As COVID-19 variants have gotten increasingly contagious and far less damaging since the original version, now that we are in December 2023, what’s the protocol for returning to training? 3.5 years ago it was at least 10 days from inset of symptoms with at least the last 7 days asymptomatic before any training. I’m wondering if now with milder illness and the vaccine, if that protocol has shortened at all? Anyone have any up to date knowledge on this from medical professionals?
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Re: COVID return to training protocol late 2023? [tedtri]
[ In reply to ]
Not sure if it's ironic or tragic that the most heavily studied and experimentally tested disease in history has so much dogma surrounding it. Will you really get any substantially different answer from any of the camps than you would have 2 years ago despite presumably knowing more now?
We know the CDC has said even still this year that you should avoid all non essential activity if you have symptoms, which feels as counterproductive as most advice during the pandemic.
We also know that even simple exercise (https://www.ncbi.nlm.nih.gov/...rticles/PMC10469390/) improves recovery which is more tested than any of the CDCs statements that feel more like heavy hand of science backed misinformation than useful advice.
You've heard from several professional athletes who have said it turns out they raced an Ironman etc while having covid. And you'll hear people say, in this very forum, how dare you suggest such a thing that incidentally would cause cognitive dissonance to my position on such and such an issue.
How many times have you been moderately sick or moderately recovered and gone out for a run? The best advice is do what you usually do that has worked for you. When I get sick, without fail it goes away when I go for some form of moderate intensity endurance exercise. It always works for me. 2020 covid infection included.
If you have different experiences when sick, act on them and apply here. I think that's the best conclusion, not putting experts who are hedging their bets and speaking a certain way in public for a specific reason as the guiding star for your compass.
We know the CDC has said even still this year that you should avoid all non essential activity if you have symptoms, which feels as counterproductive as most advice during the pandemic.
We also know that even simple exercise (https://www.ncbi.nlm.nih.gov/...rticles/PMC10469390/) improves recovery which is more tested than any of the CDCs statements that feel more like heavy hand of science backed misinformation than useful advice.
You've heard from several professional athletes who have said it turns out they raced an Ironman etc while having covid. And you'll hear people say, in this very forum, how dare you suggest such a thing that incidentally would cause cognitive dissonance to my position on such and such an issue.
How many times have you been moderately sick or moderately recovered and gone out for a run? The best advice is do what you usually do that has worked for you. When I get sick, without fail it goes away when I go for some form of moderate intensity endurance exercise. It always works for me. 2020 covid infection included.
If you have different experiences when sick, act on them and apply here. I think that's the best conclusion, not putting experts who are hedging their bets and speaking a certain way in public for a specific reason as the guiding star for your compass.
Re: COVID return to training protocol late 2023? [tedtri]
[ In reply to ]
I have been intermittently looking for updates. PubMed is the repository for peer reviewed studies. And there is currently an actively enrolling study looking at exercise post-COVID infection.
I don't know of any hard or firm guidelines, per se. A lot of the data that is out there is based on long-haul clinics and data. Mostly observational cohorts, and much of it from 2020-2022. And there seems to be many variables.
In general, symptoms resolution is based on your pre-morbid risk factors and health (I am presuming you are pretty healthy at baseline), the severity of infection, and the rage of symptoms experienced. Vaccination status and that added level of immunity suggests shorter duration of symptoms, faster recovery, and decreased risk of persistent (long-haul) symptoms.
Pooled together, it seems that in people with mild to moderate outpatient infection, anywhere from 20-30% still had some symptoms at three weeks. Fatigue being the primary symptom.
Major concern for our specific demographic (athletes) is obviously cardiopulmonary. So specific to the lungs: cough, bronchitis, reactive airways (basically acting like asthma), or in some people lung inflammation (actual parenchymal injury) a worry. And then cardiac limitations ranging from exercise intolerance to actual cardiac damage and dysfunction leading to reduced cardiac output.
At the end of the day, as a physician, I will tell you the same thing I tell my friends/family. Similar to any other acute illness. Take a rest until you feel recovered. Start back slow and monitor your symptoms and HR. Ramp up accordingly. And if anything seems off, then seek a formal evaluation.
I don't know of any hard or firm guidelines, per se. A lot of the data that is out there is based on long-haul clinics and data. Mostly observational cohorts, and much of it from 2020-2022. And there seems to be many variables.
In general, symptoms resolution is based on your pre-morbid risk factors and health (I am presuming you are pretty healthy at baseline), the severity of infection, and the rage of symptoms experienced. Vaccination status and that added level of immunity suggests shorter duration of symptoms, faster recovery, and decreased risk of persistent (long-haul) symptoms.
