If you are worried about getting back into running after suffering from COVID-19, this is a quick guide to safe return.
Research publish this year has shown COVID-19 can affect our cardiology, renal, respiratory and haematological organ systems (1,2). Therefore, runners looking to get back into training should follow steady resumption of activity and have an awareness of the physical and psychological factors after COVID-19 infection. The following advice is based on the Public health Guidelines and current Research Findings available at the time this article is published. This advice is aimed at runners who have had mild to moderate illness. Those requiring hospital admission may merit further assessment and precaution.
What are the Health Professionals suggesting?
Dr. Hull, a sports pulmonologist at Royal Brompton Hospital in London, published a paper in The Lancet giving medical advice for athletes returning to training following an infection with coronavirus (4). Previously most medical professionals and coaches have used the general rule of “neck check” to decide when an athlete with a respiratory condition should return back to training. The “neck check” rule is if a runner’s symptoms are above or in the neck (such as a runny nose, dry cough, sinus pain and sore throat), they would be cleared to train. This rule isn’t effective to use now COVID-19 has surfaced as athletes with this virus may only have symptoms above the chest and continue to play. Around 7 days later they deteriorate, and their illness becomes more severe. Therefore, it is advised to return to running after a minimum of two weeks of resting at home after symptoms have improved.
It is important to realise you will feel very fatigued when you first start running again after COVID-19 as your body with be deconditioned following a number of weeks of inactivity, in addition to the immune system still in overdrive following the virus. It is expected to have a mild cough and increased shortness of breath during running compared to when you were fit. These symptoms should reduce each day, if they persist for another week or two, or if they get worse and you develop wheezing, it may be beneficial to get your chest examined by a GP.
Further advice has been published in the BMJ in the form of an infographic in June 2020 (3):
If an athlete develops an illness with symptoms of COVID-19, they should follow national guidance, undertake appropriate quarantine, and continue testing and tracing.
They should maintain good hydration, a balanced diet and, if symptoms worsen or persist beyond 7 days, seek further medical review.
Quarantine when living with others includes practical aspects such as isolating within rooms not accessed by other persons, maintaining supplies of food and water, use of a different toilet and washing dirty linen and clothes regularly.
The authors of this BMJ article suggest following an exercises protocol called “Graduated return to play (GRTP)” which introduces progression of exercise in a safe manor.
Graduated return to play (GRTP) protocol:
Before starting GRTP, you must be able to complete normal activities of daily living (such as walking up the stairs) and walk 500m on flat ground without excessive fatigue or breathlessness.
You have at least 10 days rest and be 7 days symptom-free before starting.
If you take part in less aerobically intense sports like fishing you may progress quicker.
It may take some people over 3 weeks to recover.
Some monitoring may add value, which could include:
Resting heart rated
Rated perceived exertion.
Sleep, stress, fatigue, and muscle soreness.
If you have any symptoms (including excessive fatigue) while going through your GRTP, you must return to the previous stage and progress again after a minimum of 24hours’ period of rest without symptoms.
Graphic taken from https://doi.org/10.1136/bjsports-2020-102637
Runners with health conditions or who were hospitalised due to COIVD-19
Athletes diagnosed with COVID-19 and who have medical conditions such as diabetes, cardiovascular disease, or renal disease, or who went to hospital following infection should discuss returning to sports with a medical professional. They may advice clinical cardiovascular evaluation before returning to sport.
National Guidelines for exercise during COVID-19 national restrictions
As always, try to stick to the government guidelines to prevent the virus from spreading when you are training, here is an infographic by England Athletics (August 2020) to illustrate these:
Stick to the Basic Principles of Training
Once you are clear from COVID-19 and its symptoms, and you have successfully got back into running, it is important to continue to stick to the basic principles of training:
Take your time when increase your training volume and intensity
Try to measure all parts of your training; mileage, speed, hills, ground you are running on, HR
Try to Measure your life stresses as this can affect your training such as sleep level, or stress at work
Begin to start your strength and conditioning training to prevent injury.
Start to set new goals and plan the rest of your season
Thanks for reading
James
Sport and Exercise Health Science BSc
Physiotherapy BSc
References:
1. Condliffe et al. (2020) British thoracic Society guidance on venous thromboembolic disease in patients with COVID-19 British thoracic Society pulmonary vascular specialist Advisory group
2. Perico L, Benigni A, Remuzzi G. (2020) Should COVID-19 concern nephrologists? why and to what extent? the emerging impasse of angiotensin blockade. Nephron 2020;144:213–21
3. Elliott, N., Martin, R., Heron, N., Elliott, J., Grimstead, D., Biswas, A., (2020). Infographic. Graduated return to play guidance following COVID-19 infection. Br J Sports Med 54, 1174–1175. https://doi.org/10.1136/bjsports-2020-102637
4. Hull, J.H., Loosemore, M. and Schwellnus, M., (2020). Respiratory health in athletes: facing the COVID-19 challenge. The Lancet Respiratory Medicine, 8(6), pp.557-558. https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930175-2
5. Phelan D, Kim JH, Chung EH. (2020) A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection. JAMA Cardiol. Published online May 13, 2020. https://jamanetwork.com/journals/jamacardiology/fullarticle/2766124