How do I get back to my normal exercise after a COVID-19 infection?

Clinical Symptoms Long COVID

Exercise intolerance is one of the most commonly reported long-term symptoms of COVID-19 infection.

Scientists continue to research the underlying cause of these symptoms with attention on the autonomic nervous system. This post provides information on two common symptoms of exercise intolerance after COVID-19 and strategies to support your recovery.

Nerdy Girl Ashley here. I experienced rapid and unpredictable changes in my heart rate that made me feel dizzy and short of breath after having COVID-19. The symptoms may have been the result of something called autonomic dysfunction. A growing number of studies are examining a link between COVID-19 infection the interrupted function of nerves and response pathways in blood vessels. Your body is designed to adjust your heart rate and blood pressure to keep your organs supplied with oxygen, even during exercise when oxygen demand is higher. “AUTO”nomic regulation normally happens without our knowledge but may be impaired in some people after COVID-19 infection. One specific example of this includes the development of postural orthostatic tachycardia syndrome or POTS after COVID-19 infection. My symptoms mostly resolved after 14 weeks of slow and steady progress and patience. Stairs were a challenge in November 2021. I can now tolerate 30 minutes of moderate exercise a few days a week.

Nerdy Girl, Sandra, experienced extreme fatigue after exercise for months after COVID-19 infection. After a short walk, her muscles would feel like she had run a marathon and she needed to take a nap. These symptoms are consistent with post exertional malaise, a delayed onset of extreme fatigue that is out of proportion with the amount of exertion. Many people report extreme fatigue lasting weeks to months after COVID-19 infection. Exercise can also cause the return of brain fog and body aches. The underlying mechanisms for these symptoms continue to be studied and may also link back to autonomic dysfunction and related to conditions including chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME). Over a few months, Sandra’s symptoms have faded but have not completely resolved.

As more research is done to understand the underlying causes for exercise intolerance after COVID-19, here are some tips to assist in your recovery.

🐢 Stop, rest, pace. This approach proposed by the CFS/ME community encourages slow return of activity. If a short walk from one room to the next is what you can tolerate, it counts as exercise! Set small goals for increased activity as your body allows. Listen to your body’s demands for rest. Short naps can provide you with energy for the rest of the day and can be paired with exertion. Short sessions count! Instead of a 30-minute workout, try one or more 5-10 minute workouts spaced through the day to preserve your energy.

💺Chair exercises count! Chair exercises can be used for strength and endurance training without adding normal fluctuations in blood pressure and heart rate caused by standing or exerting yourself. There are many videos online for quality seated workouts.

📝 Keep a log of your progress. This can help identify slow and steady gains or worsening symptoms. Consider tracking how long you exercised, what you did, and any symptoms during or after the exercise.

💧 Stay hydrated! Adequate fluid volume in your blood vessels can help to counteract autonomic dysregulation during exercise that causes uncomfortable symptoms.

🏥 Call a clinician. If your symptoms are severe (chest pain, shortness of breath, fainting) or the situation is not improving you should be evaluated to rule out other underlying issues and to determine an appropriate treatment plan.

Those Nerdy Girls

Additional Resources:

Explainer in the Journal of Osteopathic and Sports Physical Therapy

New York Times Summary


Take a look at studies being done to understand COVID-19 and exercise intolerance. Some are recruiting participants.

Previous DP post “What is Long COVID?”

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