Unfortunately, one of the questions for many runners in 2020 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.
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. 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. With Covid-19, more research indicates the concerns of myocarditis (inflammation of the heart) during the illness itself and the recovery period. Pneumonia and lung damage are concerns as well. 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 headcold. If you develop Covid-19 symptoms or test positive, you certainly do NOT want to run. If you have a suspected case, you are best resting until you can confirm with testing.
Covid-19 can damage the heart and cause myocarditis (cardiac inflammation). Running while sick can increase your chances of long-term heart damage. Training through Covid-19 also comes with the risk of postviral fatigue syndrome, which is when doing too much during the illness leads to months of lingering fatigue.
The consensus from the medical and scientific community suggests waiting for a minimum of seven days after the resolution of symptoms until you resume running for mild cases. (Mild to moderate cases involve symptoms but did not require hospitalization.) If you were ill enough to be hospitalized, speak to your healthcare provider; you may want testing done before returning to running.
Before you return to running, you want to walk first. Walking will ease you back into exercise. 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. Once you can comfortably walk for a couple miles, you should be ready to carefully resume running.
Return at Reduced Mileage
The most important thing is to not resume your previous training load too quickly. Covid can damage your lungs and heart; you want to be cautious.
Current guidelines recommend 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). This guideline is sound, especially considering the cardiovascular risks of the disease.
However, this may not work for every runner so do NOT force yourself into it if it feels too high. You may find you feel better if you start at 33% of your previous mileage for a few weeks, then a few weeks at 50% mileage, followed by a few weeks at 75%. Or, you may spend a few weeks building up to 50% reduced mileage and then follow the 50/70/80/90 guideline progression.
The rate of rebuilding mileage will vary based on the intensity of your symptoms, duration of your illness, and how you recover. With Covid, it is not abnormal to experience relapses, subsequent respiratory infections, or long-haul symptoms. Everyone recovers on a different timeline; your running should reflect that.
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.)
Do not try to run at your pre-infection pace. 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.
Rebuild Intensity as if Coming Back from Injury
Because of the concerns of relapse, fatigue, and heart issues, you want to practice extra caution when training above your aerobic threshold. The faster you run, the more stress it places on your heart, musculoskeletal system, and lungs.
My recommendation: you want to ensure you can handle 100% of your baseline training volume without issue before introducing any faster running. Once you feel comfortable at your normal training volume, then introduce faster running with strides or hills. After a few weeks of those, you can reintroduce your normal quality sessions.
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 is a bumpy, unpredictable road. You will likely 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; 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. 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.
Jordan D. Metzel MD, et al. “Considerations to Return to Exercise Following Mild-to-Moderate Covid-19 in the Recreational Athlete.” HHS Journal. 2020.
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