Even a mild bout of COVID-19 can have a big impact on physical fitness, and long COVID complicates things even more. Here’s how I found my groove again.

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For so many people, January is typically a month of cutting back on sugar and alcohol after the holidays and reimagining fitness endeavors for the new year.

This year I was particularly excited to reignite my motivational fire, and then it happened — the dreaded positive COVID-19 test results for myself and everyone in my family.

Thankfully, everyone was vaccinated and very lucky to experience mild symptoms during our isolation.

Exercise-wise, getting a COVID-19 diagnosis felt like a giant stick had been shoved into the wheels of my determination — which was especially frustrating given my intolerance for the last 2 years of a stationary pandemic lifestyle.

Since I returned to a regular exercise regimen, it has been discouragingly obvious that the virus has had a noticeable impact on my ability to exert myself. Even when at rest, I can feel that my energy levels and cardiovascular system have been negatively affected.

By diving into the post-COVID-19 exercise research, I gained deeper knowledge of how the SARS-CoV-2 virus affects multiple systems of the body, the implications this has for exercise capacity, and the therapeutic benefit gentle exercise can provide during recovery.

With those insights in hand, I began to reevaluate my priorities.

My goal, for now, wasn’t to push toward new levels of power and grit. Instead, I worked to establish a new baseline with patience and compassion and ease my way back into exercise, being mindful of my post-COVID-19 limitations.

I think it’s especially important to give context and perspective to my COVID-19 experience as it relates to everyone else who has been handed this diagnosis within the last 2 years.

I am extremely lucky to have experienced such minor symptoms compared with the millions of people who have lost their lives or who continue to manage the effects of this ongoing health crisis.

My initial COVID-19 symptoms were a deep and unrelenting headache and a raspiness in my throat.

I had a lot of trouble staying asleep at night and often lay in bed listening to the rhythmic pulse of my blood through my veins. During the day I felt weak and shaky and was troubled by the rapid speed of my heart.

I had a constant feeling of unease and speediness in my chest, which was accompanied by anxiety and a sprinkling of depression.

Diving into the vast sea of research, I looked for information on how the SARS-CoV-2 virus affected the physiological systems that were most important to the adaptation of exercise.

The immune system

Some of the initial symptoms a person will experience when they develop COVID-19, as well as those involved in long COVID, are the result of the immune system’s inflammatory response to the pathogen rather than the pathogen itself (1, 2).

When the immune system feels like it’s being invaded, there is an initial release of inflammatory cytokines, which are immune cells that affect other cells of the body. This is a productive and important reaction when the body is mounting a defensive response to a virus (1, 3).

However, this inflammatory response brings with it several symptoms — headaches, muscle and joint pain, and brain fog, to name a few. Long COVID is thought to be a perpetuation of the inflammation of the immune system and other areas of the body to a chronic degree (4).

The cardiovascular system

The cardiovascular system, unsurprisingly, takes quite a hit from COVID-19, in both symptomatic and asymptomatic individuals (2).

This presents as a reduction in the body’s ability to efficiently take in oxygen, transport oxygen to tissues and muscles, and effectively use oxygen as an immediate source of energy (5).

Because COVID-19 makes it harder for the body to absorb oxygen efficiently, the brain signals the lungs to take in more oxygen, leading to an increase in the number of breaths taken in a minute and a feeling of breathlessness — especially with exertion (2).

The compromised cardiovascular system decreases the body’s ability to immediately generate energy for activities like aerobic exercise.

The nervous system

Because COVID-19 can create inefficiencies in oxygenating the body, the central nervous system — the brain, spinal cord, and all tissues that comprise them — may be negatively impacted (6).

When the brain doesn’t receive enough oxygen, there is a trickle-down effect on other organs that it directs. Symptoms can include body temperature changes, altered cardiac function and rhythm, blood pressure abnormalities, and changes to gastrointestinal functioning (7).

The inflammatory response to COVID-19 can cause an interruption in signaling between brain cells and lead to brain cell death (6).

Research on COVID-19 has concluded not only that symptoms are related to a decrease in oxygen to the brain but also that regions of the brain itself can contract the SARS-CoV-2 virus as a result of the virus’s affinity for attacking nerve tissue (8).

This would explain symptoms such as anxiety, depression, short- and long-term memory loss, difficulty with thinking, and sleep disturbances (9).

