‘How’s working going’ is a question we get asked a lot. Like those who casually approach doctor friends for some ad hoc medical advice, friends and family usually come to me with their health and fitness woes.

What’s struck me the most about these conversations over the past year is how people’s attitudes to exercise have changed during lockdown.

Before lockdown, an ordinary evening for one friend was after-work drinks, a taxi home, and something quick and easy to eat in front of the TV before nailing a family-sized bar of Cadbury’s (no judgement, we’ve all been there).

But amid global lockdowns, people began to turn toward healthier choices: home-cooked meals took precedence due to restaurant closures; people were moving more just to get out of the house; and people took up simple exercise routines as ways of coping with the anxieties of health concerns, furloughs, and spending extended amounts of time with ‘loved ones’ under one roof.

But on the flip side of this are the people who spent lockdown dealing with a covid-19 infection or post-acute symptoms.

What the long-term effects of covid recovery will be, only time will tell. Still, preliminary research has highlighted several key concerns, including persistent impairments in pulmonary function and exercise capacity in survivors.

So how should those who are suffering from long covid introduce exercise back into their daily routine?

As with anything new or unknown, research and education around exercising post-covid are limited and ongoing, with no clear, evidenced-based way to return to physical activity.

However, health professionals and researchers generally agree that a phased approach is necessary, even for those who feel that a covid infection has left them with zero symptoms, as exertion can bring on symptoms including shortness of breath and fatigue.

Yoga has been identified as one of the first phase activities introduced into a person's recovery. As you've probably seen me harp on about, yoga is excellent for a myriad of reasons, including breath control and stretching.

The British Medical Journal (BMJ) suggests that only when someone’s been symptom-free for seven days should they begin with at least 14 days of minimal exertion, including seven days of light intensity activity, such as household and light garden tasks, including flexibility and breathing exercises, followed by seven days incorporating light intensity activity, such as walking and light yoga, with graduated increases at 10-15 minute increments.

The main thing to keep in mind for anyone experiencing respiratory issues – be this covid-related or not – is to avoid any yoga poses that compromise breathing, such as those poses that require us to lie flat on our back.

Poses involving any type of support, be that bolsters or blankets, will help the back and lungs open and could be a useful starting point. Supported child's pose (balasana), half-forward fold (Ardha Uttanasana) over a blanket-covered table, or seated mediation (a chair-variant of savasana) are all recommend in phase 1 of rehabilitation. A review of post-acute covid treatments last summer by the BMJ recommended breath control techniques that use breath retention, such as pranayama and Ujjayi practices, to help work through breathlessness and chronic coughing.

Once this (minimum) 14-day period has completed, it is advised to progress to more challenging movement activities depending on an individual’s pre-illness capacity, such as two 5-minute blocks of activity such as brisk walking, climbing stairs, light jogging, swimming, or non-demanding cycling separated by a block of recovery.

The final suggested phase of introducing physical activity includes more complex movements that challenge a person’s coordination, balance, and strength, such as running but with changes in direction, side-steps, shuffles, and circuits of bodyweight exercises, but again without it feeling too demanding. After completing phase 4, people should then feel able to return to their baseline (pre-covid) level of activity or more.

A minimum of seven days at each stage is recommended for a baseline level of comfortability to be achieved. It may be worthwhile keeping a fitness diary for progression, noting which activities and exercises cause symptoms such as abnormal breathlessness, excessive lethargy, abnormal heart rate, and even bring on ill mental health.

Even after apparent symptoms have disappeared, your body is likely still dealing with the scarring and inflammation in the lungs and other tissues, and we mustn't push ourselves too far, too soon, as this could slow our overall recovery or cause a flare-up of symptoms.

As with any illness, it is best to consult your doctor before embarking on an exercise routine. If you're concerned that your breathing and overall energy levels aren't improving or your ability to complete simple activities is affected, speak with your GP, as having someone prescribe a bespoke plan knowing what exercises are safe suitable for you is the recommended gold standard approach.

Returning to exercise after covid-19.