Returning to physical activity and exercise after COVID-19

Spending time in hospital or being ill at home with COVID-19 can cause your muscles to become weaker. Exercise is important for regaining your muscle strength and endurance. BUT this needs to be safely managed alongside your other COVID-19 symptoms.

On this page, you can find the following information:

What happens when I exercise after I have been unwell?

When you have been unwell with COVID-19 and have not been exercising, or even moving around much, your muscles can get weak. When you start exercising again your symptoms can get worse, or you can get very tired even after a small amount of activity. This is known as post-exertional malaise, or PEM, and it is an important part of recovery after COVID-19. 

  • PEM can happen hours or days after physical or mental exertion.
  • Recovery usually takes 24 hours.
  • If you experience PEM, you need to avoid exercise and activities that cause fatigue or symptoms and conserve your energy – see managing fatigue.
  • If you don’t experience PEM, you can gradually increase your level of activity or exercise.

How do I get back to exercise?

Your return to exercise should take place gradually in 5 phases. The following sections describe these phases and give suggestions for activities at each phase.

It is important that you:

  • stay at each phase for a minimum of 7 days before progressing to the next
  • drop back a phase if you find it difficult, or if you experience setbacks in your symptoms
  • stop immediately if you have any chest pain or dizziness, and don't restart your exercise programme until you have talked to a healthcare professional.

Phase 1

Preparation for return to exercise: These activities should feel easy, and should not make you feel short of breath.
Examples: Controlled breathing exercises, gentle walking, stretching and balance exercises. Stretching your muscles can be done sitting or standing. Each stretch should be performed gently, and you should hold each one for 15–20 seconds.

Phase 2

Low-intensity activity: These are the kind of things you feel like you could keep doing for hours. You should be able to breathe easily and have a conversation while doing them.
Examples: Walking, light household/garden tasks. If you can cope with these activities and continue to talk to someone, you can gradually increase the time you spend exercising by 10–15 minutes per day. You’ll need to spend at least 7 days in this phase without getting post-exertional malaise before you move on to the next phase.

Phase 3

Moderate-intensity activity: When you do these activities they make you breathe heavily, but you could keep talking.
Examples: Brisk walking, going up and down stairs, jogging, introducing slopes, resistance exercises. If you can’t talk while doing an activity, then you are not ready for this phase. You could start the arm and leg strengthening exercises described below.

Phase 4

Moderate-intensity exercises with coordination and functioning skills: These activities make you feel short of breath, and you can only speak about one sentence at a time.
Examples: Running, cycling, swimming and dance classes.

Phase 5

Return to your baseline exercises: You’re now able to do the types of exercise/sports/activities you could do before you got COVID-19. 

Cautions when exercising
No exercise should be painful.

If you feel any of the following symptoms, do not exercise (or stop exercising if you have already started), and contact your healthcare provider:

  • Chest pain
  • Feeling faint, dizzy or light headed.
  • Nausea (feeling sick).
See your GP for referral to a physiotherapist if you have any ongoing concerns about exercise.

What sort of strengthening exercises could I do?

Strengthening exercises will help improve muscles that have become weaker as a result of your illness.

Examples of strengthening exercises for your arms and legs

 

Bicep curl

  • With your arms by your side, hold a weight (eg, a tin of food) in each hand, with your palms facing upwards.
  • Gently lift the lower part of both arms (bending at the elbows) bringing the weights up towards your shoulders, and slowly lower back down again.
  • You can do this exercise sitting or standing.
Image of bicep exercise

Wall push off

  • Place your hands flat against a wall at shoulder height, with fingers facing upwards, and your feet about 30 cm away from the wall.
  • Slowly lower your body towards the wall by bending your elbows, then gently push away from the wall again, until your arms are straight.
Image of wall push off exercise

Arm raises to the side

  • Hold a weight in each hand with your arms by your sides and your palms facing inwards towards your body.
  • Raise both arms out to the side, up to your shoulder level (but not higher), and slowly lower back down.
 Image of arm raises to the side exercise

Sit to stand

  • Sit in a chair with your feet a hip-width apart.
  • With your arms by your side or crossed over your chest, slowly stand up. Hold the position for the count of three, and slowly sit back down onto the chair.
 Image of sit stand exercise

Knee straightening

  • Sit in a chair with your feet together.
  • Straighten one knee and hold your leg out straight for a moment, then slowly lower it.
  • Repeat with your other leg.
  • Increase the time holding your leg out straight to a count of 3.
 
 Image of knee straightening exercise

Squats

  • Stand with your back against a wall or other solid surface and your feet slightly apart.
  • Move your feet about 30 cm away from the wall.
  • Keeping your back against the wall, or holding on to a chair, slowly bend your knees a short distance; your back will slide down the wall.
  • Keep your hips higher than your knees.  Pause for a moment before slowly straightening your knees again.  
 Image of squat exercise

Heel raises

  • Rest your hands on a stable surface (such as a chair) to support your balance, but do not lean on them.
  • Slowly rise up on to your toes, and slowly lower back down again.
 Image of heel raise exercise

References

  1. Support for rehabilitation – self-management for COVID-19 related illness WHO, 2020
Credits: Editorial team. Reviewed By: Victoria Lai, Senior Physiotherapist, Waitematā District Health Board, committee member Cardio-Respiratory Special Interest Group, Physiotherapy New Zealand Last reviewed: 12 Nov 2021