Resuming Physical Activity after COVID

You may feel fatigued for a few weeks or longer even after other symptoms resolve. As you resume physical activity, you may not be able to match your pre-illness activity levels. In the beginning, you may feel short of breath, get tired easily, or cough a little. It is advisable to start slow with low intensity activity and build up gradually.

Athletes should avoid resuming regular training for at least 10 days from symptom onset and 7 days after symptom resolution. Exercise plays an important role in recovery from COVID. It helps to:

  • Improve fitness levels

  • Improve energy

  • Increase muscle strength

  • Improve balance and coordination

  • Improve thinking

  • Reduce stress, elevate mood

  • Enhance confidence

  • Reduce breathlessness

Tips to exercise safely:

  • Always warm-up before exercising, and cool down after exercising

  • Wear loose, comfortable clothing and supportive shoes

  • Wait at least an hour after a meal before exercising

  • Drink plenty of water

  • Avoid exercising in very hot weather

  • Exercise indoor in very cold weather

Stop exercising and contact your doctor if you experience any of the following symptoms:

  • Nausea / feeling sick

  • Dizziness / light headedness

  • Severe shortness of breath 

  • Clamminess / sweating

  • Chest tightness

  • Increase in pain


Warm-up exercises- Warming-up prepares your body for exercise to prevent injury. Your warm-up should last around 5 minutes, and should leave you slightly breathless.

1. Shoulder shrugs

Slowly lift up your shoulders towards your ears and then lower them down.

2. Knee lifts 

Lift your knees up and down slowly, no higher than your hip, one at a time.

3. Side bend

Start with your body straight, arms by your sides. Slide down one arm slightly, then the other, bending sideways.  

4. Shoulder circles 

Keeping your arms relaxed by the side or resting on your lap, slowly move your shoulders round in a circle forward and then backward.

5.  Ankle taps 

Using one foot, tap your toe and then your heel on the ground in the front direction; repeat with the other foot.

6. Ankle circles 

Raise your leg and draw imaginary circles with your toes; repeat with the other foot.


Fitness Exercises- You should aim to do these exercises for 20-30 minutes, 5 days a week.

1. Marching on the spot

This exercise is beneficial when you cannot go outside for a walk or are unable to walk very far before feeling the need to take rest.

  • In the standing position, lift your legs up one at a time.

  • If needed, hold onto a stable chair or surface for support, and have a chair nearby to rest.

Progressing this exercise:

  • Increase the height you lift your legs to, aiming to reach hip height, if possible.


2.  Step-ups

This exercise is beneficial when you cannot go outside for a walk or are unable to walk very far before feeling the need to take rest.

  • Stand close to the bottom step of any staircase.

  • Step up and down, changing the leg you start with on every 10th step.

  • If needed, hold on to the handrail for support, and have a chair nearby to rest.

Progressing this exercise:

  • Increase the height of the step, or speed of stepping up and down.

  • If your balance is good enough to do this exercise without any support, you may carry weights as you step up and down.


3. Jogging or cycling

You may do this exercise if walking is not making you breathless, if it is medically safe for you, and if you could jog / cycle before getting infected with COVID.



4.  Walking
You may do this exercise if you are comfortable getting outdoor

  • Use a walking frame, crutches, or stick for support, if needed.

  • Choose a route that is relatively flat.

Progressing this exercise:

  • Increase the distance / speed, or if comfortable, include an uphill walk in your route.


Strengthening Exercises- Strengthening exercises will help strengthen muscles that weaken as a result of illness. You should aim to do 3 sessions of strengthening exercises each week. Try to complete up to 3 sets of 10 repetitions of each exercise, resting briefly in between sets. Do not worry if you find these exercises hard. As you advance, you should scale up to 10 sets of these exercises. This workout will not make you feel breathless in the same way as fitness exercises; it will instead feel  as if your muscles did some hard work. 


1. Bicep curl

You can do this exercise sitting or standing.

