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How to Resume Marathon Training After Long COVID

A group of people running in a marathon

For some, the promise of autumn brings pumpkin spice lattes and apple picking. But for runners, it often means the height of marathon training season. While there's nothing like running in the crisp air, some athletes may be facing a new challenge this season: how to train after a COVID-19 diagnosis.

After recovering from any injury or illness, getting back into the swing of things can be difficult for some avid runners, as it comes with a variety of concerns such as understanding how and when to return to training. It can be further challenging when recovering from post-COVID conditions or long COVID — with symptoms such as pain, poor endurance, psychological issues, cognitive impairment, and more.

"Let the symptoms be your guide," says Jason Pan, MD, an assistant professor of Clinical Physical Medicine and Rehabilitation in the Perelman School of Medicine at the University of Pennsylvania, who also works with Penn's Post-COVID Assessment and Recovery Clinic. People are not expected to power through their symptoms when dealing with long COVID, and in some cases, people experience a worsening of symptoms after over-exertion.

If your level of activity is setting off your symptoms, Pan says, that is your body telling you that it is too much. If you overdo it, it can make recovery harder and set you back in your progress. It is also important to make sure you build rest into training activities.

Although there is no clear understanding as to why some people develop long COVID symptoms and others do not, rest is thought to be a great way to avoid exacerbating long COVID symptoms. However, continuous rest without any activity may prolong recovery. "The consensus at this time is to participate in an individualized, structured, gradual return to a running program. This is typically accomplished with the help of a physical therapist, with overarching guidance by a physician," Pan explains.

And when it comes to returning to training, there is no strict cutoff or amount of days to adhere to, as it mostly depends on symptoms. Some people do not experience any residual symptoms after recovering from COVID-19 and may return to exercising and activities as soon as they feel comfortable. "On the other extreme, there are patients in our clinic over one year out from their initial COVID-19 illness who still have residual symptoms," Pan says. However, most patients with long COVID symptoms will recover within one to three months.

For those with prolonged symptoms, planning a return to activity and training is often decided based on more than the singular symptom of fatigue — patients may experience chest pain, shortness of breath, joint pains, or other symptoms which may limit activity and should be taken into account.

When dealing with mild fatigue, Pan recommends applying "the rule of tens." This means increasing the duration, intensity, and frequency of training by 10 percent every 10 days. Pan explains that if light activity causes the symptoms to worsen, it would be worth seeking formal medical and rehabilitative care.

"If you have access to a dedicated long COVID clinic or a post-COVID recovery clinic such as what we have at Penn, that would be an ideal place to seek care. You can also go through your primary care provider as a good place to start," says Pan.

First, a provider would assess other symptoms and other possible contributors or causes of fatigue. If appropriate, a formal physical therapy program may be prescribed. Physical therapy sessions are aimed to improve strength and stamina as well as neurologic symptoms such as such as dizziness or vertigo, and general physical changes such as muscle weakness and severe fatigue.

"Though formal research studies are still ongoing, we have seen promising results from our therapy protocols," Pan says. "But for all those runners working to jump back into training, the best advice to keep in mind is that gradual return to training. Of course, expert care is available should one experience any challenges along the way."

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Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department(s), University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

Health information is provided for educational purposes and should not be used as a source of personal medical advice.

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