Exercise After Covid-19? Take It Slow
For the past 20 years, when patients asked me about exercising while recovering from a viral illness like the flu, I gave them the same advice: Listen to your body. If exercise usually makes you feel better, go for it.
Covid-19 has changed my advice.
Early in the pandemic, as the initial wave of patients with Covid-19 began to recover and clinically improve, my colleagues and I noticed that some of our patients were struggling to return to their previous activity levels. Some cited extreme fatigue and breathing difficulties, while others felt as if they just couldn’t get back to their normal fitness output. We also began to hear of a higher than normal incidence of cardiac arrhythmias from myocarditis, inflammation of the heart muscle that can weaken the heart and, in rare cases, cause sudden cardiac arrest. Other complications like blood clots were also cropping up.
What was most surprising is that we saw these problems in previously healthy and fit patients who had experienced only mild illness and never required hospitalization for Covid-19.
In my sports medicine practice, a cyclist in her 40s with recent Covid-19 symptoms had leg pain that was abnormal enough to warrant an ultrasound, which showed near complete cessation of blood flow because of arterial and venous blood clots in both legs. Thankfully, our team caught these early enough that they didn’t spread to her lungs, which ultimately could have killed her. Recently, a college student in Indiana with Covid-19 died from a blood clot that traveled to her lungs. As the pandemic has evolved, we’ve learned of a much higher risk of blood clots from people who contract the virus.
In those early months of the pandemic, my colleagues and I learned of a New York City mental health worker in her early 30s, a dedicated athlete with no underlying health problems who developed symptoms of Covid-19. Her low-grade fever and congestion went away, but she continued to feel “sluggish.” Like she had done many other times after getting over an illness, she went for a run to feel better. She died on the run of cardiac arrest; it appears she had undiagnosed myocarditis caused by Covid-19.
We now know the heart is a particular cause for concern after coronavirus infection. A study in JAMA Cardiology looked at 100 men and women in Germany, average age 49, who had recovered from Covid-19, and found signs of myocarditis in 78 percent. Most had been healthy, with no pre-existing medical conditions, before becoming infected. A smaller study of college athletes who had recovered from Covid-19 found that 15 percent had signs of heart inflammation. Experts continue to assess the data regarding heart risks to help clinicians better determine when athletes can return to play.