  • With your arms by your side, palms facing forward, hold a weight in each hand

  • Keeping the top part of your arms stationary, gently lift the lower part of both arms (bending at the elbows), raising the weights up

Progressing this exercise:

  • Gradually increase the weight you use while doing this exercise

2. Wall push off

  • Place your hands flat against a wall at shoulder height, with fingers pointing upwards, and your feet about a foot away from the wall

  • Keeping your body straight, slowly lean towards the wall by bending your elbows. Gently push away from the wall, until your arms are straight

Progressing this exercise:

  • Stand further away from the wall

3. Arm raises to the side

You can do this exercise sitting or standing.

  • Hold a weight in each hand, with your arms by your sides, and your palms facing inwards

  • Raise both arms sideward, up to your shoulder level (but not higher), and slowly lower down

Progressing this exercise:

  • Increase the height that you lift your arms to, but no higher than your shoulder level

  • Increase the weight you use while doing this exercise

4. Sit to stand

  • Sit on a chair with your feet hip-width apart. With your arms by your side or crossed over your chest, slowly stand up. Hold the position to the count of 3, and slowly sit back onto the chair. Keep your feet firm on the floor throughout

  • If you are unable to stand up from the chair without using your arms, try a higher chair. If it is still hard, you may push with your arms

Progressing this exercise:

  • Make the movement as slow as possible

  • Perform the exercise using a lower chair

  • Hold a weight close to your chest while doing this exercise


5. Squats

  • Stand with your back against a wall or any other stable surface with your feet slightly apart. Move your feet about a foot away from the wall. Alternatively rest your hands on the back of a stable chair

  • Keeping your back against the wall, or holding on to the chair, slowly bend your knees; your back will slide down the wall. Keep your hips higher than your knees

  • Pause for a moment before slowly straightening your knees again

Progressing this exercise:

  • Bend your knees further (remember to keep your hips higher than your knees)

  • Increase the time you pause to a count of 3 before straightening your knees back

6. Heel Raises

  • Rest your hands on a stable surface to support your balance without pushing too hard

  • Slowly rise up on your toes, and slowly lower down back 

Progressing this exercise:

  • Hold the raised toe position to a count of 3

  • Stand on one leg at a time


Cool down exercises- Cool down exercises allow your body to return to normal state before you finish your workout. A cool down session should last approximately 5 minutes, and your breathing should return to normal by its end.

1. Slow-pace walk - Walk at a slower pace or gently march on the spot, for approximately 2 minutes

2. Repeat warm-up exercises- Repeat the warm-up exercise sequence. These can be done in sitting or standing position

3. Muscle stretches- Stretching your muscles can reduce any soreness you may feel after the exercise. Below mentioned stretches should be performed gently, and you should hold each one for 15-20 seconds. You can do these stretches in sitting or standing position.

1. Quads (Front of thigh) Stretch

While standing, hold onto something stable for support. Bend one leg up behind you, and if you can reach it, use the hand on the same side to hold the ankle or the back of your leg. Push your foot towards your buttock until you feel a stretch along the front of your thigh. Keep your knees close together and your back straight as you do this. Return to the starting position and repeat on the opposite side.

2. Shoulder stretch

 

Grab one arm above your elbow with your opposite hand, and pull it across your body towards your chest until you feel a stretch in your shoulder.

Return to the starting position, and repeat on the opposite side.

3. Calf (lower leg) stretch

 

Stand with your feet apart and lean onto a wall or something sturdy for support. Keep your body upright and move one leg backward. With both toes pointing forward, bend your knee, keeping your back leg straight and your heel on the floor. You should feel a stretch in the back of your lower leg. Return to the starting position and repeat on the opposite side.

4. Side stretch

Raise your right arm and place it behind your head; lean over to the left slightly. You should feel a stretch along the right side of your body. Return to the starting position and repeat on the opposite side.

5. Hamstring (back of thigh) stretch

Sit on the edge of a chair with your back straight and feet flat on the floor. Move your leg out straight in front and let the heel rest on the ground. Place both your hands on the other thigh. Sitting as tall as you can, bend slightly forward at your hip until you feel a slight stretch behind the thigh of the leg that is stretched out. Return to the starting position, and repeat on the opposite side.


Breathlessness Scale- This scale helps you rate the difficulty in breathing you experience during exercise. It starts at 0 which means you are experiencing no difficulty at all, and progresses through to number 10 where your breathing difficulty is maximal. A scale of 3-4 indicates that your exercise is effective.