Olympians exercised with COVID-19. Should patients?

Days after winning gold in the 100-meter dash, Olympic champion Noah Lyles lined up to race the 200-meter dash—with COVID-19.^[] Lyles placed third in the event, after which he was rolled off the track in a wheelchair. Masked up, he accepted his bronze medal at the awards ceremony a day later.

Lyles wasn't the only athlete allowed to compete in the Olympics with COVID-19—an opportunity made possible due to changes in Olympic health restrictions from 2021 to 2024. According to the World Health Organization, as of August 6, at least 40 athletes at the Olympics had tested positive for the virus.^[]

In 2021—the year the 2020 Olympics was moved to after being delayed due to the onset of COVID-19—athletes underwent extensive COVID-19 testing and followed strict social distancing requirements during the competition.^[] For instance, athletes were tested twice for COVID-19 before boarding their flights to Japan and again upon arrival. Throughout their time in Japan, they had to provide daily saliva samples. Athletes who tested positive for COVID-19 were isolated in a separate hotel, impacting their ability to compete.^[] 

On Friday, the day of Lyles’s bronze medal awards ceremony, International Olympic Committee President Thomas Bach reportedly stated that COVID-19 “is being treated like flu now, so there is no obligation for any special measures or notifications.”^[]

In a statement to NPR about Lyles’s COVID-19 diagnosis, USA Track & Field said that the organization had been following Centers for Disease Control and Prevention (CDC) guidelines and that the organization’s “primary commitment is to ensure the safety of Team USA athletes while upholding their right to compete.”^[]

Exercising and COVID-19

While Lyles has since tested negative for COVID-19, questions linger about his decision to race with the virus—and what takeaways the general public should (or shouldn’t) take from it.^[] For instance, on a non-Olympic stage, your patients might wonder whether it’s healthy to exercise vigorously with COVID-19 or if it’s smarter to rest and recover.

Perhaps unsurprisingly, the answer is complex. For starters, it’s likely still evolving—similar to the virus itself, with different variants and according to the presence or absence of surges. Additionally, it might not be not a one-size fits all answer, particularly for people with different health conditions or vulnerabilities.

In the early days of the pandemic, some doctors recommended a 14-day break from exercise—in line with original 14-day quarantine recommendations—followed by a gradual return to former activity levels.^[] Some health agencies, like the National Institute of Health (NIH), still recommend rest over vigorous activity.^[] In its COVID-19 treatment guidelines—last updated in February—the agency says that “[r]est is recommended as needed during the acute phase of COVID-19, and ambulation and other forms of activity should be increased according to the patient’s tolerance.”

But changes may be on the horizon. 

Now, some doctors suggest that working out with COVID-19 is OK for some people, so long as they are mindful of personal limitations. Research has also shown the benefits of exercise against COVID. For instance, studies have shown that people who practice regular physical activity have fewer and/or less severe symptoms of acute COVID-19 when infected with the virus when and if they come down with the virus.^[] While exciting, this might not be true for long COVID.

Neal H. Patel, DO, a family medicine doctor at Providence St. Joseph Hospital in Orange, CA, says that “although there are some hypotheses that show exercise may exacerbate long COVID symptoms, most articles and research bodies agree that exercise has an overall protective and beneficial impact against COVID.”

“Working out overall is safe,” Dr. Patel adds. “However, if you or someone you know does have COVID and has a fever or symptoms, it’s best to avoid crowds or exercising in a closed area like an indoor gym.” 

Dr. Patel encourages patients to avoid contact sports and be mindful of any flare-ups of symptoms “like dizziness, chest pain, shortness of breath, palpitations, nausea, or weakness.” If these symptoms do arise, you should stop your workout and seek medical attention, he adds.

To come up with the best recommendation for individual patients, you may want to discuss their health history and how you think their current symptom profile may respond to the benefits or risks of exercising with COVID-19. Some patients may benefit from knowing that their body is already doing a few workouts of its own to flush out germs, and so it’s OK to take a day off every so often.