Exercise guide
Myocarditis is inflammation of the heart muscle, and pericarditis is inflammation of the sac around the heart. Both usually follow a virus, and most people recover fully. While the heart is inflamed, exercise has to wait: European heart specialists recommend restricting it until the inflammation has settled, for at least a month, and older guidance and UK charities often say 3 to 6 months before hard exercise or sport.
Your cardiologist sets the timing from your tests. Nobody has tested in a trial how long people should rest, so the advice comes from expert agreement, and this page shows where the sources differ.
This guide explains why rest matters, the tests before you go back, a step-by-step return from walking to full training, pericarditis, exercising after a virus or a coronavirus (COVID-19) vaccine, children and athletes, and the symptoms that mean stop and get help.
During the active illness, the European Society of Cardiology (ESC) advises no physical activity beyond everyday, mostly sitting-down activities until your symptoms have gone and your tests are back to normal, and complete rest in the early stage of myocarditis, because exercise on an inflamed heart has been linked with dangerous heart rhythms.
The 2025 ESC guideline recommends restricting exercise until the inflammation has settled, for at least 1 month, decided person by person. Its 2020 sports guideline, the British Heart Foundation (BHF) and the ESC's own patient guide give 3 to 6 months before vigorous exercise or sport after myocarditis. Your cardiologist decides.
Before you go back, expect blood tests, an electrocardiogram (ECG), a heart scan, a heart rhythm monitor, an exercise test and, after myocarditis, usually a cardiac magnetic resonance imaging (MRI) scan within 6 months.
Once your doctor approves, the ESC's patient guide says start with light exercise, such as walking or an exercise bike, and increase it slowly over weeks. Move up only when you've had no symptoms; hard intervals and competition come last.
Rest while you have a fever or feel unwell, as the NHS (National Health Service) advises for colds and flu, then build up gently: a precaution rather than a tested rule. If you feel well after a COVID-19 vaccine, UK guidance says there's no need to cut back on exercise.
Chest pain, palpitations, unusual breathlessness, feeling faint, or tiredness that doesn't fit the effort mean stop and contact your doctor. Call 999 for chest pain that feels tight or spreads, severe breathlessness, or if someone faints while exercising.
Myocarditis is inflammation of the heart muscle, usually after a virus; some people have no symptoms, and most recover. Pericarditis is inflammation of the lining around the heart, and most people recover within weeks. When both happen together, it's called myopericarditis, and the 2025 ESC guideline now groups them as inflammatory myopericardial syndrome because they so often overlap.
The commonest cause is a virus, such as flu or COVID-19. Others include bacterial infections, autoimmune diseases such as lupus, drugs such as cocaine, certain medicines, including the antipsychotic clozapine, and, rarely, vaccines.
Myocarditis can cause chest pain or tightness, breathlessness at rest, when active or lying down, unusual tiredness, palpitations or an irregular heartbeat, light-headedness or fainting, and flu-like symptoms. The BHF says symptoms often start up to 2 weeks after an infection. Pericarditis usually causes sharp or stabbing chest pain that gets worse when you breathe in deeply, swallow, cough or lie down, and better when you lean forward.
One registry found myocarditis in 6.3 to 8.6 people per 100,000 a year, mostly young men, and acute pericarditis affects about 3 to 32 per 100,000 a year, again more often men and younger people. The UK Health Security Agency (UKHSA) cites a UK study estimating about 2,000 hospital admissions for myocarditis in 2017.
The BHF says most people have one episode of myocarditis and get better with rest, medicine and avoiding high-intensity exercise while the heart recovers. The ESC says it comes back in about 10% of people, and that pericarditis usually settles within 4 to 6 weeks of treatment, but comes back within 18 months in 20% to 30% of people. A minority of people with myocarditis are left with scarring, heart failure or rhythm problems.