My initial reaction to the research on long COVID was alarm and defeat.

How had we lived through 2 years of hiding, masking, handwashing, social distancing, and vaccinating only to find ourselves not just sick but also with a possibility of being changed, inflamed, and compromised forever?

And then the exercise physiologist in me thought, “How can exercise help?” After all, I have always believed and taught that exercise is medicine.

I shifted my outlook on my physical condition. Rather than focus on what I had lost, I examined all I had to gain.

To begin again is to recognize that regular exercise enhances immune function; decreases inflammation; and improves blood flow to the heart, the lungs, and the rest of the tissues of the body, thereby enhancing brain function (10).

With these things in mind, I began exercising again, though some of my symptoms remained long after the acute infection had passed. Here’s how I did it and what I focused on.

My first piece of advice for anyone beginning to exercise again after having COVID-19 is to assess and monitor your current baseline.

By using tools and techniques to monitor your resting and working heart rate, and mindfulness to tune in to your level of effort, you’ll have a starting point to grow from.

Here are two ways of measuring your heart rate and effort level.

Monitor your heart rate

It’s important to first identify your resting heart rate. This might have changed since your COVID-19 diagnosis, and it’s important to know where you’re starting from.

There are a number of ways to measure your heart rate by checking your pulse. Or, if you’re like me and would rather have a device giving you feedback, a heart rate monitor is a wonderful tool for regular exercise.

Monitor your rate of perceived exertion

Rate of perceived exertion is a numbered scale that helps the exerciser subjectively determine how hard they are working.

This is a simple way of associating the exercise you’re doing with your effort level. It’s also a great way of strengthening your mind-body connection and intimately understanding your various levels of physical determination.

When it comes to exercise, start with walking. Given what we know about the benefits of walking, it’s a simple way to gently oxygenate your body and gain some energy and aerobic conditioning.

Low intensity walking will stimulate dilation of the capillaries — the smallest blood vessels of the cardiovascular system — enhancing oxygen transfer between blood and tissues and throughout the muscles and various organs of the body (11).

You can moderate your pace to your liking. Try to not be driven by making up for lost workouts. Start with 30 minutes of walking, 3–5 days a week, for 1–2 weeks.

Don’t overexert yourself, because your body is still enduring some amount of inflammation. Your immune system could become overtaxed by too much intensity right away (12).

After a couple of weeks of walking, you can begin to exercise at an aerobic heart rate. Be sure to warm up at an easy level for 3–5 minutes, and then increase your intensity so your heart rate is at the lower end of the aerobic level for your age range.

Core exercises, yoga, and Pilates are all great options for waking up your stabilizing muscles, regaining your range of motion, and getting your body moving again.

Your core muscles have probably lost some endurance because of a decrease in your activity levels, so be sure to breathe through your repetitions and apply all your mental energy to making your quality of movement strong, stable, and intentional.

You can spend 20–30 minutes moving — being mindful of staying at a very doable level of work — and then cool down at an easy intensity for a few minutes. Try this 3–5 days a week, and make sure you’re not experiencing any symptoms of overtraining.

After a month of monitoring your heart rate at rest and during exercise, you should start to see a change.

Your resting and working heart rates should both decrease with the same level of work you’ve been doing consistently. This means your rate of perceived exertion should also decrease.

These are signs that your body is positively adapting to your cardiovascular training. Rest and recovery will remain very important components of your exercise progress and your continued recovery from COVID-19.

COVID-19 negatively impacts numerous systems of your body, and even after recovering from it, you may experience symptoms of deficiency.

Using tools and techniques to determine your post-COVID-19 baseline is essential and will allow you to safely return to exercise and enhance your recovery.

Stay aware of your current baselines and start with simple aerobic workouts that scale up in intensity over time, and you’ll be starting your post-COVID-19 exercise journey on the right foot.

Alexandra Rose began her career in New York as a professional modern dancer and a personal trainer. After receiving a master’s in exercise physiology from Columbia University, Alexandra has worked within clinical exercise settings, commercial gyms, with pre-professional dancers, and with clients in their homes. Alexandra is a certified personal trainer and fascial stretch practitioner, providing clients of all athletic endeavors with body work that helps to restore healthy movement patterns, improve strength and performance, and prevent overuse injuries.