This is a rapidly developing situation. For the most up-to-date information, check resources like the Centers for Disease Control and Prevention (CDC) and local health guidelines regularly. This story will be updated as new information becomes available.
Even if you socially distanced from others on your runs, washed your hands frequently, and wore a mask in public, there’s still a chance for contracting COVID-19, especially if you are an essential worker or are in contact with many people every day. And there have been enough stories to show that runners and healthy individuals aren’t exempt.
If you were sick with COVID-19, but now that you’re starting to feel better, you might be wondering, When can I run after recovering from coronavirus?
Unfortunately, we still don’t understand every detail about the long-term effects of COVID-19 on the body, especially organs like the heart and lungs. That’s why a return to your normal workouts after recovering from coronavirus should be cautious and gradual.
We tapped Heather Milton, M.S., exercise physiologist supervisor at NYU Langone Health’s Sports Performance Center; Brian Clark, M.D., assistant professor of medicine at the Yale University School of Medicine, and Patrick Green, M.D., UCHealth general cardiologist with special interest in sports cardiology to help break down how to safely return to your runs after you’ve had COVID-19 or experienced symptoms of the virus.
This is a rapidly developing situation and illness and recovery vary on an individual basis. Contact your healthcare provider for specific information based on your own illness and treatment plan.
If you’ve been diagnosed with COVID-19, how long should your break from exercise be?
Right now guidelines are all over the place, which speaks to the fact that no one really knows the right answer. That being said, a person should definitely wait until complete recovery from their symptoms. Keep in mind, however, that this illness sometimes affects people in multiple phases—you start to feel fine, and then a second phase of symptoms comes on, Clark says. That’s why, to play it safe, you should wait 10 to 14 days after total resolution of symptoms before resuming any normal activity. And, as you start to run or work out again, it should be a slow resumption, says Milton.
During the time you are ill, this doesn’t mean you should take a total break from any type of movement. “By rest, we mean not participating in strenuous exercise, it’s important to keep walking, keep moving, and stay mobile,” Clark says.
One thing that has been frequent is people who are ill—without any other risk factors—is getting blood clots, and being immobile increases the risk for blood clots, Clark explains.
Before exercising again, what precautions should you take?
If you were diagnosed with COVID-19, especially if your illness required hospitalization, you should consult with a medical professional. Depending on the severity of your illness, it may also be beneficial to get an EKG (measures rhythm of the heart), blood tests, and possibly an echocardiogram (measures the structure and function of heart). But, it is unlikely that all people who tested COVID-19 positive will be able to get all those tests due to cost or accessibility, says Clark. For example, an echocardiogram can be costly, but provides considerably more information because it looks at the structure of the heart.
“The main reason to have the heart checked out is that we worry about the rare risk of heart attack or more concerningly, an arrhythmia (irregular heartbeat) that could lead to sudden cardiac death. This is going to be incredibly rare but possible,” Clark says.
However, there’s not really the same risk with regard to the lungs. There is not something that would show up on lung function testing that would help detect a risk for sudden death and, because of that, lung function testing can be reserved for people who are symptomatic, Clark explains.
Additionally, if you were on a ventilator, you should work with your doctor to get an EKG to make sure there are no major changes, says Milton.
If you were on a ventilator for a short period of time, such as a couple of days, you don’t necessarily need your lung function checked out, but if you were on a ventilator for a prolonged period of time, it’s likely you’ll have an impairment in lung function and could benefit from lung function testing, Clark explains. Clark suggests waiting at least three months after the acute illness to get lung function testing, however, because recovery is slow and this would allow more time for people to stabilize.
If you’re a casual runner and had a mild case, it’s probably okay to wait 10 to 14 days after resolution of symptoms and then resume exercise with caution. (It’s always a good idea to check with a doctor, especially if you have any concerns.)
Most people who are asymptomatic or had mild symptoms can resume exercise without consulting their physician, Green says. But if symptoms were severe or you were hospitalized, consult with your physician. The American College of Cardiology suggests those with pre-existing conditions consult with a doctor before any return to exercise.
If you’ve been diagnosed with COVID-19, how should you return to exercise safely?
Though there isn’t great evidence on return to sport protocol, starting up again at no more than 50 percent of your baseline pace and distance is likely the way to go, says Clark. You’ll want to monitor how you feel once you start out. You should expect exercise to feel harder and worse than you’re used to after a combination of being ill and an extended period of rest.
After starting at 50 percent of your base, as you feel up to it, you can gradually increase your exercise intensity and distance weekly. Both Clark and Milton suggest increasing intensity/mileage by about 10 percent each week until you are back to your normal training base.
What are some signs you should back off your exercise once starting again?
Exercise may not feel good right away due to deconditioning from time away from exercise as well as possible lingering effects of the virus. If you have more shortness of breath than you would expect, or chest discomfort to heart palpitations, consult with your physician, Green says.
So if your workouts are tolerable but challenging, and you can maintain the same effort over period of time until it feels easier, you’re likely feeling the effects of deconditioning.
But it’s easy to mistake deconditioning with still being sick, says Clark.
“Some clues to look for—chest pain, fainting or feeling like you’re going to faint, all mean mean stop instantly, do not pass go, and go right to your doctor,” Clark says.
Shortness of breath comes with feeling out of shape, and runs or workouts feeling harder also may just be due to being out of shape. If these feelings are mild and don’t cause a lot of distress, it’s okay to keep going to improve your conditioning. With consistent, slow and steady training, every week you should be feeling better. If you aren’t that’s when it’s time to check in with your doctor.
Should I be worried about myocarditis?
The concern for myocarditis—inflammation of the middle layer of the heart wall—is that this can cause long-term scar in the heart muscle, which can be a source for potentially fatal heart rhythm problems down the road, Green says. The condition can lead to heart failure, abnormal heartbeat, or even sudden death.
There does appear to be a higher incidence of myocarditis seen with COVID-19 than we see with other respiratory viruses. That incidence isn’t fully known. It is thought myocarditis is more common in more severe cases (those typically requiring hospitalization) and less likely to occur in asymptomatic or mildly symptomatic cases, says Green.
However, a recent study published in JAMA Cardiology using MRI to assess for myocarditis found a high incidence of myocarditis in both hospitalized cases and cases that did not need hospitalization.
If you weren’t diagnosed with COVID-19, but were ill and exhibited symptoms, what should you do when it comes to time off?
Even if you weren’t diagnosed and had mild symptoms similar to those of COVID-19, it’s still a good idea to take two weeks off after your symptoms resolve, then return slowly to exercise, Milton says. Whether you had a confirmed diagnosis or symptoms, you should start up gradually, again no more than 50 percent of your baseline pace and distance.
One thing for runners to note, according to Joshua Zeichner, M.D., Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in New York City, is that one of the skin manifestations of COVID-19 is a phenomenon known as COVID toes. Patients develop bruise-like spots on the toes thought to be caused by inflammation or impaired circulation of the blood vessels. Runners, especially those who sometimes experience bruised toenails should check in with their doctors if they notice any concerning bruising or rashes on their feet.
Zeichner says he is cautious in giving patients with COVID toes the all-clear to run, given the potential trauma to the feet in the setting of compromised blood flow. (Additionally, other doctors have found that COVID and exercise can be a bad combination.) Experts recommend working with your doctor or a sports cardiologist before participating in any strenuous exercise.
If you aren’t exhibiting symptoms but were exposed to someone who tested positive, you should self-isolate and get a test if possible.