Pericarditis is treated with anti-inflammatory painkillers such as ibuprofen, and colchicine if they don't work or it keeps coming back. Myocarditis treatment depends on the cause and on how the heart is affected. Exercise doesn't treat the inflammation; the return to exercise is about rebuilding your fitness once your heart has healed.
Older case series list myocarditis as a cause of up to 2% to 20% of sudden deaths in athletes, and in studies in mice with a viral infection, daily exercise made the myocarditis worse. In the UK, it caused 1.1% of 7,702 sudden cardiac deaths between 1994 and 2022. These are the reasons for resting, but no study has measured how exercise affects people's recovery.
No study has compared rest periods, or tested whether a fixed period prevents problems. The 2025 ESC guideline calls the older fixed periods of 3 to 6 months arbitrary, and bases the return on your symptoms and test results instead.
In a US college registry, 27 athletes with myocarditis after COVID-19 had a repeat MRI 4 to 14 weeks after their positive test. The changes had completely gone in 41% after a median of 8 weeks, but in only 1 of 6 athletes who'd had symptoms of myocarditis, after 10 weeks. A sports medicine editorial points out that MRI signs of inflammation often settle sooner than the 3-month rest period.
The 2025 ESC guideline says at least 1 month, until the inflammation has settled, decided person by person. Its 2020 sports guideline says no moderate to high-intensity exercise for 3 to 6 months after acute myocarditis, the BHF says avoid vigorous exercise for 3 to 6 months, and the ESC's patient guide says sport and vigorous exercise usually stop for at least 3 months. The American College of Cardiology (ACC) says athletes can be reassessed from 1 month.
Every guideline asks for a gradual, step-by-step return once you're cleared, and a sports medicine editorial suggests a structured programme with supervised training and steadily rising effort. This is agreement among experts; no trial has tested one plan against another.
The ESC advises restricting physical activity to everyday, mostly sitting-down activities until your symptoms have gone and your tests are back to normal, and complete rest in the early stage of myocarditis. With pericarditis, its patient guide says mild activity such as short walks might be allowed, but definitely no heavy lifting or intense exercise.
The sources give different times, and your cardiologist decides from your tests:
The ESC says people who have fluid around the heart with no known cause and no symptoms, and a normal C-reactive protein (CRP) blood test, should be reassured, and shouldn't restrict their activity.
Source 1
If the MRI shows scarring but no ongoing inflammation, and your other tests are normal, the return is decided case by case. The ESC's sports guideline says people with extensive scarring and a heart that still pumps less well should avoid moderate or high-intensity exercise. Our heart failure guide covers exercise when the heart is weakened.
After myocarditis, the ESC recommends follow-up within 6 months that includes:
The ESC's sports guideline says the return to sport should be considered when you have no symptoms, normal blood tests, a heart that pumps normally on the scan and MRI, no ongoing inflammation or scarring on the MRI, good fitness, and no complex rhythm problems during exercise or on a longer heart monitor. For pericarditis, the ESC looks for no symptoms and a normal CRP.
In uncomplicated myocarditis, the ESC says check-ups at 6, 12 and 24 months are enough; complicated cases, and pericarditis that keeps coming back, are followed for longer. Its sports guideline suggests yearly re-checks for people who play sport.
This stage plan is our editorial suggestion, built on the ESC patient guide's advice to start with light exercise and increase it slowly over weeks; the time in each stage is our suggestion too. Start only once your cardiologist says you can, and move up a stage only after at least a week with no symptoms.
The ESC's patient guide says if symptoms such as tiredness or chest discomfort return, stop and talk to your doctor, and the BHF says see a doctor straight away or phone 111. After any minor illness, drop back a stage for a few days (our suggestion).
The ESC asks for an exercise plan made for you. Our suggestion: in stage 2, start with your own body weight or light bands, 8 to 10 steady repetitions, breathing out on each effort, and leave heavy lifting until your cardiologist clears you for hard exercise.
