When is it safe to return to exercise post-COVID-19?

A’Court et al suggest that patients with ‘mild’ COVID-19 illness, and who are asymptomatic, do not need to restrict exercise.¹ While this seems to be a straightforward distinction, new evidence on ‘Long COVID’ presentations even in patients with ‘mild’ illness is starting to raise questions on how we define the severity of COVID illness. The National Institute for Health Research recently suggested that patients with ‘Long COVID’ may well represent four subgroups of clinical syndromes, and therefore have different rehabilitation needs.²

Often patients report symptoms that are refractory, intermittent, or resolve before returning in episodic bouts (these include (muscle aches, chest pains, dyspnoea, and fatigue), many of which are relative contraindications to exercise.³ The reality of COVID is that the clinical course of infection and recovery does not fit clearly defined categories (of mild, moderate, or severe illness) and symptoms rarely fit into the binary category of cardiac or non-cardiac. In addition to this, patients’ rehabilitation goals are very individual and often relate to their pre-morbid status, and this requires a tailored approach that takes into account the physical demands of their day-to-day activities and occupation.

• © British Journal of General Practice 2020