Should You Exercise With COVID-19?

Many people adhere to the belief of “sweating out” a cold or virus. They insist they feel better afterward. Whether it’s a placebo effect, endorphins setting in, or if working out truly helps shorten the duration of a cold is unclear.

But COVID-19 is a different beast from an upper respiratory virus. COVID-19 is still novel and, while we have seen that it can cause illness ranging from the common cold to more severe and long-lasting symptoms, its effect on the body is still being evaluated. As we continue to research and understand these effects, we know that like any virus, if you catch COVID-19, the only exercise you may be interested in is moving from the bed to the couch and back again. 

On the other hand, if you luck out and have only mild symptoms of COVID—something similar to what you’d experience with the everyday cold—you probably will want to keep up with your fitness routine. The question is: Should you? Is it safe to exercise if you have COVID-19? 

Exercise and Illnesses: How They’re Connected

The studies examining if working out can shorten the duration of an illness or reduce the severity of symptoms are inconclusive. Many find no changes, and those that do find improvement are too small and inconsistent to make definitive conclusions.

Additionally, cardiologists worry when people work out while they have a significant infection, says Dermot M. Phelan, MD, PhD, director of cardiology with Atrium Health Sanger Heart and Vascular Institute in Charlotte, North Carolina. “During flu illnesses, we see an increase in heart attacks. The elevation in inflammation that occurs during an illness is compounded by the further elevation in inflammation caused by intense exercise,” he explains.

What is clear, however, is that being moderately active on a regular basis—not necessarily while you’re sick—is beneficial for our immune defenses, Phelan says. People who consistently sweat have reduced markers of low-grade inflammation, more robust immune responses to vaccines, and reduced risk of illness.

Exercise and COVID-19: What Studies Show

Anyone who’s watched the news and heard the number of people who are in the ICU and who have died from this pandemic understands that COVID-19 can certainly be a “significant infection”. Yet in April of 2020, headlines told us that exercise may protect against a deadly complication from the virus. However, that study is not talking about exercise during acute illness, Phelan says. And it certainly didn’t indicate that you can “sweat out” COVID. (In fact, the study didn’t even look at people who had the virus.) Rather, the findings support previous evidence of long-term benefits of regular exercise on the immune system, Phelan explains. 

Then the info seemed to boomerang: A study published in JAMA Cardiology in July looked at 100 adults who’d recovered from COVID. About three-fourths had structural changes to their hearts and three in five had myocarditis, a condition where the heart muscle becomes inflamed. “When this happens, it can lead to inflammation and scar in the heart muscle. Either could set up the heart to have extra beats and lead to new symptoms such as palpitations,” explains Eugene H. Chung, MD, MSc, an electrophysiologist, director of the Sports Cardiology Clinic at the University of Michigan, and chair of the American College of Cardiology‏ Sports and Exercise Cardiology Leadership Council. 

Severe cases of myocarditis can lead to heart failure, while mild or moderate cases are believed to increase the risk of dangerous arrhythmias that could lead to collapse or even sudden death—and exercise might worsen that situation.

It’s alarming to think you could be working out and have no idea your heart might give out because myocarditis doesn’t always cause symptoms. But, Chung adds, this study also has limitations, including the fact that many of the participants had other conditions that could cause changes to show up on a cardiac MRI. 

Can You Exercise With COVID-19?

No wonder it’s so hard to figure out what the average exerciser should do. To clear things up, at this time, cardiologists recommend the following guidelines to determine if it’s OK for you to work out with COVID-19: 

If you are asymptomatic or have mild symptoms (mild fatigue, nasal congestion, loss of smell or taste, GI symptoms, sore throat, cough but no congestion): Do not exercise for at least 10 days from testing positive or first experiencing symptoms. “The reason is, we often only see the systemic manifestations of COVID-19 in the second week of infection. So you may initially be asymptomatic but become symptomatic later, and exercise during this time can make things worse,” Phelan explains. This also aligns with quarantine guidelines of staying isolated from others. 

If you have mild to moderate symptoms (fever, body aches, chills, severe fatigue, chest pain, or tightness): Do not exercise while sick and continue to rest for 10 days after symptoms resolve, Phelan says. “These symptoms are systemic and require rest,” Chung says. You also should never exercise until fever resolves.

If you have severe symptoms (in the hospital): If doctors diagnose myocarditis, limit exercise for at least three months to allow your heart time to recover and work with your cardiologist, Chung recommends. If there’s no myocarditis, do not exercise for 10 days to ensure no more recurrence of symptoms. Then consult your healthcare provider to determine if it’s OK to return to activity, Chung says.

No matter how nonexistent or severe your COVID-19 symptoms were, when you go back to exercise, don’t go straight for the hardest class or hilliest run. Ease back into things. “If you were normally active at a high level, even if you feel great, grade your return to exercise,” Chung says. He suggests going at about 25 percent of your normal exertion level for the first two days, then 50 percent for another day or two. After that, see how you feel and continue to progress. It’s especially important to slowly ramp up your exercise over the course of five to seven days if you had any significant symptoms like a prolonged fever or myalgias (a.k.a. muscle pain), Phelan says. 

As you begin to work out again, listen to your body. If you notice any chest tightness or pain, shortness of breath that’s greater than expected, abnormal heartbeat or palpitations, or fainting or near fainting, stop! It may be a sign that you’re not over the infection yet, says Chung, adding that some COVID-19 patients have arrhythmias. “Their heart rate responds too fast to just a little activity or their resting heart rate is faster than usual,” he explains.

After resting, if you feel better, ease back into your workout. On the other hand, if your symptoms don’t resolve easily with rest, do not return to exercise for the day and call your doctor for an evaluation. 

Overall, if you follow this advice, the outlook is positive for returning to exercise after COVID-19. “Early in the disease, we had real concerns that we would see lots and lots of people developing long-term heart damage related to COVID-19,” Phelan says. “While we do see it and it’s very serious when it occurs, it’s much rarer than anticipated. The vast majority of people, especially those who are asymptomatic or have mild symptoms, should be able to return to an active lifestyle without concern.” 

Just don’t forget to stay socially distanced and wear a mask if you work out with others.