[zenaloha]

Just returning to training after almost 5 weeks off after a moderate case of COVID followed immediately by a separate upper respiratory infection. Prior to that I had been doing ~4 – 1 hour long incline treadmill sessions a week in Z2. Looking for any advice on or experience with returning to training after COVID. I’m back to doing hour long incline treadmill sessions, but trying to keep HR in Z1 only. I’m finding my pace has to be incredibly slow compared to pre-illness just to keep my HR in Z1. The first few sessions I had to actually reduce the treadmill speed way below what my warm up speed was previously just to stay in Z1. I have heard that the cardiovascular system takes a HUGE hit from COVID and it can take a while to make up lost ground. Curious if anyone has any research regarding how significant that hit is and / or any guidance on increasing volume of training or pushing into Z2 to help regain what feels like significantly decreased aerobic capacity.

Thanks!

Risto

[druwwl]

The Covid infection itselfs is mostly not the problem instead you should be beware of Long covid.This symptoms set in after three month especially if you  start your training too early.so, you should be very careful with your training(load).Especially athletes that try to pushes they limits permanently are vulnerable to Long Covid.

[brianlcox]

Sorry to hear of your health troubles Risto!

I am also recovering from a covid case that turned into pneumonia. I’ve been off training for two weeks, and before that I spent 3 weeks at around 50% volume to deal with a case of achilles tendonitis. I’m still off work for another week, so I’m pretty early in the recovery process.

Starting yesterday my doctor has allowed me to walk, but nothing too strenuous. I’m planning on walking about an hour a day, trying to keep the average heart rate under 110bpm, with no spikes above 130 bpm on hills. My AeT is 160, so this is theoretically very easy for me, but at 130 bpm I feel like I am working too hard and start coughing, so I try to avoid that. I plan to keep at this intensity for a week or two before increasing the heart rate cap to around 140 bpm, while trying to keep the average around 125. This will allow me to run the flats and downhills, but probably walk on the steeper uphills. I will probably increase my weekly volume up to around 8-9 hours during these weeks. After these two weeks I will increase the heart rate cap by another 10 beats a minute (which is pretty much my normal easy running intensity) and increase the volume back to my “normal” healthy volume which is around 10 hours. After two weeks like this I will start to add some strides and short speed work, depending how I’m feeling.

 

Best, Brian

[Dr Andy Reed]

Hi there

Returning to sports after COVID infection is best done in a very slow and patient fashion, and there are really no short cuts. Fortunately most cases are mild, and I have been using the BJSM guidelines – here: https://www.fsem.ac.uk/infographic-grtp-covid-19/# to help guide RTP decisions and to dictate intensity. This is a good infographic that sums things up nicely.

But in general, I think that for most athletes, once they are back to some sort of normal daily activity, without lingering symptoms, it makes a lot of sense to have a few weeks in zone 1, then slowly increase the intensity, listening to how you feel, and taking additional rest days as you need. Remember too, that your Aerobic threshold will have changed, so what was once your aerobic threshold before illness, may well now be closer to your anaerobic threshold, so I do think when well enough, repeat testing with a drift test makes sense.

I always believe that it’s way smarter to go slow and be perhaps overly cautious in these situations, than to rush back, and end up digging yourself into a hole that takes much longer to climb back out of. It’s never wrong to go slower, but stepping up the intensity too early is often the wrong thing to do.

[rachelnutting]

Hey there,

We actually see this a decent amount in clinic (PA in cards here). To echo the above, make sure you take it very slow, get enough rest, and fuel appropriately. Unfortunately, it takes as long as it takes. Pushing it only sets you back. I know it is hard, but try not to have expectations of what you should be doing when (I am not very good at this, but have gotten better). If you are having chest pain, shortness of breath, palpitations, etc it is not a bad idea to get an ECG/echocardiogram/troponin to check for inflammation in the heart or get a referral to cardiology and/or pulmonology. With a severe case, I would definitely recommend evaluation prior to return to play and not just trying to push through it and making sure everything is ok.

I remember when the BJSM guidelines first came out for that! I think they were the first ones that were a good resource for eval of athletes prior to return to play?

Good luck!

Rachel

[brianlcox]

Thanks Andy and Rachel for the feedback. I feel like the bigger concern for me is the lung damage due to the bacterial infection rather than the covid damage. I still feel quite a bit of pain in my chest while breathing deeply, so I’ll keep things very easy until that passes. At this point I’m just happy to be well enough to leave the house and move my body again, albeit slowly.

 

I’ll check in from time to time to report my progress.

[zenaloha]

Thanks for the advice Andy and Rachel. I had no idea COVID could cause my AeT to decrease. I figured I was just muscularly deconditioned with a little loss of aerobic capacity, so this is a big shock. Planning to conduct a HR drift test this coming weekend, will reset zones from there, and take it very slowly. Thanks again for the evidence-based advice!

Risto

[brianlcox]

Here’s an update 11 days after my last post and about a month after the covid infection.

My lung pain is now nearly completely gone and my breathing feels close to normal. My resting heart rate is still about 10 bpm too high, and also my running heart rate is about 10 bpm too high compared to pace.

 

I’ve been back to really easy running for 3-4 days. I’m planning on keeping at this intensity for another week with around 1 hour per day for another week. After this, depending on how my resting heart rate improves, I plan to add strides for a week and then hopefully add more intensity the week after.

 

How are you recovering?

 

[zenaloha]

Glad to hear things are starting to feel better for you Brian!

I conducted a HR drift test last weekend and my AeT dropped by about 10-15 bpm which is why working out near the top of my old Z2 felt so strained. I’ve since reset my zones and have returned to every other day aerobic training with 1 hour long incline treadmill sessions in Z1 and Z2. Feeling much more recovered and stronger after these sessions than before the zone reset. The one strange, nagging symptom is a tickle in the back of my throat / nose that starts ~2 hours after the workout and lasts for the rest of the day (all workouts are first thing in the morning before work and the kids wake up). It’s the same feeling I get at the start of a cold. It’s totally gone by the following morning, so I’m not too concerned about it and am attributing it to the normal lowering of immune function after a training session.

Planning to continue this training schedule for another couple weeks before doing another HR drift test to see if I can start slowly moving back up to my previous zones and training load.

Hope your recovery continues to go well and your back at peak form before any scheduled trips or events!

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