Running after Covid: How to get back into exercise

In March 2020, Dr. Niall Elliott was planning the Summer Olympics with his colleagues at the British Olympic Association. Plans were made for what to do if an athlete suffered a catastrophic injury or mental health crisis as the Games progressed. There were meetings about how to transport some of the world’s best athletes around the world and how to deal with logistical snafus.

They had plans for almost everything except a global pandemic, he said.

Overnight, Dr. Elliott began providing support and care to athletes who were locked in training facilities and feared how this new virus would affect their athletic careers. The questions were endless and the answers were few.

“We were very cautious in the beginning because it was a new virus,” Dr. Elliott said. “We just didn’t know what effect it would have on the body.”

Urgent question for athletes: How long will Covid-19 keep you out and when could you return to training?

Olympians and weekend warriors have been asking this question ever since. And the answer continues to shift as doctors learn more about the coronavirus and its variants wreak havoc on exercise schedules.

The key is to reset expectations and rethink the timeline for a full game return or running back.

“Compared to most viral illnesses, athletes should expect it to take twice as long on average to get back to where you were,” said Dr. Denver said. “So if a person is normally back to work within a week of getting seasonal flu, it might take two weeks to get back to work after getting Covid-19.” But it also takes three to four weeks for many people, and some people take much longer.”

It’s a tough pill to swallow for athletes trying to get back to themselves once symptoms subside. And it’s not easy to tell runners to slow down when many of their goals are to speed up.

In June 2020, Dr. Elliott published a protocol that has been developed and adopted by other doctors as more information becomes available about the virus and how it affects athletes. The original protocol called for a gradual six-step return to play, starting with a minimum rest period of 10 days and working up to frequency, duration and intensity of workouts.

In the two years since then, doctors have differentiated how to treat athletes based on symptoms above the neck and below the neck. Patients with symptoms above the neck recover more quickly and can return to athletics more quickly than patients with symptoms below the neck, which can include fatigue, aches, pains, and lung or heart problems.

This distinction—along with patients who test positive but remain asymptomatic—helped Dr. Elliott change his Guidelines for a five-step protocol, which better serves athletes trying to return to training. Now patients can go through different stages of the protocol, depending on their symptoms and their severity.

And in post-vaccine data this year, doctors have found that increasing the pace or intensity of exercise can backfire dramatically.

“They’re used to solving every problem by trying harder,” said Dr. Olin, who has worked extensively with Olympic athletes. “And Covid-19 is seemingly unique, if you push yourself really hard – if you practice it – there’s this phenomenon of failure, which is analogous to a hip injury, where you get a little bit better and then you try to crash. Hammer for training and go back three months.

I should know, it happened to me. I tested positive for Covid-19 at the beginning of May and soon started back into my running routine, albeit at a slower pace, without any training, soon after. To my surprise, four and a half weeks later, I tested positive for Covid-19 again. (Yes, really, it’s very possible.) The first time I tried to go back to running, the second time I bounced off the walls. This week I thought I had recovered enough to do some short speed training. But when I reach the first interval, it’s like my body laughs, “No.”

I learned that getting to the starting line of a race, or to the playground, doesn’t have to be a race at all.

But athletes, and arguably runners in particular, have a particular impatience when it comes to tying their shoes again. When we asked Running Newsletter readers to share their stories of getting back into running after Covid-19, hundreds shared their ongoing frustrations and small victories. Many shared their feelings of gratitude to be back racing, and countless expressed concern that their recovery is still ongoing.

Akwen Kimmel, a 26-year-old runner, said her first run since testing positive for Covid-19 last December was “a slow run that was tougher than I’ve done in years”. The hills are still harder for him than he remembers, and his pace isn’t quite back to where it was, he said.

Dave Madigan, 52, had Covid in March and although he has made a slow comeback, he said the effort was harder than it should have been. “My VO2 max isn’t much different from what I expected, but I feel really exhausted,” Madigan wrote, referring to oxygen uptake, a measure of aerobic fitness. “I tried some short intervals, but they were harder than usual.”

It took 38-year-old Jenna Chiongoli a few months to stop feeling like that. “Even now, seven months later, when I’m still running as fast as I used to, I still don’t feel as fast as I used to,” she wrote.

As a pulmonologist in the ever-busy city of Denver, Jewish National Health MD Vamsi Guntur is used to these responses and has begun talking to athletes about adjusting their expectations.

“What we consider recovery is different than what athletes consider recovery,” Dr. Guntur said.

“An Olympic athlete very early on, before the vaccine, said, ‘I’m just used to pushing myself. I want to get rid of myself,” she recalls. “I said, ‘I know you can, but I don’t want to.’

It’s a sentiment that doctors and experts share even more widely post-vaccine, warning of regression if athletes return to high-intensity training or racing before their bodies are ready.

“You always have another competition, another race, another workout,” Dr. Elliott said.

“But you only have one body,” he added. “You have to look after him.”

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