Last August, Lauren Bull, an 18-year-old freshman soccer player at Bloomsburg University in eastern Pennsylvania, tested positive for COVID-19. After two weeks in quarantine, she went for a light jog and had to stop.
She felt out of breath, pressure in her chest and a rapid heart rate. Furthermore, her heart would race simply from standing up and walking up stairs. She went to her doctor, who completed an electrocardiogram, which measures the rhythm of the heart, and a echocardiogram, an ultrasound of the heart that provides information on the structure and function of the heart. The results were normal. However, an MRI of her heart showed signs of post COVID-19 myocarditis, or heart inflammation, which can be deadly.
“They told me, ‘If you overdo it, the reality of it is that your heart could literally explode,'” Bull says. “Mentally, it did hit me hard.”
Bloomsburg University athletic training staff coordinated with a team of doctors at nearby Geisinger Medical Center to develop a safe return to play for student athletes who had COVID-19. It included a three-month rehab protocol, gradually reacclimating athletes with COVID-19 to exercise. Bull’s process was similar but included a longer rehab process due to her myocarditis.
I personally went through a parallel experience with COVID-19. I tested positive on January 15, and as someone who practices yoga, runs regularly and strength trains, I was eager to get back to exercise. While I wasn’t diagnosed with myocarditis, I have long COVID. Symptoms include persistent chest pain, shortness of breath and abnormally rapid heart rate both during activity and while lying down.
I was able to practice yoga through my initial infection, and after a week, I was briskly walking outside. Then I stopped walking as more urgent symptoms developed. Two months after my initial infection, I woke up from sleeping and couldn’t catch my breath. My heart was racing, to the point I thought I was having a heart attack. I decided to admit myself to a hospital. The x-rays of my chest showed inflammation in my lungs. However, my electrocardiogram was normal, and I was cleared to return home. My primary care physician assured me I was safe and advised me to slowly reintroduce exercise back into my routine.
A Gradual Return to Exercise
According to Bloomsburg University athletic trainer Syrena Hess, Bull started right after her myocarditis diagnosis by casually walking on a treadmill and biking. Then increased her output until she was at 50% intensity. Intensity is measured by perceived exertion and using a pulse oximeter to make sure her oxygen saturation was normal and that she didn’t exceed 50% of her maximum heart rate.
Over 45 days, Bull progressed incrementally to 90% of her maximum heart rate, where she ran for 25 minutes with a heart rate of around 180, a near full-sprint effort for the duration. Activity would stop if she felt any chest pain, abnormal fatigue, an unsafe rapid heart rate or shortness of breath.
Then with clearance from her doctors, Bull began weight lifting and soccer drills. She then completed a high intensity interval running test, known as a beep test, where she ran for a segmented time and walked between sets, picking up speed each round. By March, after being re-examined by her cardiologist and completing a full panel of tests, she safely returned to working out at her max competitive threshold with the team.
Bull had an extensive series of tests performed before she could safely return to full exercise. Her cardiac MRI was clear, as was her holter monitor — a wearable device that monitors heart rhythm over several days — a stress test and bloodwork. “Then I felt better about it, and I was a little more confident,” Bulls says. “But it was nerve wracking at first.”
Before I ramped up my exercise regimen, I took it upon myself to see a pulmonologist and cardiologist to ensure my heart and lungs were healthy enough for exercise. Like Bull, I took a list of similar tests to be safe. As these test results came back normal, I was less anxious about returning to exercise.
I also practiced yoga and breathwork through my illness. Like Bull, I initially reintroduced walking into my routine, and within a week, I progressed to a light jog. However, I was alone and without any monitors to check on my heart and vital signs. This made for some stressful moments where I experienced extreme fatigue, dizziness and shortness of breath. When I felt these come on, I would slow my pace back down to a walk. After about three and a half months of mindfully building my cardio capacity back to its normal range, I finally feel comfortable pushing my limits during intense exercise.
