When patients can safely resume exercising after a COVID-19 diagnosis

As COVID-19 patients begin to bounce back, they are sure to have plenty of important questions about the recovery process. When can they be with their families again? When can they go out in public?

For athletes and other especially active individuals, one of the biggest questions is sure to focus on when they can start exercising on a regular basis—and a new analysis in JAMA Cardiology tackled that very issue in detail, zeroing on the cardiovascular side of the equation.

“Evidenced-based recommendations for return-to-play guidelines are currently limited and clearly subject to change as further data are obtained in concert with improved COVID-19 case identification,” wrote first author Dermot Phelan, MD, PhD, Sanger Heart and Vascular Institute in Charlotte, North Carolina, and colleagues. “Acknowledging these imperfections, our recommendations are exclusive to cardiovascular considerations and concomitant pulmonary limitations also require consideration.”

Asymptomatic athletes with a confirmed COVID-19 infection should wait at least two weeks from the date of their positive test before any kind of training, the authors explained. Following “strict isolation guidelines” is also key for such individuals.

If athletes with a confirmed infection experience “mild or moderate symptoms,” waiting at least two weeks from the time those symptoms fade is recommended.

“Whether the increased risk of myocardial injury in hospitalized patients with COVID-19 translates to mildly ill nonhospitalized patients is unknown but underscores the need to carefully consider the possibility of cardiac injury among nonhospitalized patients with COVID-19,” the authors wrote. “For recovered individuals ready to resume training after temporal restrictions, we recommend a careful, clinical cardiovascular evaluation in combination with cardiac biomarkers and imaging.” 

When “cardiac involvement” is detected, Phelan et al. added, returning to a full exercise program should be based on myocarditis-specific guidelines.

In cases where the patient was hospitalized and experience more severe symptoms, it is also recommended that they followed myocarditis-specific guidelines.

“For those who were hospitalized with COVID-19 but whose cardiac biomarkers and imaging studies were normal, we recommend a minimum of 2 weeks’ rest after symptom resolution before they undergo careful clinical cardiovascular evaluation with consideration of repeated cardiac testing, followed by a graded resumption of exercise,” the authors wrote.