Pooled together, it seems that in people with mild to moderate outpatient infection, anywhere from 20-30% still had some symptoms at three weeks. Fatigue being the primary symptom.
Major concern for our specific demographic (athletes) is obviously cardiopulmonary. So specific to the lungs: cough, bronchitis, reactive airways (basically acting like asthma), or in some people lung inflammation (actual parenchymal injury) a worry. And then cardiac limitations ranging from exercise intolerance to actual cardiac damage and dysfunction leading to reduced cardiac output.
At the end of the day, as a physician, I will tell you the same thing I tell my friends/family. Similar to any other acute illness. Take a rest until you feel recovered. Start back slow and monitor your symptoms and HR. Ramp up accordingly. And if anything seems off, then seek a formal evaluation.
Re: COVID return to training protocol late 2023? [tedtri]
[ In reply to ]
Not up to date person data here but I think I’d go the same way if I get it again. Got a mild case in summer 2021. Felt sick for 2 days and took a full week off while monitoring HR data to make sure it was elevated. Took a full week off from running (no swimming or cycling) then went easy for a week then back at marathon training. I actually did a tempo workout the morning I tested positive because I was negative at the time and felt ok.
To me the very small chance of long term issues is worth taking it easy. But seems new variants are even more hit or miss with sickness so maybe I had it and didn’t know? But if I knew I’d be cautious just because it’s not worth it for the training I’m doing.
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To me the very small chance of long term issues is worth taking it easy. But seems new variants are even more hit or miss with sickness so maybe I had it and didn’t know? But if I knew I’d be cautious just because it’s not worth it for the training I’m doing.
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Re: COVID return to training protocol late 2023? [jrielley]
[ In reply to ]
I am a high school swim coach so I have had to follow the protocols set forth by medical professionals when my athletes get Covid.
Our protocol is now.
Kid gets Covid, they are out of school 5 days.
When they come back they are immediately cleared to participate 100 percent. Just like any other sickness.
Just like any other sickness, I won't put them in a competition until they can come back and do a full day of practice to show me they are good.
I've had two kids get it this season so far. One was one hundred percent the day he got back. They other couldn't finish half the practice on day 1. Took him the good week to ten days before he seemed "normal" again.
Our protocol is now.
Kid gets Covid, they are out of school 5 days.
When they come back they are immediately cleared to participate 100 percent. Just like any other sickness.
Just like any other sickness, I won't put them in a competition until they can come back and do a full day of practice to show me they are good.
I've had two kids get it this season so far. One was one hundred percent the day he got back. They other couldn't finish half the practice on day 1. Took him the good week to ten days before he seemed "normal" again.
Re: COVID return to training protocol late 2023? [tedtri]
[ In reply to ]
Listen to your body - every case is different.
Re: COVID return to training protocol late 2023? [tedtri]
[ In reply to ]
I had a doctor give me these 3 rules for exercise and illness pre-covid. They make sense to me and i have followed them for many years. These guidelines assume an otherwise healthy and active person and that you will compensate with extra rest and excellent nutrition.
When I had covid I continued to train as normal but also slept as much as possible.
- Stop exercising if your heart rate is elevated more than it should be for the given level of effort.
- It is OK to exercise while coughing, as long as the exercise does not cause the coughing or make it worse.
- I forgot #3 but it was so outrageous that even I would have stopped exercising without needing a doctor to tell me.
When I had covid I continued to train as normal but also slept as much as possible.
Re: COVID return to training protocol late 2023? [WannaB]
[ In reply to ]
I had it back in September. In bed for a day, felt a little crappy the next day, then another couple days of just feeling blah, then it was gone. The current strains are little more than a glorified flu.
I don't know of any hard or firm guidelines, per se. A lot of the data that is out there is based on long-haul clinics and data. Mostly observational cohorts, and much of it from 2020-2022. And there seems to be many variables.
In general, symptoms resolution is based on your pre-morbid risk factors and health (I am presuming you are pretty healthy at baseline), the severity of infection, and the rage of symptoms experienced. Vaccination status and that added level of immunity suggests shorter duration of symptoms, faster recovery, and decreased risk of persistent (long-haul) symptoms.
Pooled together, it seems that in people with mild to moderate outpatient infection, anywhere from 20-30% still had some symptoms at three weeks. Fatigue being the primary symptom.
Major concern for our specific demographic (athletes) is obviously cardiopulmonary. So specific to the lungs: cough, bronchitis, reactive airways (basically acting like asthma), or in some people lung inflammation (actual parenchymal injury) a worry. And then cardiac limitations ranging from exercise intolerance to actual cardiac damage and dysfunction leading to reduced cardiac output.
