Author: Breanne Brown, D.O., medical director, Providence Sports Medicine
Providers are growing more concerned about heart problems in active people and athletes once they've had COVID, regardless of how fit they are. Researchers say even active people who had a mild or moderate case of COVID-19 and recover after a couple weeks need to take it easy. They should wait to exercise and then ease back into it gradually.
Researchers and physicians now recommend waiting at least 10 days after the end of symptoms to begin a slow return to exercising. Providence Sports Medicine has developed a guide that explains the return-to-play stages of exercise after COVID. Patients should start with 10 to 15 minutes of slower-paced activity, while keeping their heart rate at specific targets with the guidance of a provider. Activity intensity and duration can increase as patients progress. Patients should stop exercising immediately if chest pain or shortness of breath is present and contact their doctor.
Depending on patients’ pre-COVID fitness level and the severity of their COVID infection, it can take several weeks to several months to return to their earlier fitness level.
Research* shows about 7% of patients who had mild or moderate cases of COVID, and who weren't hospitalized, develop some type of cardiac problem. Exercising too rigorously post-COVID potentially can cause long-term damage to the heart, even with a moderate case.
Patients with COVID can develop myocarditis, which can lead to inflammation and long-term scarring and weakening of the heart. If that occurs, exercise should be avoided for three to six months. Another risk is arrhythmia, which can be fatal if former COVID patients try to push through their fatigue and exercise too soon and too vigorously.
For active patients with moderate symptoms – who exercise regularly and place a high premium on their health through training, competition or sports achievement – it makes sense to consult with a provider prior to returning to their former level of activity. Screening may be recommended based on age, risk factors and severity of COVID symptoms. These tests may include an EKG, lab studies or ultrasound of the heart to evaluate the individual prior to clearing them back to a graduated return-to-play protocol.
Consider this excerpt from a Nov. 17, 2020 edition of the New York Times, written by sports medicine expert Jordan D. Metzl, M.D.:
A study in JAMA Cardiology looked at 100 men and women in Germany, average age 49, who had recovered from Covid-19, and found signs of myocarditis in 78 percent. Most had been healthy, with no pre-existing medical conditions, before becoming infected. A smaller study of college athletes who had recovered from Covid-19 found that 15 percent had signs of heart inflammation. Experts continue to assess the data regarding heart risks to help clinicians better determine when athletes can return to play.
It’s difficult to interpret the small studies on athletes who had COVID-19 and to explain the limited information with our patients. We have more research emerging with promising data that suggests the initial suspected high percentages of long-term cardiac abnormalities may be less than initially thought.
More studies are needed to understand how this virus and other viruses can affect exercise and heart function. There’s so much we don’t know yet with this new, devastating disease. But it’s becoming clearer every day that there are potential cardiac effects in some patients, and we should be careful and conservative in supporting their return to an active life.
*Clerkin, Kevin et al.Circulation. 2020;141:1648–1655. DOI: 10.1161/CIRCULATIONAHA.120.046941
For more information:
Dr. Breanne Brown
Providence Sports Medicine
Providence Medical Group Bridgeport Family Medicine
18040 SW Lower Boones Ferry Road, #304
Tigard, OR 97224
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