2020 was totally dominated by the COVID-19 virus. It has disrupted our businesses, ruined our social lives, tampered with our mental health and challenged the physical health of our clients, colleagues, companions and maybe even you personally. The severity of symptoms can range across a broad continuum, from experiencing little or nothing all the way through to admission into ICU and life-threatening scenarios. Almost everybody now knows somebody who has been through COVID-19 but, for those who are recovering from the virus and wanting to return to full health and fitness, what can we as fit pros do to help? What advice should we follow? What are the contraindications? How can we coach members and clients through the process?

As a fit pro myself, I have worked with individuals recovering from COVID-19. David was one of the first individuals I knew to catch COVID-19 back in March and, although he has made steady progress, he can still feel the effects of the virus months down the line. David shares some of his experiences with us throughout this article.INSERT

As fit pros, our initial approach should be to help set realistic expectations for our members and clients. Many fitness enthusiasts out there will be eager to make up for lost training time and keen to regain their full vigour as swiftly as possible. Lacing up their running shoes and striving to match their pre-COVID 5km time may, however, prove a little more challenging than they anticipated and could possibly lead to greater symptoms of fatigue. As fit pros, we can coach their expectations in terms of what they might experience upon return to exercise and what sort of timeline might be realistic to return to their full health and fitness.

The broad range of symptom severity is reflected in the varying lengths of time it takes to fully rehabilitate an individual. Generally speaking, the more severe the symptoms experienced the longer the rehabilitation timeline is to be expected. Individuals who isolated and recovered at home with mild symptoms can be back up on their feet and active again in a matter of weeks. Others who were admitted to hospital for treatment and/or had other underlying medical conditions will likely require months to fully recover.

According to yourcovidrecovery.nhs.uk: 

  • after four weeks, most of the chest pains and phlegm (sputum) should have reduced
  • after six weeks, the cough and feeling breathless should have greatly reduced
  • after three months, most symptoms should have settled but tiredness may still be present
  • after six months, symptoms should have all settled. 

Our very own Boris Johnson resumed his running programme roughly four weeks after discharge from hospital, as reported by The Times. For individuals who have been admitted into ICU recovery it will be a longer and medically supervised process, taking possibly up to a year to recover full health. 

David’s experience

Upon your return to exercise, what did you initially aim on improving and how did you progress?

My aim was just to get moving again. To slowly increase the amount of exercise I could do without feeling worse/fatigued the following day.

Can you identify anything you found particularly difficult regarding returning to exercise?

I still had a lingering dry cough from COVID, so particular things that triggered that made it harder, such as dry cold air while cycling or leaning forward like in the plank.

It’s important to note that, as well as physical symptoms throughout recovery, it is also common to experience mental and emotional side-effects. According to blf.org.uk, the side-effects are as follows:

Physical side-effects

  • Struggling to breathe when you’re resting or when you’re active
  • Inability to do activities you could do before you became ill
  • Feeling very tired (fatigued) and low on energy
  • Experiencing loss of appetite, weight loss and muscle atrophy
  • Experiencing loss of taste/smell
  • Lacking good-quality sleep

 Mental side-effects

  • Forgetfulness
  • Inability to think clearly and to concentrate
  • Struggling to perform everyday tasks that involve organising, planning and problem solving

 Emotional side-effects

  • Low mood
  • Anxiety
  • Depression 

Although many will experience fatigue post COVID, a good sign that exercise could be back on the cards is the ability to complete daily chores and the undertaking of short but regular walks. Under the pretence of fatigue, it may be tempting to want to lounge around on the sofa browsing Netflix and debating whether to commit yourself to the next six-season box set. This is the wrong thing to do, as inactivity can actually contribute to fatigue and lengthen the recovery process. Getting up and doing activities, such as housework and walking little and often, is where the return to activity begins. The NHS recommends setting a goal and building up to 30mins of walking per day. The Columbia Department of Rehabilitation and Regenerative Medicine at Columbia University New York goes one step further and recommends the following structure to build up your walking:

  • Week 1: five minutes, five times per day
  • Week 2: 10 minutes, three times per day
  • Week 3: 15 minutes, twice per day

Achieving 30mins of walking per day is a good sign that a more structured exercise programme can begin. Upon return to exercise, fit pros should maintain a cautious approach and build a client’s fitness and confidence gradually and systematically. You may well find that it is sensible to reduce the duration of workouts to 30-45mins to begin with. Emphasis should be placed on a gradual increase in functional capacity and specifically improving aerobic fitness, balance, co-ordination and strength. Aim to give your clients a physical and mental lift by beginning with low-level, achievable exercises and providing progression only when physical competence is demonstrated. Allow them to experience progress and give them a mental lift. Encourage them to keep a diary of their exercise achievements and to score their energy levels daily, so that progress can be mapped and highlighted as success.