Walking or an exercise bike for 10 to 20 minutes on most days at a chatting pace (our editorial stage plan); the slow breathing page's dose is at least 5 minutes, as part of your daily routine.
Twice a week, 8 to 10 steady repetitions with your body weight or a light band, breathing out on each effort (our editorial starting point).
Once your cardiologist agrees: the elliptical trainer page's dose is 10 to 20 minutes at a moderate effort, building towards 30, and the indoor rowing page's is 3 rounds of 4 to 5 minutes at a pace you could hold a conversation at, resting a minute between.
The 2020 ESC sports guideline says people who have fully recovered can return to all exercise, including competitive sport, after 30 days for a mild episode that settles quickly, and up to 3 months for a severe one. The BHF says avoid high-intensity exercise for at least 3 months, and the 2025 ESC guideline says at least 1 month, until the inflammation has settled. If you had myopericarditis, follow the myocarditis advice.
Pericarditis comes back in 20% to 30% of people, fewer with colchicine, and the same rule applies each time: rest until the inflammation has settled. The ESC says limiting exercise keeps the heart rate down, which may help settle the inflamed layers. The BHF says that for some people recovery takes several months.
The NHS advice for colds and flu is to rest. As a precaution, don't exercise while you have a fever, aching muscles or feel generally unwell, and start back with a few easy sessions once those have gone (our suggestion, not a tested rule). Myocarditis symptoms can start 1 or 2 weeks after an infection, so chest pain, palpitations, breathlessness or fainting in the weeks after a virus need checking before you exercise hard.
The ACC's advice for athletes after COVID-19: with no symptoms, take 3 days off training; with mild symptoms that don't affect the chest, wait until they've gone; with chest pain, palpitations, breathlessness or fainting, get checked before exercising hard. Then build up gradually.
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The UKHSA says that if you feel well after a COVID-19 vaccine, there's no need to cut back on exercise. If you get chest pain, palpitations, unexpected breathlessness or fainting, get medical help, and avoid strenuous exercise until your symptoms improve. The ACC says vaccination on its own doesn't need a set time away from exercise.
Myocarditis after the mRNA COVID-19 vaccines is rare, mostly in young men after the second dose, usually within a few days, and usually mild. The BHF says COVID-19 itself is much more likely to cause myocarditis than a vaccine in most people: in 42.8 million people in England, the risk after infection was higher than after vaccination, except in men under 40 after a second dose of the Moderna vaccine. Of 393 young people in the US who had it, 81% were considered recovered at least 90 days later.
If you have long COVID with a crash in energy after activity (post-exertional malaise), pacing comes first rather than a step-by-step increase: our long COVID guide explains how.
Children's care is led by a children's heart specialist, and the ESC's patient guide says school activities and sport may be limited for a while. Younger children may not describe chest pain, but seem very irritable, breathe quickly or refuse to eat. Cardiomyopathy UK says many children recover completely, though some develop heart failure and need long-term care.
The ESC says restricting exercise can affect mental health, especially in children and young adults, and can lead to frustration, sadness and depression, so decisions about it should be shared with the young person.
Source 1
Competition comes back once the tests show the heart has healed, as described above, and the ESC's patient guide says sport usually stops for at least 3 months, followed by repeat heart tests. The ESC's sports guideline suggests yearly check-ups after myocarditis for people who play sport.
If scarring remains after 3 to 6 months but there's no ongoing inflammation and the other tests are normal, the ESC says the return can be decided case by case.
Source 3
Only once your cardiologist says you can start: the easy cardio workout and walks after meals for stage 1, the bike ride, home, cardiac rehab-style and band workouts for stage 2, then the interval walks, run-walk and swim workouts for stage 3. Leave out high-intensity interval and tabata workouts until you're cleared for hard training.
A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA steady bike ride for a first triathlon or fitness: 5 to 10 minutes easy, a ride you can talk through, optional short faster bursts and an easy cool-down.
