Returning to play following a COVID-19 infection

It is important to know how to safely return to exercise and play after recovering from COVID-19.

This is because spending time in hospital or being ill at home with COVID-19 can cause your muscles to weaken. It is important that regaining your muscle strength and endurance is appropriately managed alongside your other COVID-19 symptoms. If in any doubt, seek medical advice about safe return to play and competition.

Health Navigator has information to help you to understand what to do to ensure your return safely to exercise and sport. 

Returning to physical activity and exercise after COVID-19 | Health Navigator

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 or sport? 

Your return to play should take place gradually in five phases. The following sections describe these phases and give suggestions for activities at each phase. If any doubt about your ability to advance through these phases, seek individual medical advice.  
 
It is important that you: 

  • stay at each phase for several days before progressing to the next. Players should not return to team training until they have successfully navigated stages 1 and 2 of this protocol. 
  • 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 

Aim: To allow recovery and protect Cardio-respiratory system 
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 

Aim: Increase Load gradually and manage any post virus symptoms like fatigue 
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: Returning to rugby-specific training  

Aim: Exercise co-ordination/skill and restore confidence 
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. Commencing with individual and unit skill work with minimal to light contact (1 on 1 etc.) Sessions 30-45 mins.  
If you can’t talk while doing an activity, then you are not ready for this phase. 

Phase 4 

Aim: Assess readiness for more intense sessions 
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 exercise classes. Introducing more intense skills and unit sessions with moderate contact work included. Sessions less than 1 hour. 

Phase 5

Aim: Normal training preparing for match play 
Return to your baseline exercises: Return to full training and competitive activities which 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. 
 
Source: Health Navigator New Zealand

Updated 22 March 2022