Long Covid: Regaining fitness following infection


A man is seen jogging at a recreational park. — Bernama photo

KUALA LUMPUR (June 16): While most people recover from Covid-19 relatively unscathed, some, however, experience prolonged effects of the infection including symptoms associated with long Covid or post-Covid-19 syndrome.

And, according to an infectious diseases expert, many long Covid sufferers have reported significant deterioration of their fitness levels.

Consultant infectious diseases specialist and professor of medicine at International Medical University Prof Dr James Koh Kwee Choy said while many factors affect each individual’s experience of long Covid, generally, people who are unfit to begin with or have cardiovascular or respiratory diseases are more prone to significant compromise of their fitness levels.

However, even relatively fit people with mild or asymptomatic Covid-19 have been reported to experience significant deterioration of their fitness levels post-Covid-19, he added.

Recovery dependent on many factors

Commenting on long Covid, Dr Koh said the effects of Covid-19 are not only confined to the respiratory system – the primary target of SARS-CoV2, the virus responsible for Covid-19 – but can also extend to other systems including the cardiovascular, dermatological, musculoskeletal and neurological systems.

“Although most people recover from Covid-19 relatively unscathed, some do experience prolonged effects of the infection including symptoms associated with long Covid syndrome and chronic fatigue syndrome.

“According to medical data, a person is said to have long Covid if symptoms persist beyond 12 weeks after recovery from a Covid-19 infection. People experience a wide range of conditions such as fatigue, persistent shortness of breath and chest pain or tightness. Some also have problems focusing and have other symptoms as well,” he told Bernama.

He added that many of these symptoms are subjective and not easily detectable by routine investigations such as electrocardiogram and ultrasound, making it difficult to identify reliable investigation markers that can help to diagnose the effects of long Covid.

“We need to know that Covid-19 can cause hyper-inflammatory responses in the body, especially in severe categories of the infection. How these responses affect or influence the recovery of affected organs in the body is still largely unknown. Some patients recover completely while others seem to have residual effects weeks and months down the road.

“The time taken to fully recover (from long Covid) is dependent on many factors including the presence of other illnesses before (contracting) Covid-19,” he added.


Stressing that the existing fitness level of a person may determine how quickly he or she recovers from Covid-19, Dr Koh pointed to the importance of maintaining a healthy lifestyle that includes exercising regularly and eating healthily and avoiding smoking and excessive consumption of alcohol.

As for exercising after recovering from Covid-19, Dr Koh said generally, exercise is not recommended if the person still has symptoms. Those with pre-existing heart or lung problems should consult their doctor before restarting exercise.

“There are important issues to consider before one jumps in and starts exercising after Covid-19. What we are concerned about the most is the risk of myocarditis, a known complication in post-Covid-19 patients which can be fatal. Chest pain, palpitations and shortness of breath are symptoms of myocarditis. The important thing is to listen to your body,” he advised.

Meanwhile, personal trainer and triathlete Shen Choo opined that exercising is one of the best ways to regain one’s fitness level post-Covid-19.

Having contracted and recovered from Covid-19 in March this year, Shen’s advice for those who are embarking on a fitness journey post-Covid-19 is to start slowly and keep a journal of how they feel after each exercise session. This will help to determine what works for them and how their body responds.

“Start with gentle exercises such as yoga stretches. It is something you can do even if you’re down with Covid-19. It helps with blood circulation and will make you feel better. Stretching includes simple movements such as arm twists and hugging your knees to the chest.

“Every time I moved a little bit (when I was down with Covid-19), I felt a little better. There is a lot of joint soreness so when you mobilise yourself, you get the circulation going. Endorphins will also kick in and this helps to take away some of the pain,” she added.

Covid-19, however, has affected Shen’s stamina. Being a triathlete, Shen is used to running more than 10-kilometre stretches, but post-Covid-19, she found that she could not run more than three kilometres.

“However, with regular gentle exercises, my body is slowly getting back to normal,” she added.

Dr Koh, meanwhile, said the road to full recovery of fitness levels post-Covid-19 is very much individualised as it would depend on a person’s pre-existing fitness level and the presence of other comorbidities such as diabetes mellitus, high blood pressure, high cholesterol and obesity as well as habits such as smoking and excessive alcohol consumption.

“Some guidelines recommend an incremental exercise load stretched over weeks to slowly regain one’s fitness level. This should, ideally, be done under the supervision of trained personnel or monitored by a doctor.

“It’s true a person with few or no risk factors tends to regain their fitness level faster. However, some patients never really recover their pre-Covid-19 fitness level although this may be possible given more time.

“But the most important thing is that any improvement of one’s fitness level post-Covid-19 is still considered beneficial,” he said. — Bernama