NEWS

How Athletes With Long COVID Are Adjusting Their Exercise Routine

guy doing push-ups

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Key Takeaways

  • Exercising can aggravate symptoms such as fatigue and lightheadedness in long COVID patients.
  • A recent study found that long COVID patients carry an SARS-CoV-2 S1 protein in cells that are mobilized by exercise, which tricks the body into thinking it has worked out more than usual.
  • Former athletes with long COVID are learning to slow down and pace themselves to manage their condition.

Jess Scolieri, 37, is reinventing herself as she battles long COVID.

A former weightlifter, boxer, CrossFit enthusiast, and world traveler, Scolieri’s athletic capabilities plummeted after she contracted COVID-19 in March 2020. She went from training six days a week to doubting if she would live to see the next one.

“My old mentality of lifting a heavy weight and just pushing through the pain no longer applies,” Scolieri says. “You need to pace yourself. Because if you try and push through it, you end up really backwards.”

Scolieri is one of many long COVID patients who experiences a spike in symptoms after exercising. Some researchers have found a link between exercise intolerance and a specific SARS-CoV-2 S1 protein in long COVID-patients, while others have found that exercise can reduce long COVID fatigue.

For now, some athletes with long COVID are working slowly to get back on their feet while staying mindful of their energy levels.

Scolieri caught the virus while working as a podiatrist in the United Kingdom, and flew home to Darwin, Australia several months later when her symptoms did not go away.

“I got to a point in May, where I'd had enough,” Scolieri says. “I was living there by myself, and I decided to come home because I thought I wasn't going to make it.”

In the following months, she developed worsening symptoms—most of which were neurological while others affected her heart. Back in Australia, Scolieri continued to monitor her diet and exercise to avoid flare ups. Her flare-up symptoms are similar to those associated with postural orthostatic tachycardia syndrome (POTS), such as lightheadedness and palpitations.

POTS

Postural orthostatic tachycardia syndrome (POTS) is a medical condition characterized by lightheadedness and palpitations in response to standing. With POTS, the heart rate increases dramatically with body position.

She now incorporates small amounts of exercise, like 10 minutes of stationary cycling or rowing, in her routines. These exercises are easier on her spine than walking or running, she says.

To avoid repercussions, she only works out for three days before taking two days of rest even if she feels fresh. 

“[It] is really frustrating because I just want to go and do things,” she says.

A recent study showed that exercise intolerance is common among long COVID patients. It is largely a result of the SARS-CoV-2 S1 protein, which is found inside endothelial cells that are mobilized by exercise.

Bruce Patterson, MD, a pathologist and virologist who led the study, tells Verywell that when these cells are mobilized, they can infiltrate a person’s blood brain barrier and cause vascular inflammation in the brain.

Patterson does not recommend exercise early in a patient’s recovery. Some clinics promote exercise therapy for long COVID patients, which “couldn’t be worse for these individuals,” he adds.

“Patients should get back to exercise, but only when they are ready, after treatment and testing to show cytokine levels have returned to normal,” Patterson says. “Otherwise, exercise is likely [to] do far more harm than good.”

There are currently no active cases of COVID-19 in Scolieri’s hometown. This is a blessing since she has a smaller chance of reinfections, but it also means there are limited options for long COVID treatment. Without a nearby clinic, Scolieri relies on trial-and-error methods to protect her health.

“It's like sticking your finger in an electrical socket,” she says. “After you stick your finger in it too many times, you start to learn.”

Cesar Velasco, who has also been dealing with long COVID since last March, has started to add low-intensity workouts into his weekly routines.

Before the pandemic, Velasco practiced martial arts and fighting. Now, he tries to do a few minutes of body workouts, like push-ups (he can now do eight), punching, and kicking every couple days. This takes a lot of energy out of him and usually puts him in bed for a few days after, he says, but the repercussions are worth it to do what he loves.

“At least I could do something to help my mind again, to remember that I used to do it, and I don't want to stop doing it,” Velasco tells Verywell. “It's part of my confidence building at the same time. In some ways, I still know that there’s hope to be better again.”

Peter Staats, MD, medical advisor for Survivor Corps and president of the World Institute of Pain, says the messaging around exercise and long COVID is mixed. He recommends that people who are experiencing extreme fatigue first talk to their provider about their symptoms to better understand why they are feeling that way, and how exercise will affect their recovery.

Overall, Staats says existing data does not suggest that exercise will make long COVID substantially worse long term. People who want to exercise should start slowly, take breaks to re-evaluate their recovery, and if one method is not working, try another, he says. 

“If you were doing an hour's worth of exercise before COVID, do 10 minutes, and then work your way up the next day to 15 minutes and slowly regain your strength,” Staats tells Verywell. “That's the best I can tell people at this point.”

For people like Scolieri, regaining strength doesn’t mean reaching a pre-COVID fitness level. It means leaning into and adjusting to her new self. She’s taking things one day at a time.

“I'm really resilient as an individual,” Scolieri says. “I've really had to go, ‘well you know what, that's the old Jess,’ and now I have to reinvent and relearn this new one.”

What This Means For You

If you’re an athlete dealing with long COVID, talk to your doctor about how exercise might affect your recovery. Chances are you will need to start slow, take breaks, and set different fitness goals than you had before your condition.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Patterson BK, Guevara-Coto J, Yogendra R, et al. Immune-based prediction of covid-19 severity and chronicity decoded using machine learningFront Immunol. 2021;12:700782. doi:10.3389/fimmu.2021.700782