STOP exercise if you get any sudden symptoms including:

  • chest pain or tightness
  • feeling dizzy, nauseous, clammy or cold
  • feeling increasingly wheezy
  • sore joints or muscle weakness.

David’s experience

How long after contracting COVID-19 did you feel like you could start physical activity again? One month.

What type of activity did you begin with and how did it make you feel?

Cycling, short jogs and short home workout routines. I was slightly less fit and out of breath than a month before, probably due to inactivity as much as COVID directly.

Aerobic fitness

Restoring lung function is the priority in the early stages of rehabilitation and so aerobic exercise should take up the majority of a client’s training volume. Ultimately, if you can increase the oxygen level in their body’s tissues, you will begin to rejuvenate their energy levels and ability to maintain exercise over time. Activities such as brisk walking, jogging, rowing and cycling within the aerobic fitness zone (60-80% bpm heart rate) are a great place to start. Lack of conditioning in muscle tissue due to excessive sitting/lying may mean that high-impact activities may cause severe DOMS (delayed onset of muscle soreness) and so should be reintroduced slowly and systematically.

Just about all of the exercise guides I have read encourage use of the ‘Talk Test’ to manage intensity level. The talk test requires that exercising participants must be able to complete full sentences without pausing for breath while maintaining their current intensity. If the sentence is broken, the intensity level should be decreased. Be aware that many fitness enthusiasts will want to push themselves harder very quickly – this can lead to increased fatigue later in the day or the subsequent days. Do your best as a coach to manage enthusiasm and to build bouts of aerobic exercise gradually by duration first. Monitor how well they recover over the following days. Once they are able to maintain aerobic exercise for 30-45mins without presenting with excessive fatigue or DOMS in the following 48 hours, then you can begin to look at adjusting intensity.

David’s experience

Can you advise on anything you found particularly useful?

Not a particular exercise, but just being very aware of how good/bad I was feeling each day and doing a level of exercise that matched, as that related to how much energy I had that day and how bad I would feel if I did too much.

Balance and co-ordination

After prolonged sitting or lying, it’s inevitable that some joints will become stiff and some muscles feel tight. Sense of balance and proprioception may also temporarily be down regulated. Prescribing standing functional exercises that explore 3D movement can help to neurologically fire up the furnace and help it restore full function. Consider starting with low loads and work on restoring ROM. Develop exercises that are multi-joint, explore sagittal, frontal and transverse planes of motion, and stimulate anterior, posterior, lateral and spiral kinetic chains. Some of the following examples demonstrate low-intensity ViPR exercises that are great for restoring balance and co-ordination.

David’s experience

Do you feel you have regained your full fitness?

Following the initial period of COVID, I have still had recurring waves of it on and off. The cough and flu-like symptoms have returned for four distinct patches, possibly linked to being run down with an additional cold but, between those repeat ‘waves’, I have been close to fully fit again.

Strength

Muscle loss and reduced strength are recognised side-effects of COVID-19, largely due to bed rest and lack of activity. Strength training will be an important aspect of training to regain full functional capacity. Once again, caution by the fit pro should be taken to reduce risk of DOMS and excessive fatigue, particularly over the following 48 hours. To assist the restoration of full-body function and avoid overworking isolated muscle groups, try to prescribe exercises that utilise the full kinetic chain. Consider working with primary movement patterns such as squat, lunge, deadlift, push, pull and twist. The British Lung Foundation recommends starting with 1 x 10 repetitions and gradually building to 3 x 10 reps over time where good recovery is seen between workouts. One or two strength workouts per week is a good place to start. Utilise a weight that facilitates good-quality movement and avoid loads that might create loss of balance, excessive trembling or loss of postural position. Using a functional training tool such as ViPR is a great way to reintroduce strength training while restoring functional capacity. ViPR will facilitate multiple options to progress and regress exercises in order to match a client’s current ability level.


  • Sit to stand
  • Kneel to stand
  • Deadlift
  • Overhead press
  • Bent over row
  • Woodchop

David’s experience

What advice would you offer to others who are recovering from COVID-19 and wanting to return to exercise?

Trust that you are the best judge of how you and your body are feeling and exercise to a level that matches. If you do too much it can set you back a week in recovery versus doing slightly less but being able to exercise more consistently.

It must be noted that the above is only a guide and that there are so many factors that can affect an individual’s recovery that it is unlikely two clients will have the same experience. The responsibility lands upon us as coaches to assess, record, communicate, refer where necessary and be adaptive in our approach. Where possible, proactively try to communicate with other professionals who may be involved in the process, such as doctors and physiotherapists. Attempt to complement what other professionals are trying to achieve. As an industry, we can play a key role in improving the physical and mental health of the nation. Let us show professionalism by being methodical in our approach and allowing our passion for health and fitness to shine through, coaching and supporting clients’ and members’ recovery to optimal health.