Physical activity advice

Spending time in hospital and also being ill at home with COVID-19 over a long period of time can result in a significant reduction in your muscle strength and endurance.

Exercise is very important for regaining your muscle strength and endurance BUT this needs to be safe and managed alongside other long COVID symptoms.

Activities around the house and gentle short walks whilst pacing are considered safer whilst you are recovering before returning to exercise.

Using the BORG scale (see below) will help you regulate your exertion and develop a good understanding of the level of activity or exercise that you should be working at. It is a good tool to help you understand any symptoms of breathlessness you might have.

Staying active during your recovery will improve:

  • The strength of your breathing muscles, heart and circulation.
  • The strength of your arms and leg muscles.
  • Your energy levels.
  • Your wellbeing, independence and confidence.

Staying active during your recovery will reduce your:

  • Anxiety or depression
  • Stress levels and blood pressure
  • Risk of falling by improving your balance
  • The risk of developing other problems associated with bed rest such as chest infections, bed sores, blood clots, reduced mobility and weakness

How to use the BORG scale during activity and exercise

Below you will see a copy of the BORG scale, you can use it to understand how hard you are working and your feelings of breathlessness whilst undertaking any physical activity and during exercise.

This scale is based on how effortful your breathing feels at rest and during activity or exercise.

Using this scale during activity and exercise will really give you guidance and a greater understanding about the safe level to challenge yourself.

Aim to stay at level 4-5

Exercise and fatigue

If you are suffering from on-going fatigue, please seek advice from a physiotherapist before getting back to ‘strenuous’ exercise.

Fatigue and exercise need to be carefully considered and phased to prevent Post Exertional Malaise (PEM) and a ‘relapse’ of your symptoms. The return to exercise section on the “your COVID recovery” website is a good source of information.

PEM symptoms include a marked physical and or mental fatigue in response to increased activity/exercise and can be debilitating and cause a relapse.

The exhaustion felt maybe immediate after the activity/ exercise or maybe delayed by hours or days. Recovery normally takes 24 hours or longer and can affect your fatigue levels, concentration, sleep, memory and can cause muscle/joint pains and flu like symptoms.

To avoid PEM, follow the advice in the fatigue management section on pacing of activities.

If you experiencing fatigue symptoms after exercise then we recommend:

  • Monitor your heart rate as you exercise and introduce new exercises.
  • Monitor your rate of perceived exertion using the Borg Rating of Perceived Exertion Scale.
  • Keep your heart rate at less than 60% of your maximal heart rate.

To calculate your maximal heart rate you subtract your age from 220 then multiply the answer by 0.6

(220-age) x 0.6 = 60% of your maximal heart rate

E.g. if you are 40 years old then 220-40 = 180, 180 x 0.6 = 108.
During exercise you aim to keep your pulse at less than 108 beats per minute.

You can monitor your heart rate by taking your pulse or you may have a phone or smart watch that can do this for you.

If you cannot confidently do this, then continue to use Borg Rating of Perceived Exertion Scale (using the chart above).

Exercise and chest pain and/or a racing heart beat

If you are suffering from chest pain, palpitations, severe breathlessness or feel faint then please seek advice from a physiotherapist before starting any exercise programme.

A physiotherapist will ensure that you have had the necessary investigations prior to starting exercises.

If you have a diagnosis of any cardiac problems or autonomic nervous system problems such as Postural Orthostatic Tachycardia Syndrome, you may need a more individualised exercise programme than the suggestions in the following pages.

Phases of exercise

You should consider your return to exercise in 5 phases; the following sections describe these phases and give suggestions

No exercise should be painful. If you experience pain, chest pain, feel faint or dizzy during exercise you should stop immediately and not restart your exercise programme until you have been seen by your physiotherapist.

Phase 1 - Preparation for return to exercise

Types of exercise: Gentle walking, breathing exercises, flexibility and stretching

Breathing exercise example

Relaxed tummy breathing

  1. Make sure you are in a comfortable position with your head and back supported and your shoulders and upper chest relaxed.
  2. Place one hand on your tummy – feel your tummy rise and expand as you breathe in and relax back down as you breath out.
  3. Rest and wait for your next breath to come.
  4. Breathe gently when practicing; there should only be a slight movement of your tummy at rest.

Flexibility and stretching exercises

Phase 2 - Low intensity activity

Types of exercise: Walking, light household/garden tasks, light yoga.

Light Yoga is a form of stretching, breathing control and relaxation that has been found to be beneficial during your recovery from COVID.

Yoga is shown to assist with the lymphatic system that helps to

  • Remove toxins from the body.
  • Increase flexibility in the thoracic region (where your heart and lungs are) that can become weak and stiff during illness and resulting inactivity.

Iyengar Yoga UK have developed a COVID 19 yoga programme, downloadable from covid-19-recovery-a-suggested-yoga-programme/

Phase 3 - Moderate intensity aerobic and strength exercises

Types of exercise: Walking – introducing inclines, resistance exercises.

Resistance exercises

Phase 4 - Moderate intensity aerobic and strength exercises with co-ordination and functioning skills

Types of exercise: Cycling, swimming, jogging, racket sports, Zumba classes, dance classes

Phase 5 - Return to your baseline exercises

You are now able to complete your usual pre COVID regular exercise/activity regime.

Top tips:

  • Spend a minimum of seven days at each phase.
  • Drop back a phase if you have difficulty.
  • Only exercise if you feel recovered from the previous day and have no return of symptoms and no new symptoms.
  • Choose exercises that you enjoy. You are more likely to do them and they will help to improve your mental wellbeing.
  • Exercises that you did prior to COVID may not be appropriate to your stage of recovery.
  • Doing less intensity of the same pre COVID activity may not always be the best way to approach your phased return to exercise.
  • Track your exercise progress using an exercise dairy on the next page.

No exercise should be painful. If you experience pain, chest pain, feel faint or dizzy during exercise you should stop immediately and not restart your exercise programme until you have been seen by your physiotherapist.