Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org
By Liora Engel-Smith
Exercise was the last thing on Crissi Harrison’s mind when she learned she had contracted the novel coronavirus in November. The emergency room nurse, who works in Gastonia but lives in Charlotte, had many of the classic symptoms of coronavirus. She felt tired and she had a fever and congestion.
But perhaps the most difficult symptom to handle, the 39-year-old said, was the feeling of not having enough air. Even after the chest tightness subsided, Harrison found that her stamina was gone.
A former college athlete who is used to working out for an hour each day, Harrison found herself getting winded on short walks and when climbing the stairs.
“It was pretty frustrating and a little scary because you hear so much about residual long-term effects of COVID,” she said. “I was just nervous that I wasn’t going to be able to exercise.”
With cases of COVID-19 in North Carolina past the half a million mark and coming up on a half million patients presumed recovered, accounts like Harrison’s, in which cardiovascular symptoms such as shortness of breath stay on after the virus is gone, are not uncommon. Exactly who experiences these residual effects and why remains unclear, said Blase A. Carabello, chief of cardiology at Vidant Medical Center in Greenville.
“It’s almost like every patient has a different story,” said Carabello, who also heads the Brody School of Medicine’s Department of Cardiology at East Carolina University. “Some return to completely normal stamina very quickly and in other people, the illness just lingers on. And obviously, there’s some people that apparently had the virus and had no symptoms.”
Exercise after COVID
- Talk to your doctor: Aaron Vaughan, who heads Mountain Area Health Education Center’s sports medicine program in Asheville, says patients with pre-existing conditions should talk to their doctor before returning to exercise. Healthy adults can begin to exercise roughly two weeks after their symptoms subside.
- Don’t push it: Regardless of the type of exercise they did before coronavirus, patients should begin with very light workouts that aren’t taxing on the heart and lungs, such as slow walking and jogging or short stints on the exercise bike. Whatever activity patients choose should not raise the heart rate too much and patients should stop and consult their doctor if they experience chest pain, heart palpitations or other unusual symptoms.
- Increase the intensity gradually: Vaughan advises patients to increase the intensity of their exercise every five to seven days, and only advance to the next stage if their heart and lungs can tolerate it.
- Be patient: Returning to normal workouts should be gradual and could take weeks or months.
Scientific understanding of the novel virus has advanced almost as quickly as the outbreak itself. We know, for instance, that people with pre-existing conditions are more likely to develop complications that require hospitalization. Those patients will take longer to return to normal energy levels, Carabello said.
But we don’t know why some people, even those with mild disease, go on to develop cardiovascular symptoms. A July study in JAMA Cardiology found that 60 out of 100 people who had coronavirus, showed signs of myocarditis, or heart inflammation. That heart damage was present even in some patients whose disease was mild and did not require hospitalization, the authors said. The long-term implications of this inflammation remain unclear, said Aaron Vaughan, an Asheville-based sports medicine doctor.
“It’s not straightforward,” said Vaughan, who directs Mountain Area Health Education Center’s sports medicine program. “This is an ever-changing process and the evidence that we have keeps changing.”
Current medical guidelines recommend that people with coronavirus avoid all exercise for two weeks and return to their normal activities gradually after the infection is gone. But returning to exercise right away isn’t always an option.
A long process
Sunny Bettua’s cough was the last thing to go. The Holly Springs resident, who works as a medical office assistant at a UNC women’s clinic, thought she had a summer sinus infection. But when the fever and cough started, the 42-year-old suspected something more was going on. She tested positive within days.
Bettua, who usually benches 85 pounds at the gym, felt like she couldn’t catch her breath. Even once the chest tightness subsided, the cough stayed.
“For the full two months, I didn’t exercise or nothing,” she said. “I just couldn’t get my energy back.”
Coronavirus attacks the lungs, blood vessels and can even leave lasting neurological issues, such as the much-vaunted losses of taste and smell. Current research suggests the virus causes fluid or pus to accumulate in the lungs, giving them a “ground glass” appearance on X-rays. Since the heart and lungs work in concert to deliver oxygen to cells, anything that affects the lungs could make the heart work harder, Carabello of Vidant, said.
“So that either a problem in the lungs or the heart can cause you to have trouble exercising,” he added.
Fatigue can be part of that equation, Vaughan, of MAHEC said. Younger, relatively healthy adults who are recovering from coronavirus will likely be able to return to their usual activities within weeks or months, according to Vaughan. But some patients may develop longer-term symptoms. Older adults, those with pre-existing conditions and obese people are particularly at risk, he said.
Patients, particularly those with pre-existing conditions, should consult their doctor before returning to exercise. Generally healthy adults who develop new symptoms, including chest pain during exercise or heart palpitations should consult their doctor, Vaughan said.
Recovering from coronavirus fully can be a long process, he said, and everyone — whether they were generally healthy before coronavirus or not — should begin with very light activities including slow walking or jogging. Proceeding to more strenuous exercise should happen gradually and slowly, with the goal of returning to pre-coronavirus activities over a period of weeks or even months.
Bettua, the receptionist who got coronavirus in late July, tried to exercise for the first time in September.
“I didn’t push myself really that hard,” she said of her first workout. “I slowly got back into it. I definitely lost muscle strength.”
By mid-December, Bettua said, she was within striking distance of her baseline and can bench 67 to 75 pounds at the gym.
Harrison, the nurse who had coronavirus in late fall, is still working on her recovery.
“I feel like I’m starting to get it back,” she said. “I still don’t have my strength but I want to work out.”