The recommendations and guidelines of authoritative organizations, experts on the topic, and a top cycling esports coach who battled COVID-19 for two years himself.
More than two years into the COVID-19 pandemic, it’s become clear that we need to find a way to live alongside the virus using the tools and knowledge we have. Athletes emphasize exercise, training, and competition as lifestyle choices, and they aren’t willing to do without.
There’s a time when the motivation to pursue our sport-related passion gets in the way of what’s best for our health. During these times, it’s wise to take a step back and make rational decisions based on objective findings and expert recommendations.
At no other point in my lifetime has this been more critical. The following is an accumulation of information and recommendations from several authoritative organizations and experts.
Every athlete’s situation is individual, and so is their response. Nothing replaces a health professional’s advice, but you can use the following as a guideline when making your post-COVID-19 training decision.
General COVID-19 Facts and Information
Three stages characterize COVID-19 infection signs and symptoms. The “Acute COVID-19” phase describes the initial symptoms that patients experience for up to four weeks. According to World Health Organization data, approximately 25% of those infected experience symptoms at least four weeks.
The second phase, termed “Ongoing symptomatic COVID-19,” lasts four to twelve weeks. “Post-COVID-19 syndrome,” the third classified phase, is the designation describing symptoms of infection lasting longer than 12 weeks that are attributable to infection. 10% of patients experiencing symptoms fall into one of these categories, together referred to as “Long COVID.”
Exercise is Essential in the Battle Against COVID
Medical professionals have touted exercise to reduce the risk of severe infection in the general population. For individuals recovering from COVID-19, exercise is essential to eliminate the debilitating effects of physical deconditioning. The physical inactivity associated with COVID-19 recovery is a public health emergency.
A recent study involving 70 individuals reproduced in mice found an increase in antibody production in those who performed 90-minutes of exercise following COVID-19 vaccination. There are multiple studies in the literature supporting the claim.
The side effects of COVID-19 are long and varied, making it challenging to determine when an individual should resume exercise. The reported incidence of potential complications such as myocarditis (inflammation of the heart muscle) and other conditions adds complexity. Moreover, premature return to activity is a possible risk factor for “Long COVID.”
Cycling After the COVID Vaccination Improves Effectiveness
It’s common knowledge that riding is good for us in countless ways. Did you know that regular riding before and after the COVID vaccination improves your protection? Add it to the list.
According to an October 2022 study published in the British Journal of Sports Medicine of 200,000 subjects, routine exercise enhanced the vaccine’s effectiveness.
Also Read: When is it Safe to Return to Cycling After the COVID-19 Vaccination?
The active participants in the study were 25 percent less likely to be hospitalized due to the disease than sedentary individuals. Those who performed moderate activity for 150 minutes a week were three times less likely to be hospitalized when developing COVID.
An August 2022 review in the same journal looked at almost 2 million subjects and found that exercisers were significantly less likely to get infected, be hospitalized, or die of COVID. The widely held consensus is that regular physical activity improves immune function.
The growing evidence points to daily exercise combined with vaccination as the single most effective way to prevent severe COVID-19 symptoms.
Return to Exercise Recommendations for the General Population
The guidelines for the return to exercise for the general population are more straightforward than those given high-performing athletes. A team of doctors from the Hospital for Special Surgery in New York made the following recommendations.
- If you were healthy beforehand and had a mild case of the virus, you can consider returning to exercise after you've been symptom-free for seven days.
- Expect to take about a month after that before returning to your entire training schedule.
- If you have a heart or lung condition, consult a doctor before returning to exercise.
- Stop exercising and see a doctor if your symptoms return, especially chest pain, fever, palpitations, or trouble breathing.
If you are reading this, however, you likely don’t consider yourself a member of the general exercising public. The recommendations are more complex for athletes, and the stakes are higher.
An extended exercise-free period causes mental frustration and stress for the goal-oriented athlete. A premature return to training brings the potential for more devastating consequences.
