Recovering from long COVID - a cyclist's guide

As the COVID-19 pandemic has progressed, one of the few things that has become clear is that individual cases of the disease can have wildly different outcomes. 

Of course, there is the stark and tragic disparity between those who die of COVID and asymptomatic carriers who don’t even know they have it; but for cyclists and people who enjoy exercise, there are further levels of distinction as the various roads to recovery take their unique turns. Some people can resume life in the saddle after the initial infection almost as if nothing has happened, while others still aren’t up to full speed and continue to feel the debilitating effects of COVID months later.

So, what can you expect and how will you recover? We do our best to answer those questions here.

A disclaimer: we had planned to run this as a Q&A session with a qualified medical practitioner. However, the constantly evolving nature of the COVID pandemic – for example, as we went to press, the Health Secretary at the time Matt Hancock had just announced a new strain of the disease – along with health authorities’ restrictions on anything other than approved official guidelines, has meant that the frontline doctors we contacted were understandably hesitant to publicly put their name to any advice. So, for this article, we will be using official NHS guidance and specifically that found on the Your COVID Recovery website.

What is ‘Long COVID’?

Despite its increasing use in the media and among the public, there is no clinical definition of ‘Long COVID’. It generally refers to the longer-lasting effects of COVID infection beyond the initial acute phase. From browsing the comments on a number of cycling and sports forums, it is clear that some people who have contracted COVID are still finding it hard to return in full to their previous exercise regimes, even months after the initial infection.

According to the Your COVID Recovery website: “Clinicians and scientists across the world are working to find out what happens to people as they recover [from COVID]. They are also trying to identify any long term problems that occur… At the time of writing, we do not know exactly what will happen to people as they recover, however, there is a lot of information to help us… 

“Many people will make a full recovery. It may take weeks to a few months. We expect that some people will have ongoing symptoms of cough, breathlessness, poor or reduced sleep, fatigue, anxiety and low mood.”

What can I expect in terms of COVID recovery? 

Before we look at long-term physical recovery, it’s worth understanding what to expect as soon as you return to normal life after COVID; because the effects of even a relatively minor infection can be dramatic. 

One doctor who we spoke to for the purpose of this article, who contracted COVID himself, was shocked that on returning to work, he was left exhausted just from walking up the stairs to his office – as he had always done previously – and was reduced to taking the lift. So, be prepared initially to deal with some potentially significant impairments to your physical and even mental abilities, as COVID can also cause lack of concentration.

When it comes to longer-term recovery periods, it's then helpful to appreciate a couple of points: the first is that many viral infections, not just COVID, have the potential to ‘knock somebody for six’ and will require an extended recovery, that can take weeks or months. So, do not think this is a specifically unpleasant added extra in the case of COVID.

The second is that the severity of symptoms during a person’s initial acute infection can be a rough indication of how long recovery will take. COVID sufferers who were hospitalised, for example, will almost certainly take a longer time to recover than those who only had low-level symptoms. 

What’s the recovery time frame?

As with all things COVID, an individual’s recovery time frame is very much unique. Most symptoms of the initial, acute phase of COVID – fever, cough, a change in sense of smell, etc – will clear up within a couple of weeks. 

However for people who have had more severe symptoms during the acute phase, who were hospitalised, or who have other underlying health conditions, this recovery period can be significantly protracted. 

According to the Your COVID Recovery website: “For most people who have had the COVID infection and were severe enough to need hospital care, we would expect from experience with other similar bacterial and viral infections that in around:

• 4 weeks most of the chest pains, and phlegm (sputum) should have reduced.
• 6 weeks cough and feeling breathless should have greatly reduced.
• 3 months most symptoms should have settled but tiredness may still be present.
• 6 months symptoms should have all settled.”

People admitted into intensive care will often find that recovery takes longer than this, possibly up to a year.

How can I aid my recovery?

There is little you can do to speed up your physical recovery, although making sure you are getting enough sleep and eating well will go a long way to helping your general wellbeing. If you're finding even daily tasks tiring – quite aside from cycling or exercise – the NHS recommends conserving your energy by following the ‘3 Ps Principle – Pace, Plan and Prioritise’.

Although not all of these measures have a specific benefit to cyclists, there are still some relevant messages, especially in the Pace section, such as:

• Give yourself permission to slow down. Don’t expect to be able to do everything at once, or at the pace you used to do. Do less than you think you can.
• Break activities into smaller tasks and spread them throughout the day. You’ll recover faster if you work on a task until you are tired, rather than completely exhausted.
• Build rests into your tasks and plan 30-40 minutes of rest breaks between activities. Resting is key to recharging your energy.