45 minBeginner4 movesCardio machine, A wallA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesA wall, A bench or boxA full-body resistance band workout: squats, rows, push-ups, presses, pull-aparts, band walks, good mornings and flyes.
30 minBeginner9 movesA band, An anchor pointA 25-minute walk with short faster bouts: notice your heart and breathing speed up, then settle. A gentle way to get used to the feelings of effort.
25 minBeginner5 movesCardio machine, A wallA 40-minute walk alternating 3 minutes fast and 3 minutes easy, five times over: the interval walking tested in Japanese trials, built up from three rounds.
40 minBeginner3 movesCardio machine, A wallA 30-minute beginner run-walk session: a brisk walk, then 1-minute jogs with 1-minute walks, building to 3-minute runs over your first three weeks.
30 minBeginner5 movesCardio machine, A wallA 30 to 45-minute beginner pool swim: a shoulder warm-up on the side, easy lengths, a main set of repeats with rests, and an easy swim down, any stroke.
35 minBeginner5 movesOther / check instructionsThe walking plan builds to 150 minutes a week over 8 weeks, and Couch to 5K is a stage 3 and 4 option once your cardiologist agrees.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginnerThe ESC says exercise restriction can lead to frustration, sadness and depression, and supports shared decisions about it. Its patient guide suggests joining a support group, focusing on what you can control, setting small goals such as a daily walk when it's allowed, and gradually going back to hobbies and routines you enjoy. Our anxiety and depression guides can help too.
This is general information, not a diagnosis. A&E means accident and emergency, and GP means general practitioner. In the US, call 911 where this page says 999.
Call 999 (911 in the US) if:
Don't drive yourself to A&E. Sit and rest on the floor with your knees bent and your back supported. Take a 300 mg aspirin if you have one and aren't allergic to aspirin, and use your GTN (glyceryl trinitrate) if you have angina. The person you speak to at 999 will give you advice about what to do. If someone stops responding and stops breathing, start CPR (cardiopulmonary resuscitation).
Source 9
The ESC's patient guide says call the emergency services or go to an emergency department (in the UK, call 999 or go to A&E) for:
Source 2
Ask for an urgent GP appointment or get help from NHS 111 if you have chest pain that's sharp or stabbing, or that gets worse when you take a deep breath in, swallow, cough or lie down. Call 999 for sudden chest pain that spreads to your arms, back, neck or jaw, makes your chest feel tight or heavy, started with shortness of breath, sweating and feeling or being sick, or lasts more than 15 minutes.
Source 12
Call 999 or go to A&E if you have palpitations that don't go away, or that come with chest pain, shortness of breath, feeling faint or fainting. If they've stopped, ask your GP surgery for an urgent appointment or call NHS 111.
Source 18
Stop and contact your doctor if symptoms come back, such as tiredness or chest discomfort. Our suggestion: don't exercise again until you've spoken to your cardiologist or GP if you get chest pain or pressure, palpitations or a racing heart that doesn't settle with rest, breathlessness out of proportion to the effort, dizziness, a temperature, or tiredness that's still there the next day.
The NHS says call 999 or go to A&E if you or your child have any of these within a few days of being vaccinated, and contact NHS 111 if symptoms are getting worse or you're worried:
If someone is unresponsive and not breathing normally, call 999, start CPR straight away and send a helper for the nearest defibrillator. Put the phone on loudspeaker: the call handler will help you, and can tell you where the nearest defibrillator is. Push down hard in the centre of the chest, about 5 to 6 cm deep, twice a second, and don't stop until help arrives or the person shows signs of life. A defibrillator talks you through what to do, and will only give a shock if one is needed.
Being ill and told to rest can affect your mood. If you feel you can't keep yourself safe, call 999 or go to A&E. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any time. In the US, call or text 988. The BHF's Heart Helpline is free on 0808 802 1234, weekdays 9am to 5pm.