The challenge is finding a safe and effective balance for health and fitness professionals and athletes. The athlete and their coach must weigh the adverse impact of a pause or training at low intensity against diminishing fitness levels.
The American College of Sports Medicine’s Guidance for Athletes
The American College of Sports Medicine (ACSM) is among the first organizations to offer guidance for athletes. The ACSM assigned levels of risk to COVID-19-positive athletes. Those under 50 who were asymptomatic or had mild respiratory symptoms resolved in seven days are low-risk.
Low-risk patients should rest a minimum of ten days after diagnosis. The ACSM recommends a graded and gradual return to training without further revaluation if asymptomatic for seven days.
Intermediate-risk athletes exhibit symptoms of fatigue for more than seven days or prolonged shortness of breath or chest pain that didn’t require hospital admission. Patients experiencing shortness of breath or chest pain during daily activity or required hospitalization are high-risk. Both groups should undergo testing under the care of healthcare professionals for clearance and a personalized exercise prescription.
For athletes that fall into the intermediate or high-risk groups, the ACSM has the following recommendations.
- The athlete should return to their regular work routine and sleep patterns easily without symptoms and demonstrate the ability to walk 500m without shortness of breath or fatigue before exercising.
- The initial activity consists of fifteen minutes of light exercise, and the athlete can gradually increase the duration after achieving pre-COVID energy levels.
- Before resuming their sports, athletes should engage in a minimum of two weeks of light exertion.
- An athlete's pre-illness capacity guides progression to more physically demanding training.
- The athlete must immediately notify their primary care provider if they experience any red flags, like chest pain, severe shortness of breath, or irregular or rapid heart rate.
Cycling Coach Aleksandar Coh Uses His Personal Experience with COVID-19 To Guide His Athletes
Aleksandar Coh coaches many elite athletes, including elite eracer James Barnes, and is a fine cyclist in his own right. Coach Coh has personal experience with COVID and is struggling to recover from a two-year battle. Aleksandar believes a bikefit client exposed him during the initial wave of COVID after returning from a heavily infected region.
Coach Coh was alarmed when he became highly fatigued, his heart rate spiked to over 180 bpm, and he got winded with minimal exertion, like climbing stairs. His symptoms progressed, and two months later, specialists detected massive scarring of his heart and lungs. Aleksandar was functioning at 40-percent capacity and felt horrible.
The coach took a long break from cycling because even short endurance-paced rides would make his heart jump out of his chest. After six months, the specialists warned that he would never be back to 100 percent.
Coach Coh was determined to prove them wrong, and over the next 21 months, he took the steps required. “It took a complete lifestyle change,” he said. Aleksandar cut out alcohol, ate only organic and unprocessed foods, and “my hydration had to be on point.”
It was a long, challenging journey, but Coach Coh is back! A recent FTP test showed solid numbers. “My body is fully back to normal, and in a physiological test, I scored a VO2 Max of 72,” he notes with encouragement, knowing he is on his way to the VO2 of 84 he enjoys when racing.
Alex is the founder of Endurance Sport and you can follow him on Instagram @endurance_sport_alex_coh.
Coach Coh knows that if it can happen to someone as fit and knowledgeable as him, it can happen to anyone. He would like to use his story to warn his athletes and fellow cyclists. Aleksandar cautions against a hasty return and has the following suggestions.
1) Give your body time to recover and do all post-COVID-19 testing (e.g., heart and lung ultrasound, CT, anything you can get) to get an accurate indication of your condition.
2) Start with super-easy workouts, 30 mins max first 2-4 rides (max 50% FTP), and assess your condition and response.
3) The first four weeks post-COVID-19 train at 55-75% FTP and continuously check your condition. If you have Oura or Whoop, you can easily see your resting HR, respiratory rate, and other metrics to measure improvement, but trust your feelings more than any electronic device.
4) In the second month post-COVID-19, perform a max of two intense workouts per week at 80-105% FTP. Include active recovery days at 50 percent FTP or less between intense training.
5) During and post-COVID-19, hydrate well, eat healthy unprocessed food, and try to get 20-30% more sleep than usual to allow your body to recover effectively and more efficiently.