I don’t seem to be improving - when should I seek medical advice?

If your symptoms are steadily getting better, the likelihood is that recovery is just a matter of patience and time. Don’t push yourself too hard and cause your own relapses in fitness.

If you are concerned that things just aren’t improving as you’d expect, or you naturally start to experience worsening symptoms - such as being able to walk or cycle shorter distances before stopping because you are out of breath, or getting dressed more slowly in the morning - contact your GP or health team.

It’s particularly important to seek medical advice if you develop new symptoms, such as:

• Swelling of a leg or arm
• Chest pain
• Losing more weight/not wanting to eat anything
• A racing heart
• Muscle aches

And, call 999 or 111 if you experience any of the following:

• Coughing up blood
• Severe chest pain
• Getting more breathless

Although this is a busy time for the NHS, do not hesitate to get in touch with primary healthcare providers if you have a concern. The Your COVID Recovery website says: “Many people worry about calling the specialist teams or their general practice, thinking that there is too much work and pressure on services. In the NHS we are busy, but we would prefer you to contact us as we are here to support your recovery and will be doing our best to support you… Please do not feel that you are wasting NHS time, we want to help you to get better as quickly as possible especially if you develop new or worsening symptoms.”

Conclusion

The only indicator of a successful recovery is that people are able to resume their normal lives again, including exercise, even if only in moderation at first. So, remember these points:

• Listen to your body and stay well within your new reduced limits
• You cannot return immediately to the same level of cycling you had before infection (quite aside from any effects of ‘Long COVID’, your fitness levels will have dropped during the period you were ill)
• Everyone’s recovery is different, and it may take weeks or months to fully recover
• If in any doubt at all, contact your GP or local NHS for advice
• For further post-COVID information, visit www.yourcovidrecovery.nhs.uk

Finally, if you have had COVID and are finding it hard to get back to your previous levels of cycling, rest assured you are far from alone. There is no point in rushing your return to full fitness, it will not speed things up and there is the potential to do yourself further harm. Recovery is more a test of patience than performance when it comes to this infuriating disease. 

Rehabilitation resources

For further reading, Sussex Community NHS Foundation Trust has collated some excellent COVID recovery strategies on its Rehabilitation Resources page.

Further updates 

Since this article was first published, a NICE guideline titled "COVID-19 rapid guideline: managing the long-term effects of COVID-19" was published online. It's a lengthy and evolving document intended for health and care practitioners, health and care staff involved in planning and delivering services and commissioners - which will hopefully lead to an improvement in the treatments and recommendations given to long COVID sufferers. An article in The Lancet at the time said that while the guideline is welcomed, "certain gaps are evident and it will be crucial to fill them as soon as possible".

As of 17th August 2021, it's estimated that there have been over 6.3 million cases of COVID-19 in the UK. The latest release of an article on the Office for National Statistics website titled 'Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK' (dated 5th August 2021) estimated that 945,000 people living in private households in the UK were experiencing self-reported long COVID symptoms at 4th July 2021 - almost 1.5% of the population. This is slightly down from 962,000 at 6th June, but it's clear the problem is far from going away. 

Here are a selection of comments from readers that we've had across the site and social media: 

I caught what I thought was a chest infection in March last year, but now we know more about Covid it turns out there's a good chance I was unlucky to catch it early. My lungs haven't gotten back to normal and I have flare ups where the coughing and fatigue come back fairly regularly (at least one week a month). It's not crippling, but I can't ride anywhere near as much as I used to. It takes me as long to recover from a 30-40mile ride as a century would have beforehand. And I'm only 28, it's not something you want to mess with if you can avoid it.

Had covid and felt awful for 2-3 weeks. Started to feel better, had a couple of short rides (10-12 miles) to see how I would react and seemed ok. Did a 32 mile ride on New Years Day and that was that. Not ridden since and set me back to where I was. Had chest pain and coughing loads. Don't rush back and listen to your body.

My experience after catching it in March after a trip to the states was complete debilitating fatigue for around 4-5 days, unable to even get out of bed. Short of breath even going to the bathroom, then seriously fatigued for another 2-3 weeks before able to get back on the bike. Long term I'm noticing regular joint pain even when I've not been on the bike. 

Hopefully even more information and useful resources will be available for long COVID sufferers and medical professionals soon. It's very clear from the responses we've had and the prevalence of the problem reported in the national media that those who have been hit hard by the disease are far from outliers. In the meantime, we hope our readers who are still feeling the effects go on to make a full recovery, and that all of you stay safe and well until this pandemic is fully over.