Exercise after a COVID -19 infection

Dr Etti Barsky
GP & Sports Physician


Getting back into training after recovering from a COVID infection is not as clear cut as it is after other viral infections. For the past 30 years, we have relied on the “neck check” to decide when an athlete – elite or recreational – can return to sport after a respiratory infection. This rule would extend to anything from the common cold to a complicated pneumonia and is as follows:-

If your symptoms are confined to your head and neck, for example, a runny nose, sinus pain or a scratchy throat; AND you don’t have a fever or muscle aches, then you are most likely clear to train.

These criteria however, do not apply in the COVID scenario. There are many reasons for this, but the two that are the most worrying are:

  • It is possible for someone with mild novel coronavirus symptoms to deteriorate on around day 7
  • Cardiologists are seeing a higher incidence of heart issues in people infected with the virus. There is a 22% higher prevalence of cardiac injury in patients hospitalised with COVID-19 as compared to 1% in patients with other viral infections. It is currently not known how far reaching the effects of the virus are on asymptomatic people; on people who have mild-moderate infection and are not hospitalised; and the long term effects on those who have had severe infection either with or without cardiac involvement.

International sporting & cardiology experts therefore agree on a stepwise approach to resuming physical activity in the following way:-

COVID-19 POSITIVE & Asymptomatic
Wait 2 weeks before resuming training.

COVID-19 POSITIVE & Mild Symptoms
Wait for all symptoms to clear, then rest for a further 14 days before you try a workout.

COVID-19  POSITIVE & Severe Symptoms/Hospitalised WITHOUT heart issues
Wait for all symptoms to clear, rest for 2 weeks then be evaluated by your doctor.

COVID-19 POSITIVE & Severe Symptoms/Hospitalised WITH heart issue
Evaluation and clearance from a cardiologist once the 2 week rest period has been completed, is necessary.

The more high-level athlete you are, the more it is advised to go for a formal check-up which would include an ECG and cardiac enzyme level checks.

Knowing that the virus can cause complications in many systems of the body, the best practice is to resume training in a slow and steady way. You need to pay attention to both the physical and psychological effects of a workout. Things to look out for during or after your workout would be: –

  •         A higher than usual resting and exercise heart rate, as well as  a longer time to recover.
  •         Excessive fatigue – this includes knowing that you had a low intensity workout, and feeling completely exhausted afterwards (as if you’d done a much harder workout).
  •         Shortness of breath – more so than you normally would be during or after a training session.
  •         Dizziness, Chest pain, Muscle pain and Palpitations.


The best way to go about getting going again, is to start with a very low intensity session and gradually build yourself up over a 3 – 4 week period.