“It’s difficult to explain and describe,” says lang-haul COVID sufferer Matthew Montesano, a 39-year-old cyclist and public health data analyst. “I tested positive initially for five days, then tested negative, and then tested positive. I had flu-like symptoms—aching, coughing, congestion, fatigue, and felt intensely worn out. The acute symptoms resolved, but then it felt like my entire body was in revolt. There was one evening when I walked the dog, and it wore me out in a deep and profound way. I couldn’t even think.”

Montesano, a top-level track and road racer, now has long-haul COVID-19, an illness that has yet to have a cure or even a working definition. “We are trying to understand what long-haul COVID is and we can’t define it yet,” explains Brian Labus, Ph.D., M.P.H., assistant professor of epidemiology and biostatistics at the University of Las Vegas in Nevada. “We know people have symptoms, though.”

In fact, according to a recent article published in Current Sports Medicine Report, “10% to 15% of people infected with COVID will go on to have prolonged COVID symptoms that last for weeks to months and impact their ability to function and exercise.” These are not necessarily the same patients who were hospitalised when they were infected. Instead, these are people who had either minor or no symptoms to start.

Getting a long-haul COVID diagnosis is, right now, somewhat of a guessing game. Most doctors will test for other illnesses and when the results are inconclusive, they will chalk up the symptoms to “long-haul COVID.” To come to this diagnosis, though, doctors look for four weeks or more of profound fatigue, muscle and body aches, chest pressure, shortness of breath, cough, palpitations, brain fog, and/or other neurological symptoms.

Unfortunately, it’s very difficult to even see a doctor to get the diagnosis. “I had to do a bunch of digging on my own in order to find a long-haul COVID specialist, and then it took me three months to get an appointment,” Montesano says. “It’s frustrating because so much of what we hear about COVID has focused on hospitalisations and deaths, but long COVID is a risk people need to understand.”

“Athletes are used to talking about fatigue that is a result of having used your body,” explains Montesano. “Now, though, it’s like I don’t have anything available. I have no resources and a lot of brain fog. If I work a little, my brain is done for the day. It’s physical and cognitive fatigue that renders me unable to do anything.”

Why You Should Be Cautious About Intense Workouts When It Comes to Long-Haul COVID

While there are no “predictive tools to predetermine who may have prolonged symptoms” and even though studies have found that active people are less likely to get COVID in the first place and less likely to experience severe symptoms, “many athletes will suffer from prolonged symptoms that may require further evaluation and may prolong their return to exercise, training, and competition,” according to the Current Sports Medicine Report.

“Despite the many unknowns, long-haul COVID patients don’t test positive for the virus so the virus is gone in at least measurable ways,” explains David C. Nieman, DrPH, FACSM, director of the Human Performance Laboratory at the University of North Carolina. “We believe that what is persisting is an inflammatory response, but we don’t yet know why this is happening.”

It is this response that not only seems to play a role in long-haul COVID, but also plays a role in other illnesses, including chronic fatigue syndrome, the treatment of which has provided a model for long COVID treatment, Nieman says. This treatment model may include medications, both prescription and over-the-counter, as well as rest and exercise recommendations.

While experts aren’t exactly sure what leads to long-haul COVID, Nieman does feel confident saying that no one, with COVID or any other illness, should exercise when they are sick. In fact, Nieman says, there does appear to be one common behaviour that prolongs COVID and is also an aspect of long-haul COVID. “The common trigger is exercising too hard around the time of sickness,” says Nieman. “Intense exercise may be a trigger to an inflammatory response.”

What constitutes intense exercise? That answer is different for every cyclist, but breathlessness is a good measure. If you can talk easily, you aren’t exercising intensely. If you can only get out a few words or need to stop to take some breaths, then you are working out hard. You want to avoid the former if you have COVID, even if you don’t feel sick from it.

Here’s what can happen: A cyclist gets COVID, but isn’t highly symptomatic, and so goes on their normal training ride. A few hours later or the next day, they will “crash,” or have an experience of exhaustion that may last seven to 14 days, according to Nieman.

The official term for this experience of completely crashing after a ride or other workout is post-exercise malaise or PEM, Nieman says, and not only is it a potential trigger for long haul COVID, but it is also an ongoing symptom. Montesano, who has experienced this, says it’s “like meltdowns of my body and brain.”

How to Avoid Post-Exercise Malaise from COVID

PEM is most closely associated with chronic fatigue syndrome (CFS), which some research has suggested is also a post-viral response, although Labus stresses that there is a significant difference between the two illnesses. “We are in a better position to understand long-haul COVID than we were with chronic fatigue syndrome because we know COVID is causing the symptoms we are seeing. With CFS, no one knew what led to the symptoms,” he explains.

Nevertheless, Neiman advises his patients both with COVID and with long-haul COVID to heed the advice given to CFS patients: Take it easy if you have a symptom, such as a fever or fatigue, that points to an infection or if you have been exposed to COVID and believe you may become infected. Don’t push yourself just because that is your typical training behaviour.

“In my first month of recovery, I walked to go vote, and the next day my brain and body didn’t work. I had to go home from work.” Montesano says. “I’ve helped myself by just limiting what I do. I haven’t trained. I barely rode.”

After taking this time off, Montesano began to see some improvements. “In the past month, I’ve felt a little bit better, but I’m still left with a sense that if I overreach, I could have a setback.”

How to Return to Exercise After Long-Haul COVID

Neiman works with many athletes and adventure athletes, and “they have the hardest time backing away, but they have to stop competing and regain their health,” he says. The good news, he adds, is that studies have shown that a lot of your strength and endurance will return even if, for a year, you walk instead of cycle.

To make sure you recover properly and avoid even more long-haul COVID complications, follow these tips for easing back into movement.

Walk Rather Than Ride

Don’t even think about pushing yourself, Nieman says. When you have COVID or if you’re suffering with lingering symptoms even if you aren’t testing positive, take leisurely walks rather than getting your heart rate up in the type of exercise that you would consider a “workout.” During your illness, exercise should be easy-going and not at all sweaty or a “push,” he says.

Find a Substitute

If you take something away from your life, you need a substitute, and “we have shown in our immune lab that the immune system handles back-and-forth activity really well,” Nieman says. This might include moderate tennis or even gardening. Basically, the activity should include movement that isn’t intense and has periods of rest built into it. In other words, don’t try to play like Serena. Your goal is not to sweat and to keep your heart rate down while having fun.

Pace Yourself

One common experience of those with long-haul COVID is having a good day and then pushing themselves because they feel better, which leads, unfortunately, to a “crash.” Of course, intensity is personal to each athlete, so keep in mind that with COVID, a “push” may not necessarily feel like what it would have before COVID. “Pace yourself,” says Nieman. “If you have a good day, you still need to rest the next day in order to not have a crash that leads to two weeks of malaise.”

Just as with an active COVID infection, long-haul COVID patients should check in with themselves every week to two weeks to see if they can add some activity to their routine, and when they do, the increments should be small.