Women and exercise post Covid - pacing, planning and prioritising
Updated: Feb 6
Most women I'm seeing have had Covid 19, and many are encountering bumps in the road to recovery. If you, like some of my patients, are unsure about when to start exercising again, how hard to push yourself and what to expect, I've summarised the official guidance from the British medical, allied health and sporting fraternity.
We know exercise is usually good for us, but there are risks from doing too much too soon after a viral infection. According to the latest figures from the National Office of Statistics (March 2022), women between 35 and 49 are the most likely group to have self reported 'Long Covid' - where symptoms persist beyond 12 weeks post infection. Fatigue (51%), shortness of breath (34%), loss of smell (28%) and muscle ache (24%) were the most common long COVID symptoms. Of over 200 known symptoms associated with Long Covid, the most common are shortness of breath, post-exertional tiredness – in which even a tiny amount of exercise leads to exhaustion – and cognitive difficulties dubbed 'brain fog'.
It's hard for women who are used to pushing themselves to take a gradual approach to returning to exercise post Covid. To understand why we need to take a gradual approach to returning to exercise post Covid, consider the 3 phases of the infection:
Early viral infection - when you first become infected. You may not have symptoms, but can spread infection.
Acute viral infection - where your airways and other systems become inflammed. You might experience symptoms. During this phase, your immune system will react to 'fight' the virus.
Covid recovery - where your body is recovering. The time this takes is different for each person, and not defined. Persistent symptoms, lasting more than 12 weeks, may be labelled as 'Long Covid'. It's not always clear why some people's symptoms last longer, but it's possible to have ongoing changes in breathing, circulation, energy levels, aches and pains for weeks and months to come. Even when you are symptom free, it's vital to remember that your lungs and circulatory system, including the heart, may have been inflammed, your breathing patterns (how well we coordinate our breathing muscles when resting or exerting ourselves) may have changed, and you may have lost some fitness. Exercise pushes these systems to their limits, so return should be gradual.
The following information outlines the medical consensus presented in the British Medical Journal and British Journal of Sports Medicine.
Key things to know:
Only return to exercise after being symptom free for at least 7 days
Begin with at least 2 weeks of minimal exertion
Use daily self monitoring, such as heart rate, shortness of breath and fatigue to track progress.
If you have ongoing symptoms or have had severe Covid 19, with possible cardiac involvement, you should consult with a Doctor before returning to high intensity exercise.
If you were training at a high level pre Covid and want to know how to get back to where you were, the following protocol is for you. It shows how to pace your return. It was developed for clinicians and high level athletes, so is pretty technical, but the basic principle is that you need to be 10 days from initial infection, 7 days clear of symptoms and off all Covid related treatments before starting to exercise. Sticking to suggested activities and heart rates for each stage and monitoring your response is important to avoid overloading your systems.
Recovery won't necessarily be a smooth trajectory, but before embarking on high impact exercise, consider the need to build strength back (including possibly doing weights or resistance exercise, such as swimming or exercise band work). If running, start on the flat, pace yourself, perhaps using an app such as the This Mum Runs Run30 app, developed specifically for women. To quote from the political sphere - you don't want 'boom and bust'. Research notes the role of hormones, diet, sleep and stress affect our ability to exercise well, so consider these too.
Long Covid and Female Hormones
As women in midlife are more likely to develop Long Covid, researchers are questioning a link between female hormones and Long Covid. According to Newson Health's Long Covid and female hormones factsheet, symptoms of Long Covid may be partly due to hormonal change, and/or an altered chronic inflammatory response due to sex based immune system alterations. A Newson Health survey of over 450 women found 77% of women reported Long Covid symptoms were worse just before their period, so taking care not to over-exert yourself at that time may be important. Further, some women with Long Covid may in fact be experiencing effects of perimenopausal hormonal change, or vice versa. Some women also experience changes in their periods with Covid ,but this should normalise. Do get medically reviewed if it doesn't.
If you are struggling to maintain energy levels during and after Covid, The Royal Society of Occupational Therapists have written practical guidance to help. They refer to the 3 Ps - PACING, PLANNING and PRIORITISING. See here for more.
You can also use the NHS Covid recovery resources:
Newson Health Long Covid and Female Hormones Factsheet