Journal Article

Returning to physical activity after covid-19

Salman, David, Korgaonkar, Jonathan, Majeed, Azeem, McGregor, Alison H, Le Feuvre, Peter, Beaney, Thomas, Vishnubala, Dane

2021

Overview

Patients with ongoing symptoms or who had severe covid-19 or a history suggestive of cardiac involvement need further clinical assessment Only return to exercise after at least seven days free of symptoms, and begin with at least two weeks of minimal exertion Use daily self monitoring to track progress, including when to seek further help Our professional experience suggests that, after mild suspected covid-19, a proportion of people experience a prolonged recovery, particularly when trying to return to exercise. [...]there is increasing recognition of potential long term complications of covid-19, including enduring illness (“post-acute” or “long” covid), cardiopulmonary disease, and psychological sequelae in some people.1234 This article offers a pragmatic approach to help patients safely return to physical activity after symptomatic SARS-CoV-2 infection, focusing on those who have lost fitness or had a prolonged period of inactivity but who do not have an enduring post-acute covid-19 illness. The health benefits of being physically active, from cardiovascular to mental health, are well established.56 Conversely, the harms of physical inactivity mean it is a major risk factor for non-communicable disease worldwide, alongside others such as cigarette smoking or obesity.7 Before the covid-19 pandemic, over a third of people in the UK were not physically active enough for good health.8 There is evidence of a further decline in physical activity since the start of the pandemic for people with chronic conditions such as obesity and hypertension9; conditions associated with worse outcomes from covid-19.10 Brief advice in primary care can help people to take up physical activity, with the associated lifelong positive health impacts, and help those recovering from illness to return to previous levels of physical activity or beyond.11 People may feel unsure of how and when to return to physical activity after covid-19, and whether it is safe. A consensus statement from sports clinicians of the European Federation of Sports Medicine Associations from July 2020 recommends a review with a sports and exercise medicine physician after mild symptomatic infection, and investigations including echocardiography and lung function testing where cardiopulmonary symptoms were present.24 Guidance from the Netherlands Society of Cardiology states that, for those with systemic features including fever, electrocardiography testing should be considered before resumption of activity.25 However, the incidence of myocardial injury (box 1) or thromboembolic complications after mild or moderate covid-19 in the community is currently unknown but thought to be low. [...]a balance is needed between obstructing an already inactive population from undertaking physical activity at recommended levels beneficial for their health, and the potential risk of cardiac or other consequences for a small minority. In the natural course of covid-19, deterioration signifying severe infection often occurs at around a week from symptom onset. [...]consensus agreement is that a return to exercise or sporting activity should only occur after an asymptomatic period of at least seven days,21242627 and it would be pragmatic to apply this to any strenuous physical activity (fig 1).

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD
• Subject: Asymptomatic / Cigarette smoking / Complications / Coronaviruses / COVID-19 / Echocardiography / EKG / Electrocardiography / Exercise / Fever / Heart / Illnesses / Infections / Long COVID / Medicine / Obesity / Pandemics / Physical activity / Physical fitness / Physical training / Practice / Primary care / Rehabilitation / Respiratory function / Risk factors / Severe acute respiratory syndrome coronavirus 2 / Thromboembolism