At the end of the day, as a physician, I will tell you the same thing I tell my friends/family. Similar to any other acute illness. Take a rest until you feel recovered. Start back slow and monitor your symptoms and HR. Ramp up accordingly. And if anything seems off, then seek a formal evaluation.The fact is, most of us that participate in triathlon are well conditioned and a respiratory virus like covid is now much milder than the original iteration. Not an MD, but an RN and what I've seen this last year more or less mirrors what you're saying. People that have underlying respiratory or cardiac disease tend to have more acute cases. Tend to, but it's not a rule. For us as a population, exercise is our best friend. The covid loves to live in the lungs. Best thing we can do is not let it set up shop.
WannaB wrote:
I have been intermittently looking for updates. PubMed is the repository for peer reviewed studies. And there is currently an actively enrolling study looking at exercise post-COVID infection. I don't know of any hard or firm guidelines, per se. A lot of the data that is out there is based on long-haul clinics and data. Mostly observational cohorts, and much of it from 2020-2022. And there seems to be many variables.
In general, symptoms resolution is based on your pre-morbid risk factors and health (I am presuming you are pretty healthy at baseline), the severity of infection, and the rage of symptoms experienced. Vaccination status and that added level of immunity suggests shorter duration of symptoms, faster recovery, and decreased risk of persistent (long-haul) symptoms.
Pooled together, it seems that in people with mild to moderate outpatient infection, anywhere from 20-30% still had some symptoms at three weeks. Fatigue being the primary symptom.
Major concern for our specific demographic (athletes) is obviously cardiopulmonary. So specific to the lungs: cough, bronchitis, reactive airways (basically acting like asthma), or in some people lung inflammation (actual parenchymal injury) a worry. And then cardiac limitations ranging from exercise intolerance to actual cardiac damage and dysfunction leading to reduced cardiac output.
At the end of the day, as a physician, I will tell you the same thing I tell my friends/family. Similar to any other acute illness. Take a rest until you feel recovered. Start back slow and monitor your symptoms and HR. Ramp up accordingly. And if anything seems off, then seek a formal evaluation.
Re: COVID return to training protocol late 2023? [VegasJen]
[ In reply to ]
VegasJen wrote:
People that have underlying respiratory or cardiac disease tend to have more acute cases.(not an MD nor an RN)
I think a key for athletes is the risk of hubris. n=2, but I know two people who were elite athletes. One raced sick with the flu, got myocarditis, permanent cardiac damage, end of career. Another got similarly inflamed heart tissue, never the same after.
Keeping track of statistical likelihoods is nice. Both for the lower overall risk to fit people, and strains getting milder. But every person who gets sick is n=1, and I tend to think the "listen to your body" approach is the way to go. Ease back in super gradually, don't send it with race level efforts until you're 100%. There's nothing to be gained by coddling our Type A obsession with getting back to our "training week." Our bodies aren't going to absorb training stress all that well while busy cleaning out the last bits of inflammation and taking out the trash.
trail wrote:
VegasJen wrote:
People that have underlying respiratory or cardiac disease tend to have more acute cases.(not an MD nor an RN)
I think a key for athletes is the risk of hubris. n=2, but I know two people who were elite athletes. One raced sick with the flu, got myocarditis, permanent cardiac damage, end of career. Another got similarly inflamed heart tissue, never the same after.
Keeping track of statistical likelihoods is nice. Both for the lower overall risk to fit people, and strains getting milder. But every person who gets sick is n=1, and I tend to think the "listen to your body" approach is the way to go. Ease back in super gradually, don't send it with race level efforts until you're 100%. There's nothing to be gained by coddling our Type A obsession with getting back to our "training week." Our bodies aren't going to absorb training stress all that well while busy cleaning out the last bits of inflammation and taking out the trash.
As for the acute statement, that tends to be a degree of severity. It's impossible to imagine a scenario where a given person has an infection with versus without underlying chronic disease (and why I had a serious problem with much of the information we were given regarding various treatments. But I'm new here and not sure what the consensus of treatment options is on this board.
And with regard to resuming exercise, I kind of assumed we were mostly adults here and wouldn't need to be told to listen to your body. I am a proponent of "physical activity as tolerated". Pretty standard order, and it holds here as well. I do believe the best treatment you can do for yourself in the recovery phase is a moderate intensity workout as tolerated. The point being to raise respiratory effort and flush that virus out of the lungs.
But I'm just an RN and this is nothing more than my personal opinion as an age group athlete. Do not take it as medical advice.