COACH’S CORNER - Running Post Covid by Lyndal Maloney

Let’s imagine that your body is an 18^th birthday party, and your immune system is the special guest. Unfortunately the bouncer that your mum hired for the front door security was easily persuaded to let in some gate crashers from the unruly suburb next door, and in swaggers Covid-19  – the bad guy. 

The immune system immediately swings into action and an immune response is activated. Covid-19 has the ability to delay the body’s initial immune response, buying it some time to replicate for quite a few hours before any of the nice party guests know what has hit them.

It’s then an average of two days for infection symptoms to occur. By now the body has entered the acute response phase. Time to call in the good guys! Various aunts, uncles, and your mate’s dad have been called in to remove the gate crashers. The good guys of the immune system that fight off viruses, the T-cells, can be detected in the body within 2 to 4 days of symptoms developing. B cells take a bit longer (Google maps got them a bit lost), showing up 5 to 7 days later, with the fashionably late antibodies being detected 7 to 10 days post symptom onset.

The covid gate crashers peak in attendance numbers by 5 to 6 days post symptom onset. By day 10, the T and B cells have cleared the party of covid. Doing the math, that’s an average of 12 days for this party. That’s going to take some serious recovery time. More importantly, for those 12 days the body has been under immense stress.

This understanding of what is going on at a cellular level may give you a greater appreciation of why it is important to be very patient when recovering from covid and returning to running.

What does this mean as an athlete?

Since the pandemic began, the recommendations for returning to exercise have evolved as our understanding of the disease has improved.  A scoping review of all recommendations was undertaking in 2023 (S. Haunhorst et al), and I’ll give some general recommendations based on this below. 

Consider the following factors when determining when you will return to running:

• Peak immune response in the body happens on average 7 to 10 days post symptom onset (12 days post infection)
• Resuming regular training during this period may pose a risk of
• reduced viral clearance
• reduced inflammation reduction
• additional oxygen shortage causing cardiopulmonary distress
• reduced athletic performance
• myocarditis (inflammation of the heart tissue)

Post party return to training

Step one is to ignore the runner on Strava who gloated about running an ultra five days after testing positive to covid.

Step two is to follow a gradual return to running protocol. This will look different for everyone, but you need to follow some basic rules before starting back:

• No use of any medications
• You should be able to complete daily living activities without excessive fatigue
• You should be symptom free for 3 days

Step three is implementing a graduated return to running protocol. Below is an outline of what I have used with all my coached athletes at Serotonin Running, with the majority of them having had covid at least once over the last few years. Please note that whilst this protocol takes a period of three weeks to return to regular training, every athlete progresses differently. Every athlete also starts from a different base, thus the suggested times at each stage will vary from athlete to athlete.

The aim is to get the athlete moving again from day 10 post initial onset of symptoms, and the athlete must be 3 days symptom free. Every session also has the following caveat:

• If you experience any chest pain or heart palpitations, you need to stop immediately and consult your GP.
• If you experience nausea, headache, higher than should be heart rate, dizziness, or excessive fatigue, you need to stop and rest for 24 to 48 hours.
• You must have recovered within an hour of completing the session.
• Resting heart rate should have returned to normal.
• You must progress through each stage and be able to run for the prescribed time

Suggested protocol for Returning to exercise post Covid-19

POST COVID STAGE 1

Two days minimum at this stage.
15 to 30 min walk

POST COVID STAGE 2

2 days minimum at this stage.
5 min walk plus running drills
up to 15 mins light/easy jog
5 min walk
You can do the run as a straight 15 mins, or run walk intervals

POST COVID STAGE 3

2 days minimum at this stage
Light to moderate effort running
5 min walk
15 to 30 mins moderate jog
5 min walk

POST COVID STAGE 4

2 days minimum at this stage
Moderate effort running
5 min walk
30 to 45 mins light/easy/moderate jog
5 min walk

POST COVID STAGE 5

2 days minimum at this stage
Can get your heart rate up over 70% max hear rate
Moderate to intense effort - so adding in some hills, stairs, or intervals
5 min walk
45 to 60 mins light/easy jog
5 min walk

Return to regular training post Stage 5

If you would like some more detailed information, then I have attached links for two great articles on this down below.

Returning to physical activity after Covid 19, D. Salman et al

Current return to sport recommendations after non-severe COVID-19 from an exercise immunology perspective. S. Haunhorst et al.

As eager as you may be to return to running post covid, please remember that you have the rest of your life to run. Taking the time now to rest and miss a few weeks of training to recover well will mean that your long-term health will not suffer - and you will be able to return to the sport that you love, healthy, happy, and ready to party!