Covid recovery — a guide
COVID Recovery — a guide
I have COVID-fatigue. And some fatigue from having had COVID. It is hard to fathom which is more exhausting, the constant doom scroll, how many deaths, how many dangers, how many conspiracies, the latest spike in cases, etc. As easy as it is to hear about, it sure isn’t easy to navigate. As exhaustive as coverage of the subject may seem, few are speaking about how to recover after getting sick.
The pandemonium during a pandemic implies we care that people are dying I mean, obviously we all care… except that we don’t. How does one take care of themselves in world where no one else will do the same?
It seems like if you don’t die, didn’t spark a super-spreading event, or didn’t get cancelled for asking about horse dewormer, then you made it. Now you can just bathe in all that natural immunity, or nod along when others get it and describe the debilitating symptoms. Few are compelled to share any insight about how to come back from the disease, and from what we have experienced, getting it wrong seems like it could be just as bad as not taking any health precautions beforehand.
First, establish what kind of person you are; be honest. How much did you pay attention to health, fitness, lifestyle and any of the possible associated metrics before you got sick? If you don’t know anything and were unaware before but now feel compelled to make changes, it is important to slowly work into new physical stress, which goes against the "I want it now" tendencies when embarking on any new physical training journey. If you have data accumulated from years of training and you understand how you feel under multiple training scenarios, recovering fully and safely will be much more likely.
To be clear, these are not recommendations to treat COVID. We assume that you have consulted a medical professional. Although our symptoms and outcomes were mild compared to the potential risk, we all sought medical care to establish a baseline of options since the severity of the disease can shift quickly. The last thing you want is difficulty finding a primary care doctor to do initial screenings when hours matter in stopping the development of pneumonia or other infections as a side effect of COVID. Just because you are over the initial symptoms does not mean other problems aren’t looming and could possibly knock you out for a few weeks on top of what you’ve already experienced.
The focus of this is to guide people back into normal physical condition. It will be hard to do, unless you know your physical condition. It is important to understand and accept that it is a long road so being conservative with efforts and the time it takes to fully recover is essential. Do NOT rush your return to top end performance. There are a few dangers in exposing yourself to aerobic stress after a respiratory disease, taking it easy will reduce the chances of this.
Phil Maffetone sets a good standard for aerobic athletes. He prescribes that athletes who have been ill or are recovering from injury, should do nothing more intense than Zone 2 training for up to a year. Yes, one year! This may seem extreme, but there is good wisdom in this approach. Making a plan to limit intensity before you start can help hold you accountable. There will no doubt be days when you feel like everything is OK and you can start to push it, we advise against that. When you can (or should) increase intensity will depend on a few factors — and this may be one of few instances when tech like HRM, HRV, FitBits, and other measuring gadgets can pay off.
Referring to previously recorded numbers and tracking your waking and resting heart rate are a good start. If the average is up by 10% or more, it’s a good sign you are not ready to put stress on the aerobic system yet. You can still move around while staying below 70% MHR and limiting time to under one hour is wise. If the average HR numbers are the same as before illness you should be ok with Zone 2 training, but limit total volume to 70% of normal to prevent overly taxing the system. Pay attention to cardiac drift. This is a very good indicator to mitochondrial health and baseline aerobic response to stress. We describe this in full in our Endurance Manual, but as a quick recap: cardiac drift is the point at which HR increases (without having increased effort or speed) simply due to duration. If I can run an 8-min/mile @ a HR of 135bpm and that HR starts to climb more than 10 points at the same speed, I have reached the point of physiological shifting that moves response into other pathways, i.e., I have unintentionally increased intensity.
Recovering from a respiratory disease is a great excuse to address aerobic deficiency so this prescription is not dire. We all get in the habit of going too hard too often. The long stuff just gets more and more difficult to fit into a busy schedule. But now, post-COVID, doing the hard stuff won’t be a shortcut to anything but poorer performance. Reconfiguring your relationship with long efforts can actually be a gift. This is especially important for the first month or two. You may feel fine, but the tissue in the lungs takes a while to heal — tissue is tissue — if there was any scarring or clotting, general consensus says 6-8 weeks before tissue can be healed. You will not lose fitness by building an aerobic base for long periods of time, in fact, you will most likely improve it.
This is also a great period to work on skill, but don’t go headfirst into some advanced gymnastics program. The nervous system is also affected greatly by COVID. A less common but useful approach to measuring the state of your nervous system is a tap test. To establish an average, sit at a computer in the morning before you’ve consumed any stimulants, set a timer for ten seconds, and tap one key as many times as you can in that time. After a week you should have a good idea, my average is 64 taps in ten seconds. If the number is ever lower than 55, I avoid complex training. It is not foolproof, but between the two metrics (waking HR and tap test), you can get a good idea about the type and intensity of the stress your body is able to accommodate.
The first sessions back should not be formal, simply move. Walking and hiking are great options. Do not set a goal. Tune in to your body's response, regulate effort, and stop before you add too much stress. Being out on a hike when cardiac drift occurs means that you have to still make it back, which makes gym training a good option because you can pull the plug at anytime. No timer, no intervals, and no expectations; quit while you still feel good. Some may be able to move for 30-60 min, others might only last five. You can pick up some stuff, maybe do some lazy pump sessions — the easier the better. This will be self-imposed limitation. Even with mild symptoms, there is usually quite a bit of inflammation due to cytokine storms and in most cases, limited nutrition for the two or so weeks you were sick. The fatigue will be a result of many things, and most experience some form of dizziness or lightheadedness. There is no need to risk anything at this point, but light exercise will help move blood, lymph, and flush the system through a little perspiration. To give an idea of what to expect, twelve days after first symptoms it took me 30 minutes to "burn" 150 calories on the Air Bike. I mixed this with some DB bench presses and some shoulder mobility and called it a day. I did something similar every other day for about a week. My heart rate never went over 135, although it felt like it was redlining in some instances.
After about 20-24 days out, I could do some circuit style stuff, but nothing that resembled intensity. I mostly used the clock as a guide, and took as much rest as I needed. I trained in BJJ, but only drilling and skill work, and NO open rolling. I had some really weird inflammatory responses in my feet —feeling like full blown plantar fasciitis — so any long efforts outside were off the table. I eventually tried a little intensity, going against my own advice, and it didn’t feel terrible, but it didn’t do me any favors. Recovery from this took twice as long so I was forced to rest because even the easy stuff felt hard. Going too fast too soon is a sure-fire way to recover fitness slower in this case.
There will be a time when you can dabble with intensity and normal training paces, do them, but pay attention to recovery time. Try some sessions that you have recorded times for, match those times, and see if recovery is equal. If it isn’t, go back to building the aerobic system. If it is, you are probably clear to start building toward higher intensity.
I trust very few people, but people who know their own ability are great guides for this sort of thing. The general population “feels” better after a few weeks, but they rarely know how they actually feel anyway, so their experience means little. Those few people I do respect indicate that they didn’t start to have normal physical performance for six months post-illness. I think it depends on quite a few factors, but I could see this as being accurate given the amount of detail I, and others around me know about their own ability. One of the benefits of looking after yourself physically for many years is that you know when something is off. Do not ignore that feeling. Many of us came to intense training by learning to shut off the voice inside that begs to quit early or ease up. Now, it’s your job to learn how to listen to it. Trusting that voice is difficult when you just want to get back at it, so take your time. This is, after all, Endurance.
