Exercise and Covid
In which I try (rather unsuccessfully) to figure out if exercising is likely to help me recover quicker from Covid.
I got Covid again, a glowing red band shining out before the liquid front even made it to the control band. That was Monday morning. Two days in bed with a fever, and two more with a brain like a drugged butterfly. Unable to settle, but flitting relentlessly.
But I could walk - it didn’t feel like I would be able to but when I put on my mask and walked I could keep going. On Wednesday I walked a mile, on Thursday I walked four. It seemed like a good idea - get some exercise, get better sleep, get some air.
Today is Thursday my band is fading, but my head feels more tired and for the first time I have a headache. Was that exercise a good idea? Should I just be flat out in bed? Can I figure it out?
I start out with Google Scholar and ‘exercise and covid recovery’. There are some studies looking at exercise as part of medium/long term recovery. They suggest exercise is helpful and speculate as to why (https://www.sciencedirect.com/science/article/pii/S2666337621000585). But I’m more interested in short term recovery. An impatient patient, how can I get back in action quickest?
That first search also turns up ‘Exercise and sports after COVID-19—Guidance from a clinical perspective’ (https://onlinelibrary.wiley.com/doi/full/10.1002/tsm2.247). This starts with a slightly terrifying introduction - talking about the multi-system damage caused by Covid to heart, lungs and kidney among others, and about the importance of screening for organ damage caused by pneumonia and myocarditis. I’m choosing to believe (hoping?) that this is about severe infection and that 2 days fever isn’t that. The article’s final four sections on recovery after different types of organ damage, including ‘Exercise after COVID-19: Heart failure’ suggest I might be on the right lines. The article’s focus is on athletes returning to training, it has a useful flowchart - but it only picks up the exercise question after ‘Complete clinical recovery’, whereas I want to know about whether exercise helps or hinders that recovery.
The article does say:
’In clinical practice, 2-3 days of graded return should be considered for each training day lost due to the illness. This seemingly long duration is based on the fact that, regardless of the direct, for example, virus-induced inflammation or indirect effects (eg, mechanical ventilation), recovery of pulmonary tissue and vasculature is prolonged even when virus load has resolved. With regard to training structure, first frequency, then duration, and finally intensity should be increased. Monitoring of oxygen saturation and heart rate during exercise is a viable and practical tool for guiding exercise training during recovery periods.’
So maybe if my heart rate doesn’t go up in an unexpected way, and my blood oxygen doesn’t fall, I’m probably okay exercising - but it doesn’t tell me whether it’s likely to help. Unfortunately, I’m not sure how much my heart rate normally goes up when walking - as I tend to jog for exercise and cycle to get places. On my walk my heart rate was 80-90 bpm - quite a bit above the 50-odd bpm it normally is at rest but not dramatic.
Google Scholar search also pulls up an article from the BMJ - ‘NICE cautions against using graded exercise therapy for patients recovering from covid-19’ - which links to an opinion piece about exercise and Covid recovery. Or as it turns out a piece about long covid and the challenges of pacing recovery (https://blogs.bmj.com/bmj/2020/06/23/paul-garner-covid-19-at-14-weeks-phantom-speed-cameras-unknown-limits-and-harsh-penalties/.).
Maybe diving directly into the academic literature isn’t the way to go when trying to find about about exercise in acute recovery. I think there is a suggestion here (although not an experimental one) that it’s possible to overdo the exercise and put yourself back. So on balance I’m going to take it easier - although I’m still wondering how I decide when I should start getting back to exercise.