Millions of Germans are currently infected with Corona. Because a relatively large number are vaccinated, the infection is “mild” in most cases, ie without hospitalization, sometimes only with the symptoms of a mild cold. Once you feel healthy again, nothing should interfere with your usual sport – in order to regain strength and get fully in shape. And professional athletes show this, they are back in full training right after the last negative test or even competing.
FOCUS Online asked Martin Halle, Medical Director of the Center for Preventive Sports Medicine and Sports Cardiology at the Technical University of Munich, Chair and Polyclinic for Preventive and Rehabilitation Sports Cardiology. The professor is President of the European Society of Preventive Cardiology (EAPC).
FOCUS Online: Professionals, for example in football and ice hockey, seem to be returning to the field quickly after a coronary infection. Can the hobby be transferred to the athlete – negative test and go back to the beginning?
Martin Hall: No, the negative test only shows that the virus is no longer present in the nasopharynx. A negative test is not enough. The virus is still in the body and can affect the function of one or the other organ. Even after a negative test, for example on the heart, it can still cause inflammation of the heart muscle.
This is different for competing athletes because they can be better examined. You can do an MRI, for example, which shows particularly clearly the inflammation of the heart muscle. If this examination does not show anything abnormal, the ECG is OK and the lab, ie blood values, maximum stress test and heart ultrasound, then of course you can do competitive sports again. However, this is not the case for amateur athletes.
When can recreational athletes run or go back to the fitness center?
Hall: The corona has two phases. The first stage is when the virus hits the mucosa and you feel sick. In the second stage, about ten days later, another inflammatory reaction occurs. Therefore you should definitely wait two weeks after the end of quarantine and do not train. This is especially true for the unvaccinated.
What applies to vaccinated persons after coronary infection?
Things are a little different for those who have been vaccinated, the symptoms are not as severe, the second stage is less severe and you can usually start a week or ten days after the end of quarantine with a light load. We do this in our outpatient clinic as well: Eight days after quarantine ends, provided you are fully healthy again, competitive athletes start slowly again, recreational athletes after 14 days.
How can I determine for myself if I can start exercising again?
Hall: This is not easy. But the general rule for vaccinated people is: If there was no cough, no beating in the chest, which indicates cardiac arrhythmia, and you can climb the stairs in daily life as before – then you could say it was probably a normal flow. And I guess I can start exercising again 14 days after quarantine ends.
What does the start of training look like after Corona?
Hall: This should be very easy, first some stabilization exercises that load less on the heart, blood circulation and lungs, then strength training and I should wait at least a week before doing the endurance training. You need to approach the whole start slowly and be careful not to breathe too much. At first, moderate Nordic walking is appropriate, later you can start running slowly again and then return to normal exercises.
What are the warning signs against resuming exercise?
Hall: The muscles feel heavy, climbing stairs – as mentioned – is more difficult than before, there is still a little coughing and above all – the pulse is irregular, ie beating in the chest. Then you should wait and definitely see a doctor.
Should those who want to be on the safe side have a medical check-up before resuming training?
Hall: Of course, not all those who had Corona should go to the doctor now. But if you noticed the mentioned changes two weeks after the quarantine ended and you had a real fever and a strong cough and you had to lie in bed, I would advise you to ask your doctor.
What is the risk if these precautions are not followed?
Hall: The main problem is inflammation of the heart muscle. Everything else is not so important. Inflammation of the heart muscle can cause fluid to build up in the body, which in turn can disrupt the electrical system and lead to abnormal heart rhythms. This is why you need to control your heart.
So starting training too early or too intensely can be a big mistake?
Hall: I would like to stress the importance of resting after infection. I know athletes who said, oh, a little infection, it was very easy for me, I will start again in full force. You do not have to do this, the virus is very insidious about it. Inflammation of the heart muscle can occur even in mild cases.
But is there such a risk with omicron variants as well? Are you considered harmless?
Hall: Yes, in our outpatient clinic I also see people who have been vaccinated with omicron and who later have inflammation of the heart muscle. This is not entirely unusual. And that’s why: Omikron is definitely not harmless. This is why it is still true to me: it is better to wear a mask and not take it. But the most important thing is: get vaccinated at least three times, because the courses are usually not so pronounced.
What experience have you had so far with the athletes and patients you and your team care for – after all, more than 10,000 a year and currently some who have already had Omikron?
Hall: We are currently seeing about five patients and athletes a day after a coronary infection. This is significant. In those who had a severe cough as part of the disease, we also look for diffusion disorders, i.e. if the transport of oxygen through the lungs is limited. The virus can cause slight adhesions to the lungs, which impairs oxygen transport.
Many people believe that there should not be any lung involvement in Omicron?
Hall: Yes, that’s certainly the case with Omicron. I also see people who were quite fit before Omikron, but just can not stand up afterwards – have muscle problems, fatigue, headaches. So Omikron is not harmless, certainly not.
So there is also the long-Covid in Omikron. How can I be sure if I want to be physically active again after the infection?
Hall: So 14 days after the end of the quarantine no sport! Then start with stability training, coordination training, later strength training and later again endurance training. But if you then feel that you are getting tired faster, that you are no longer as resilient as you used to be – you can understand this – then you need to check and adjust your workout plan accordingly.