Feeling better isn't the same as healed: the ESC recommends restricting exercise until the inflammation has settled, shown by normal blood tests, ECG and scans. In US college athletes with myocarditis after COVID-19, the MRI changes had cleared in 41% after a median of 8 weeks, but in only 1 of 6 who'd had symptoms, after 10 weeks.
The 2025 ESC guideline calls fixed periods arbitrary and recommends at least a month, then a decision based on your tests. 3 to 6 months is still common advice before hard training and sport.
Most people recover fully, and a return to all sport is recommended once the tests are normal. Of 393 young people in the US with myocarditis after a vaccine, 68% had been cleared for all physical activity at least 90 days on.
Myocarditis is usually caused by a virus. The worry is hard exercise while an infection or the inflammation is still active, which is why rest comes first.
The NHS advice for colds and flu is to rest. Get chest pain, palpitations or breathlessness after an infection checked before training hard.
In 42.8 million people in England, the risk of myocarditis after infection was higher than after vaccination; the exception was men under 40 after a second dose of the Moderna vaccine.
No: if you feel well, there's no need to cut back. Get chest pain, palpitations, breathlessness or fainting checked.
Sport isn't recommended while the inflammation is active, the return takes from about 30 days to 3 months depending on how severe it was, and pericarditis comes back in 20% to 30% of people.
It depends on your tests. The European Society of Cardiology recommends restricting exercise until the inflammation has settled, for at least 1 month, and many people wait 3 to 6 months before hard training or sport, as older guidance and the British Heart Foundation suggest. Your cardiologist sets the date.
After a mild episode that settles quickly, the European sports guideline says many people can return within 30 days; after a severe one, it can be 3 months. The British Heart Foundation says avoid high-intensity exercise for at least 3 months. Your doctor decides from your symptoms and blood tests.
During the active illness, rest, with only everyday activities. With pericarditis, short walks might be allowed. Once your doctor approves, walking or an exercise bike is the usual first step, increasing slowly over weeks.
Usually blood tests, an electrocardiogram (ECG), a heart scan, a heart rhythm monitor, an exercise test and, after myocarditis, a cardiac MRI scan within 6 months. They show whether the inflammation has gone, the heart pumps normally and there are no dangerous rhythms.
Step by step: light walking or cycling first, then longer sessions with light strength exercises, then moderate exercise such as jogging, with hard intervals and competition last. Move up only when you've had no symptoms for at least a week. Our stage plan gives the order as an editorial suggestion, and your cardiologist sets the timing.
Light strength exercises usually come back early in the return, with your body weight or light bands, breathing out on each effort. Heavy lifting waits until your cardiologist clears you for hard exercise, and with active pericarditis there should be no heavy lifting at all.
Exercise doesn't cause it: most myocarditis follows a virus. The worry is exercising hard while you're ill or while the heart is still inflamed, so rest when you have a fever or feel unwell.
Not with a fever, aching muscles or feeling generally unwell: rest, as the NHS advises for colds and flu, then start back with a few easy sessions. This is a precaution rather than a tested rule. Chest pain, palpitations, breathlessness or fainting after an infection need checking before you exercise hard.
Yes, if you feel well: UK guidance says there's no need to cut back on exercise. Call 999 or go to A&E if you get chest pain or tightness, severe breathlessness or a pounding heart within a few days of the vaccine.
Chest pain or pressure, palpitations, breathlessness out of proportion to the effort, dizziness or fainting, a temperature, or tiredness that lasts into the next day. Stop and contact your doctor, and call 999 for severe chest pain, fainting or severe breathlessness.
Most people have one episode and recover. Myocarditis comes back in about 10% of people, and pericarditis in 20% to 30%, fewer with colchicine. Your follow-up check-ups look for this.
Yes. The European guideline says exercise restriction can lead to frustration, sadness and depression, especially in young people, and supports shared decisions about it. Talk to your team, and if you feel you can't keep yourself safe, call 999 or go to A&E.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
