they get very sick – why me? We don’t know why you. There is a lot we don’t know about this virus.

    While there are many questions unanswered about this COVID-19 virus, for many years endurance athletes have gotten viruses and then returned to endurance exercise. Also in the past, endurance athletes have returned to exercise post-virus only to fall ill to health issues such as Chronic Fatigue Syndrome, myocarditis, pericarditis or bacterial infections.

    Early in 2020, when we knew very, very little about this virus, one of my athletes fell ill. Exceptionally ill. At the time, medical professionals did not diagnose him with COVID-19, because his symptoms were mostly gastro-intestinal versus the typical COVID coughing and sore throat. In short, he was hospitalized twice and battled Bell’s palsy before finally returning to the ability to do workouts.

    The same principles I used to help him regain his fitness in 2020, are the principles I’ve used with every athlete diagnosed with COVID-19 that has sought my help since then. The foundation for these principles came from a column I wrote in 2008 about athletes suffering from Chronic Fatigue Syndrome. (Part I link here and Part II link here.) The fatigue description in those columns will sound familiar to those suffering from long COVID.

    Let’s look at guidelines and measures for when it is safe to return to training and racing post-COVID illness.

    Before returning to formal, structured exercise, it is important to do everything in your power to give your body the best possible tools to go to battle against the virus. This virus or any other virus.

    Some of the most important tools include rest and good nutrition. What does “good nutrition” mean? Eat foods that are very nutrient-dense. These foods are lean meats, vegetables, whole grains and fruits.

    Avoid foods, food ingredients and drinks that are associated with creating inflammation in the body. At the top of this list is sugar, highly refined foods and alcohol.

     

    How long before my body clears the virus?

    The CDC guidelines for mildly ill people states:

    • Isolation can be discontinued at least 5 days after symptom onset (day 1 through day 5 after symptom onset, with day 0 being the first day of symptoms), and after resolution of fever for at least 24 hours (without the use of fever-reducing medications) and with improvement of other symptoms.
    • Available data suggest that patients with mild-to-moderate COVID-19 remain infectious no longer than 10 days after symptom onset. 

    There was a good column in National Geographic Science that noted “Most COVID-19 patients recover from their acute infection within two weeks, but bits of the virus don’t always disappear from patients’ bodies immediately.”

    How do you know when the virus is gone or when it might be safe to do easy exercise?

    Track and monitor your illness and wellness markers

    The more data you have about your normal health markers, the more confidently you can return to exercise. Below is a partial list of markers, or symptoms, that indicate your body is not well. You may have only one on this list or you may have many:

    • Cough
    • Fever
    • Chills
    • Sore throat
    • Congestion or a runny nose
    • Shortness of breath
    • Headache
    • Body or muscle aches
    • Nausea
    • Vomiting
    • Diarrhea
    • Fatigue

    Some illness indicators can be objectively measured by fitness tracker watches or using other tools:

    • Low blood oxygen concentration (known as SPO2 and can be measured with a pulse oximeter available at most drugstores)
    • High resting heart rate
    • Increased respiratory rate
    • High exercise heart rate relative to rating of perceived exertion or pace
    • Heart rate won’t drop during exercise recovery intervals
    • Heart rate remains high after an exercise session

    It is critically important that you are brutally honest with yourself regarding how you feel. Verify your feelings with data. If you think you “feel fine” but your heart rate tells you otherwise, stop your exercise session – or don’t begin it in the first place.

    Returning to exercise

    The more illness symptoms you had and the longer your symptoms lasted, the more time you need to take off entirely. This high level of symptom volume and intensity is directly correlated with the volume of time you will need to exercise at a reduced volume and intensity.

    Depending on your symptoms, at minimum take two to 14 days off normal aerobic activity and allow your body to rest. This may seem like a wide range, but the range must be personalized. A person that has a mild sore throat for one or two days and no other symptoms can begin easy exercise earlier than someone who suffered eight of the symptoms in the top category for a week or more. Illness intensity and duration matters.

    If you are still isolating per the CDC guidelines, of course you should be exercising by yourself. This is a benefit because you can end the session based on your personal indicators rather than other people. When you think you are ready to resume exercise, the first few sessions become small tests. Depending on your pre-COVID fitness, begin with 30 to 60 minutes of Zone 1 exercise. (Exercise intensity Zones explained in a chart on this document link.)

    If your heart rate is high compared to pace or the session just feels too hard, you’re not ready yet. End the session or test, turn around and go home. Better yet, do this session on an indoor treadmill or trainer at your home so you can stop at a moment’s notice.

    Once you can complete a few sessions of exercise at Zone 1 heart rate, you can begin to progress. The progression guidelines follow:

    1. In the beginning, exercise sessions are at some 25- to 50-percent of your pre-COVID duration. For example, if you were typically riding your bike for two hours on Saturdays before getting sick, your post-COVID Saturday exercise session begins at 30 to 60 minutes.
    2. All workouts, for a minimum of three weeks after illness symptoms have subsided, need to be at aerobic intensity. (Zone 1 to 2 intensity.) The longer you suffered illness, the longer you need to stay at aerobic intensity zones and lower the duration of workouts.
      1. Some people may experience coughing for more than two weeks post-COVID diagnosis. If easy exercise makes your cough worse and makes you tired, you need to reduce intensity back to Zone 1 or walk or return to total rest. Additionally, if the cough is showing no improvement and perhaps getting worse, consider visiting your doctor to see if you have a secondary bacterial infection such as pneumonia, bronchitis or sinusitis.
    3. After three weeks, if all initial workouts have gone well, you can begin adding back some intensity. If you have successfully achieved a minimum of three weeks of aerobic exercise, you can begin to do some I have used Miracle Intervals to build high-end fitness for years and these little intervals can help rebuild fitness when wanting to be cautious with workouts that lead to fatigue. The short 10- to 30-second intervals followed by long recoveries (4 minutes and 10 to 30 seconds) pack a punch without being highly stressful to the metabolic system. Depending on how your body responds to your return to exercise, you can also begin adding small amounts of Zone 3 intensity to one workout per week.

    No racing for a minimum of eight weeks after a COVID-19 infection and you may be finished for the season

    In my coaching business, I have found that adding more intensity to exercise sessions is riskier than adding more duration. For this reason, I am very, very cautious about recommending a return to racing. I cannot say that I personally know anyone that has returned to racing within eight weeks of having a COVID-19 diagnosis. My preference is athletes do not return to racing for at least 12 weeks post-COVID.

    Given what we don’t know about the virus, the number or people suffering long COVID symptoms, and secondary issues like heart and lung infections, is it worth it to you to roll the dice by racing? In my opinion, no.

    I know there is a tremendous feeling of loss to give up a race that has consumed your training time, and mind, for months. Maybe a year or more. In addition to the loss of all that invested training time, there is an entry fee loss. Allow yourself to grieve these losses, so that you can move forward with rebuilding your health. With optimal health, you will have many more opportunities to race.

     

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