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  • Returning to exercise after having COVID-19 requires listening to your body and building up to it gradually.
  • People who have been diagnosed with myocarditis should abstain from exercise for 3 to 6 months, new guidance recommends.
  • You may also need to be cleared by a doctor before exercising.

For many people, returning to exercise after COVID-19 can be a challenge. They may find they no longer have the same level of endurance or strength that they had before their illness.

And for those who have lingering symptoms that occur with long COVID, regaining their previous level of fitness can sometimes take months or longer.

To help both professional and recreational athletes get back to their physical activities safely, the American College of Cardiology (ACC) released new guidance last week.

The guidance provides details on monitoring and treating athletes with myocarditis — heart inflammation — or other heart- or lung-related symptoms after COVID-19.

They also include a step-by-step plan on returning to exercise and athletic training after COVID-19.

There’s no one route back to fitness — it depends on how severe your illness was, what type of symptoms you had, and how long those symptoms persist.

The ACC guidance recommends that people who had heart- or lung-related symptoms during or after COVID-19 talk with a doctor before exercising again.

“For athletes recovering from COVID-19 with ongoing cardiopulmonary symptoms concerning for myocarditis or myocardial involvement… further evaluation should be performed before resuming exercise,” the ACC authors wrote.

Cardiopulmonary symptoms include chest pain or tightness, difficulty breathing, fluttering or irregular heartbeats, lightheadedness, and fainting.

In addition, people who were hospitalized for possible heart-related problems because of a coronavirus infection should be evaluated by a doctor before returning to exercise, they wrote.

People who have been diagnosed with myocarditis should abstain from exercise for 3 to 6 months, the ACC guidance recommends. You will also need to be cleared by a doctor before exercising.

The new ACC guidance suggests that it is safe for people with no symptoms to return to exercise 3 days after a positive COVID-19 test. This allows enough time to see if symptoms develop.

For those with mild symptoms that don’t involve the heart or lungs, the guidance says it is generally safe to return to exercise once symptoms resolve. This doesn’t apply to loss of sense of smell or taste, which can take weeks to resolve.

Taking time to rest while fighting an active infection will help focus your body’s energy in the right direction.

“If you return to exercise too soon, you are not allowing your body the strength to fight the virus,” said Jennifer Scherer, president and medical exercise specialist at Fredericksburg Fitness Studio in Virginia.

“Put all of your energy into self-care, gentle stretching, plenty of water, and a balanced diet complete with fruits, vegetables, lean proteins, whole grains, and dairy,” she added.

If heart- or lung-related symptoms occurred during mild COVID-19, the ACC guidance recommends against intense exercise until the symptoms resolve and cardiac testing is done.

If you had a heart condition prior to developing COVID-19, check with your doctor before resuming exercise. In addition, seek medical help for any concerning symptoms.

In all cases, people who had a positive COVID-19 test or a suspected coronavirus infection should avoid exercising around others until their isolation period is over.

While it can be tempting to pick up your exercise program where you left off before COVID-19, the ACC guidance recommends a “graded return-to-exercise program.”

“Don’t be surprised if you feel that you have lost some of your cardiovascular endurance or strength gains once you return to your exercise program after having COVID-19,” said Scherer. “This is normal.”

Athletes participating in competitive sports can get support in developing a return-to-exercise program from athletic trainers and sports physicians.

For others, a personal trainer can help you design an exercise program that gradually increases in effort. If that’s not possible, you can also safely guide yourself back to exercise.

“Listen to your body, ease back into walking and gentle mobility training,” said Scherer. “As you feel your body getting stronger, you can add in weight training and higher-intensity cardiovascular exercise.”

If you want a more structured approach, follow the 50/30/20/10 rule, which was developed by fitness professionals as a safe way to return to training after any prolonged period of inactivity.

You start out by reducing the duration or intensity of your workouts to a maximum of 50 percent of what you were doing before your break.

So if you were running 30 miles a week, you would start back at 15 miles a week. Then gradually increase it to 21 miles a week, 24 miles a week, 27 miles a week, and then back to your pre-COVID level.

Similarly, an hour-long spin class would be cut back to half an hour at first, and then build from there.

For strength training, you can reduce the frequency (session a week), intensity (sets and reps), and time rest intervals (the exercise-to-rest ratio) of your workouts. Then build up from there.

You might find that you can increase the duration or intensity of your workouts each week, but you might need to stay at each level for several weeks before moving on.

If even 50 percent of your previous level is challenging, start lower and take more time to build up gradually.

Again, listen to your body.

“Progress gradually and be patient as you build your cardio and strength back up,” said Scherer.