If you would like to learn more about Coach Coh check out this ZOM interview with him and his athlete–elite eracer James Barnes.
Each Athlete’s Situation is Unique and So Is The Decision
Every athlete and individual recovers from COVID-19 at their rate, and there is no strict formula to determine the return to activity, tolerable levels, and progression. Experts strongly believe that a gradual approach mitigates risk.
For goal-oriented high-performance athletes, the above guidelines are restrictive and lack practicality. Athletes like to rationalize their illness-related decisions by calling attention to the keen awareness of their bodies. It doesn’t help athletes who trust their instincts if their body speaks, but they don’t listen.
The above consensus emphasizes the importance of waiting until symptoms subside. The advice isn’t realistic when the end is not in view, and the athlete is left to rely upon their biased judgment. If given a choice between “pushing through” and patience, I will always choose the former.
Conclusion—Find the Balance Between Pushing and Patience
That is why I have a coach, or in this case, a doctor. That flawed decision-making strategy is at the root of most of my performance progress mistakes. Use the recommendations as a guide and practice the same discipline and forced patience that your coach has preached.
As I mentioned in this previous article describing the effect exercise has on the immune system of high-performing athletes, you won’t win the race by prematurely resuming activity following COVID-19, but you could lose it. The spectrum of symptoms and enduring adverse consequences of “Long COVID” threaten your performance and the future of your health.
All illnesses, COVID-19 included, stress your body as it fights the infection. Exercise increases the demands on your energy and recovery system. The accumulated stresses overload your body if you haven’t fully recuperated from COVID-19.
The relapse can be worse, and your body is less capable of defending itself. A hasty return to the saddle may very well lead to an extended period of unwanted couch convalescence.
The stakes are high. Find the right balance for you. It just might be the most crucial choice of your lifetime—or career.
Your Experience?
How did you successfully navigate the tricky post-COVID-19 waters? Comment below! Your fellow virtual cyclists want to know.
For more practical advice on how and when to train with illness from a top esports athlete who also happens to be a doctor, check out this ZOM article by Dr. Jacqueline Godbe!
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!
I myself have taken almost half a year to really return to proper cycling post covid. Have yet to reach my former level of fitness, but I’m getting close at last.
My best advice to anyone returning to the sport after a covid infection is take it easy and go slow. Slower than you think is necessary. The loss in fitness from only doing easy rides for another two to three weeks is nothing compared to the loss in fitness from proper long covid and months off the bike.
Great advice based on personal experience! Take care of yourself, Falk!
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It’s a good thing to share this Chris!
I’d like to offer my experience for what it’s worth. I got Covid 3 weeks ago. It was particularly bad. I didn’t sleep a minute for 2 days straight and blacked out standing up. Couldn’t talk for 2 days.
This is my experience of beating it…I started exercising feeling like death on Day 4.
Day 4: 20 minutes twice in the day at 100-120w
Day 5-9 Gradually building intensity up to Z2 until I could do 1 hour at Z2. I did not force myself too far and stopped once I felt the perceived effort was too much.
Day 10-13 Building to Z2 for 2 hours getting more comfortable.
Day 14: 160km/4hr Z2 ride started weights
Days 15-21 900+km/23.5 hour
3 weights sessions in the week
3 intensity sessions building back (3 sets of 12 x 32 on/28 off) starting with sweetspot intensity for the “on” adding 10w each time. Finish off up to 3 hours endurance ride for this as prescribed (3 times per week)
Future…I will continue this regimen adding 10w per session to gradually build. When I cannot finish 3 sets of the intervals, I will drop to 2 with the added endurance. When I continue adding 10w and can’t finish 2 sets, the block is over.
Good luck to anyone that has Covid and is trying to recover. It’s a matter of chipping away at it but not stressing yourself too far. The “right” amount of stress is good for the body. Too much and it is dangerous. There are risks of myocarditis. By starting to pedal early, I recovered quicker. I kept more of my fitness.
If this is helpful, I am happy.
All the best!