Risk stratify patients before recommending a return to physical activity in people who have had covid-19. Patients with ongoing symptoms or who had severe covid-19 or a history suggestive of cardiac involvement need further clinical assessment
Only return to exercise after at least seven days free of symptoms, and begin with at least two weeks of minimal exertion
Use daily self monitoring to track progress, including when to seek further help
Our professional experience suggests that, after mild suspected covid-19, a proportion of people experience a prolonged recovery, particularly when trying to return to exercise. Moreover, there is increasing recognition of potential long term complications of covid-19, including enduring illness (post-acute or long covid), cardiopulmonary disease, and psychological sequelae in some people.1234 This article offers a pragmatic approach to help patients safely return to physical activity after symptomatic SARS-CoV-2 infection, focusing on those who have lost fitness or had a prolonged period of inactivity but who do not have an enduring post-acute covid-19 illness. It is based on current evidence and consensus statements, and our own multidisciplinary experience in sports and exercise medicine, rehabilitation, and primary care.
The health benefits of being physically active, from cardiovascular to mental health, are well established.56 Conversely, the harms of physical inactivity mean it is a major risk factor for non-communicable disease worldwide, alongside others such as cigarette smoking or obesity.7 Before the covid-19 pandemic, over a third of people in the UK were not physically active enough for good health.8 There is evidence of a further decline in physical activity since the start of the pandemic for people with chronic conditions such as obesity and hypertension9; conditions associated with worse outcomes from covid-19.10 Brief advice in primary care can help people to