Routine Exercisers Experience Less Severe COVID-19 Symptoms
Bull believes that because she was on a consistent exercise regimen of running, strength training and soccer drills prior to her diagnosis, it helped her recover faster and with no episodes of severe symptoms, even with myocarditis. And there’s emerging research that substantiates her claims.
A study published in the April edition of the British Journal of Sports Medicine observed nearly 50,000 adults with COVID-19. Researchers found those who met the U.S. Department of Health and Human Services’ physical activity guidelines of at least 150 minutes per week of moderate to vigorous physical activity showed significantly lower risks of hospitalization, ICU admission and death due to COVID-19.
Dr. Robert E. Sallis, a family and sports medicine physician at Kaiser Permanente Medical Center in Fontana California, was the principal investigator of the study. He believes that, for cases like Bull’s, being physically active prior to a COVID-19 infection is critical for a healthy recovery.
“The bottom line from our data is that physical inactivity is the biggest modifiable risk factor of severe COVID,” Sallis says. “It’s why she likely didn’t die from it.”
While the exact mechanism by which exercise exerts this effect is not completely understood, Sallis believes it’s a combination of strengthening the heart, lungs and vascular system, along with benefits on the brain and mental health.
A Rare Condition With Potentially Fatal Outcomes
Two recent studies, one published in the American Heart Association’s journal, examining over 3,000 collegiate athletes with COVID-19, the other in JAMA Cardiology that observed 789 professional athletes with COVID-19, found less than 1% of athletes suffered from heart-related issues. It worth noting that the athletes studied also represent a younger population who typically experience less problems with COVID.
“The more recent studies have suggested that the risk of severe cardiac health is really low in athletes,” Sallis says. “I’ve got to believe that a big factor is their athletic activity. The potential is greater in those who aren’t so fit and active.”
Sallis says that while it’s common for patients to show some transient and minor heart inflammation post COVID-19, similar to the flu, it typically resolves after a few weeks. However, it can be life threatening if not handled properly, so all COVID patients should be on the lookout for cardiac symptoms (such as palpitations, chest pain, light-headedness) as they slowly return to exercise.
Bull reentered a fitness routine knowing the potential fatal risks of pushing her heart during activity. She took it slowly and followed her program of testing and communicating if she experienced any symptoms.
“It’s scary, and it’s different for everybody,” Bull says. “But if you take the right measures, be aware of it. Do the right protocol. Take it slow and definitely don’t push through because that could make it worse.”
Similarly, I found that having a plan and a supportive network of friends, family and doctors is crucial. Even if you don’t have myocarditis, don’t take your symptoms lightly, be aware as they come up and take action by getting the necessary tests.
Exercise Supports Your Health
The fact that exercise, a habit that’s completely within our control, plays a major role in helping to lessen our risk of fatal COVID-19 complications is a positive call to action. One that Sallis believes was omitted during the pandemic.
“Unfortunately most of the messaging has been around just hide in the house, wear a mask, distance and wait for a vaccine,” Sallis says. “And that’s been a huge mistake. We speak very little, which is very typical in health care today, about personal responsibility, and people need to take control of their health and the best way to do it is by being active.”
Sallis emphasizes the importance of hitting the 150-minute marker for weekly exercise. A brisk walk at a moderate pace, where you’re walking fast enough that you couldn’t sing, but not so fast you couldn’t talk, should be the goal. If you go more intensely, you get more benefit for a given time, but you don’t have to go that hard to get the benefit.
Now that I’m slowly gaining confidence in my system post COVID-19, I ramped up intense, cardio-based exercise to six days a week. I’m back to my normal level of fitness, and slowly, I’m becoming less anxious. While I’ve experienced some difficult moments during my illness, I’m sure they would have been worse if I hadn’t exercised routinely prior. It’s a reminder to take care of myself and consistently exercise for future health emergencies.
Bull is back to competing with her soccer team, and with the support of her training staff, doctors, family, team and community, she feels confident moving forward.
“Now, I feel perfectly fine,” Bull says. “The thing that helped me most was the support around me.”
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