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Advising Patients On Exercising While Distancing Due To COVID-19

By Jason Miller, DPM, FACFAS, Benjamin Marder DPM, AACFAS and Julie Lin DPM, MS

To quote an excerpt from Born to Run by Christopher McDougall from 2011, “When things look worst, we run the most. Three times, America has seen distance running skyrocket, and it’s always in the midst of a national crisis.”1 

With the emergence of the novel coronavirus, SARS-CoV-2, the world is experiencing a pandemic scare. Having many uncertainties and a lack of a vaccine or cure, the best safety measures continue to revolve around physical distancing, hand washing and facial mask coverings when in public locations.2 In the United Kingdom, the aforementioned techniques have proven to be 74 percent effective in limiting transmission of COVID-19 through a stay-at-home order.3 

However, global self-quarantine takes a toll on people’s mental health. In our observation, a rise in anxiety, depression and insomnia has also made many reluctant to leave the house. As many gyms and fitness studios are also closed, this may lead people to reconnect with nature and seek refuge in running as forms of stress relief and anxiety reduction.  

A common question health-care providers may hear from patients is: “How do we maintain safety precautions of physical distancing while exercising?” Per Centers for Disease Control and Prevention (CDC) guidelines, six feet is the minimum distance to reduce the risk of aerosol transmission of COVID-19.2 If one ignores all external factors, sitting or standing without movement and no air flow, then six feet is indeed an appropriately safe distance to significantly reduce aerosol transmission.4 However, when you start to take into consideration movement patterns, we see a different outcome. 

Working under the assumption that 1.5 meters (approximately five feet) is the distance an aerosolized droplet can travel before falling to the ground or evaporating, Blocken and colleagues, in a yet to be published study, recently utilized Rosin-Rammler droplet distribution to mimic how these aerosolized droplets will be affected in April to June weather conditions in the northern hemisphere.4 A Belgian-Dutch study recommends that walkers give each other 13 feet, fast runners 30 feet and bikers 65 feet.5 Also, those out on the trails should stagger their distance from others and not be in a direct path (or slipstream) of any droplets another runner may produce. One caveat to consider is that the study did not factor in tail or cross winds when running. This is important as it may invalidate or underscore some of these observations as some studies have shown a wide variety of effects on aerosolized droplets outdoors. Nonetheless, one should be mindful of safety corridors when exercising on public trails. 

With a surge in exercise regimens, podiatry offices will surely begin to see an increase in ailments resulting from this exercise. A common mistake we see with newly inspired or inexperienced athletes is doing too much too quickly.

One of the most common complaints is plantar fasciitis, which presents with post-static dyskinesia, classically described as plantar heel pain that is worse when standing or weightbearing after prolonged periods of rest. Ways to treat plantar fasciitis include stretching the calf muscles, ice massage and non-steroidal anti-inflammatory drugs (NSAIDs). A gradual increase in activity while wearing supportive orthotics in supportive shoe gear can help prevent plantar fasciitis. 

Other similar issues include Achilles tendinitis, which presents at the watershed area or near the Achilles’ insertion at the back of the heel. Rest and immobilization are effective treatments. However, to avoid tendinitis in the first place, it is wise to educate patients on proper warm-up exercises, stretching, gradual increases in activity and supportive shoe gear. 

For those who are running on uneven terrain, ankle sprains can be common with an inversion rolling mechanism. In our experience, an effective approach is emphasizing a period of immobilization and rest before starting physical therapy and strengthening exercises to increase proprioception. To avoid ankle sprains, podiatrists can recommend that patients wear good shoe gear, watch their footing and even wear an ankle brace if there is a history of structural instability. 

The best way for patients to avoid injuries is to increase activity levels gradually and allow the body to adjust to new stresses and loads. By steadily building endurance in muscles they have not worked as hard lately, patients can safely exercise and thrive. Although we should still practice safe physical distancing, healthy stress relief and exercise activities remain highly encouraged. Podiatrists can play a vital role in preventing and treating any negative sequelae of this surge in activity.

Dr. Miller is the Director of the Pennsylvania Intensive Lower Extremity Fellowship at Premier Orthopaedics in Malvern, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Marder is a Fellow with the Pennsylvania Intensive Lower Extremity Fellowship in Malvern, Pa.

Dr. Lin is a third-year resident with the Phoenixville Hospital/Tower Health residency program in Phoenixville, Pa.


1. McDougall C. Born To Run: The Hidden Tribe, The Ultra-Runners, And The Greatest Race The World Has Never Seen. London: Profile Books; 2010.

2. Centers for Disease Control and Prevention. Social distancing. Available at: . Published July 6, 2020. Accessed July 6, 2020.

3. Jarvis CI, Van Zandvoort K, Gimma A, et al. Quantifying the impact of physical distance measures on the transmission of COVID-19 in the UK. BMC Medicine. 2020;18(124):1-10.

4. Blocken B, Malizia F, van Druenen T, Marchal T. Towards aerodynamically equivalent COVID-19 1.5 m social distancing for walking and running. 2020. Available at: . Accessed July 6, 2020. 

5. Thoelen J. Belgian-Dutch study: why in times of COVID-19 you should not walk/run/bike close behind each other. Available at: . Published April 8, 2020. Accessed July 9, 2020.

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