Returning to Running after Having Covid-19

Update: This post was originally written in 2020 and has now been updated for 2022. Please always consult your doctor first to account for your vaccination status and underlying health conditions. In 2022, Omicron infections in vaccinated/boostered individuals may be mild and may allow a quicker return to running after having Covid-19.

Unfortunately, one of the questions for many runners in the early 2020s is, “How do I safely return to running after having Covid-19?” While there will be a range of individual recovery rates, these guidelines outline how to safely return to running after a Covid-19 diagnosis, based on the evolving knowledge of the disease.

Covid-19 recovery is highly individual, especially in regards to returning to running. Some people recover quickly; others will experience lingering symptoms for months. Some will be back to normal training in a matter of weeks; others will experience decreased exercise tolerance for months. Underlying health conditions may influence your recovery rate. Vaccination and booster status will have an impact, along with which variant you contract. At all ends of the spectrum of Covid-19 responses, you want to be cautious about returning to running. 

Major significant concerns include relapse of symptoms and long-term fatigue, which are commonly reported with Covid especially after the initial recovery. While recent research and the consensus of the American College of Cardiology indicates myocarditis is no more of a concern than after any illness (remember, you can get it after the flu, etc.), some athletes may experience lingering chest pain or irregular heartbeats that warrant medical examination and a pause from exercise. Pneumonia and lung damage are concerns, especially in unvaccinated individuals. Because of all of these concerns, your return to running after a Covid-19 diagnosis should be cautious. 

Disclaimer: This article does not serve as medical advice. If you have Covid-19, please speak with your medical provider and exercise an abundance of caution when returning to running.

Take Appropriate Time Off

Generally speaking, you should not run while sick, especially if sick with anything beyond a head cold. If you develop Covid-19 symptoms, you certainly do NOT want to run.

The new consensus (2022) from the America College of Cardiology outlines rest and return to exercise with the following protocol:

• If symptomatic with mild symptoms, rest until your symptoms have resolved. Then, you can resume normal training.
• If asymptomatic, rest 3 days to ensure no symptoms develop. Then, you can resume normal Training
• Follow appropriate isolation guidelines.
• If you experienced cardiopulmonary symptoms (chest pain, shortness of breath, dizziness,.), do not resume running until you have medical clearance

Walk First

Before you return to running, you want to walk first. Walking will ease you back into exercise, even if you just do one or two walks when symptoms first resolve. You will be able to assess how you respond to gentle exercise. If you experience worrisome symptoms such as an excessively high heart rate, shortness of breath, excessive fatigue, or regression of symptoms, you are not ready to resume running and should contact your medical professional.

If Recovering from a Severe Infection or Fatigued, Rebuild Slowly

The omicron variant is fortunately symptomatically mild in most vaccinated, healthy individuals. However, some individuals may experience lingering fatigue or have to rebuild slowly after a long duration off (such as if they had cardiopulmonary symptoms but have now been cleared.)

For athletes with fatigue (who have been medically cleared), it may be beneficial to have a more gradual return. The 2020 guidelines recommended starting at 50% of your previous baseline and progressing 10% each week. Dr. Jordan Metzl recommends first running 50% of previous mileage; if that feels comfortable, then 70% the next week (30% reduction), followed by 80% (20% reduction), and finally a week at 90% (10% reduction).  It is important to note these recommendations were made before we knew more about the risk of myocarditis (in 2020, it was believed to be higher than we now know in 2022). While myocarditis is not a risk, a gradual return is always smart if fatigue lingers.

If you did not have a severe illness, you do not have to follow these guidelines. However, if your symptoms were severe, you experience lingering fatigue, or you were off of exercise for more than two weeks, it does not hurt to exercise caution and follow these guidelines.

Focus on Effort

Some runners will find that they can return to their pre-infection paces with ease. Others will find that they are a minute per mile slower – or more, at least for a few weeks post-infection. (This is both my experience and what I discovered reading through various forums.) It is not uncommon after any illness to run slower than usual for a few weeks.

Do not try to run at your pre-infection pace if it does not come naturally. Focus on your perceived effort or heart rate and run at a truly easy, conversational effort. Easy running will safely build back your fitness without overstressing your body. If you struggle with controlling intensity, try run-walk intervals to keep your heart rate under control. 

Know When to Scale Back or Stop Running

If you experience chest pain, shortness of breath, heart palpitations, lightheadedness, develop a fever, or other concerning symptoms, stop running and contact your doctor. 

If you are struggling on your runs or recording abnormally high heart rates, you want to scale back. Most likely, your return to running after a Covid-19 diagnosis will not be linear; you will make progress, then have to scale back and rest, before being able to make more progress. Pushing too hard too soon will only delay full recovery.

Be Patient

A Covid-19 diagnosis may affect your running for weeks or even months. Research found that SARS limited exercise capacity in survivors for three to six months. Covid-19 has barely been around long enough to see the full effects, but anecdotal evidence suggests that recovered Covid patients may not return to previous levels of fitness even months later. 

Be patient with yourself. Covid-19 recovery can a bumpy, unpredictable road depending on the severity of your infection. You may experience setbacks. Do not push yourself too hard, too soon. While it may be frustrating for a short while, a slow progression will benefit you in the long-term.

My Own Experience

I was diagnosed with Covid-19 on August 13 (alpha variant); my first symptoms appeared on August 10. I was in good shape for me; before ceasing running, I ran an 8-mile progression run at an 8:18 average and a 16 mile long run at an 8:4x/mile average. My symptoms were a sore throat, loss of sense of smell, intense fatigue, and brain fog.

I waited until a week after symptom resolution to resume running, which was August 29. After the initial test run, I ended up taking a few days off of running after because runs felt too hard. I then started back at three days of running and less than 50% of mileage and gradually build up to 50%. My paces are over a minute per mile slower than before.

However, in 2022, I have seen numerous vaccinated/boostered athletes contract omicron and return much more smoothly. They rested while symptomatic and were able to resume training afterward with minimal disruption.

Sources: 

Jordan D. Metzel MD, et al. “Considerations to Return to Exercise Following Mild-to-Moderate Covid-19 in the Recreational Athlete.” HHS Journal. 2020. 

Runners’ Round-Up

Mile by Mile, Confessions of a Mother Runner, Runs with Pugs, Coach Debbie Runs, and I host the weekly Runner’s Round-Up link-up. Each week, join in a link-up for running posts.

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How did you return to running if you have ever been diagnosed with a major illness?