Covid-19 exercise rehabilitation

The extremely infectious and pathogenic coronavirus, COVID-19, has recently materialised causing a world-wide pandemic. It is known that COVID-19 predominantly affects the respiratory system; however, evidence also indicates a multi-system disease that has the capacity to be severe and result in significant health issues. There are many unknown specifics in relation to COVID-19, but evidence from previous coronavirus outbreaks suggests it may cause pulmonary and physical dysfunction, increased emotional anguish, and reduced quality of life. Furthermore, a significant number of patients with COVID-19 would have spent time in ICU, and may have symptoms that are frequent within this setting such as dyspnoea, anxiety, depression, persistent pain and impaired physical function. As such, The British Journal of Sports Medicine has now published evidence-based guidelines to assist with the rehabilitation of those who have been diagnosed with COVID-19:

Pulmonary rehabilitation recommendations

  • Respiratory complications may present with the potential for a level of impairment and functional limitation, due to decreased respiratory function
  • Low intensity exercise (≤3 METs or equivalent) should be considered initially and particularly for patients who required oxygen therapy, whilst maintaining vigilance on vital signs (heart rate, pulse oximetry and blood pressure)

Cardiac rehabilitation recommendations

  • All patients that have suffered with COVID-19 should have an assessment of their cardiac function, recovery, and potential impairments
  • Depending on the patient’s initial assessment and symptoms, specialist advice should be sought
  • A period of rest post-infection, depending on symptoms and complications, will reduce risk of post-infection cardiac failure
  • If cardiac pathology is present, specific cardiac rehabilitation programs should be provided tailored to the individual based on their cardiac complications, impairments and rehabilitation needs assessment

Musculoskeletal rehabilitation recommendations

  • All patients requiring rehabilitation following COVID-19 should have a comprehensive functional assessment to determine residual musculoskeletal impairments in order to determine appropriate rehabilitation
  • Patients that have had an ICU admission should have a multidisciplinary team approach for rehabilitation

General rehabilitation recommendations

  • Those who required oxygen therapy or had acute lymphopenia should be identified and have a pulmonary function test
  • Those who experience severe sore throat, body aches, shortness of breath, general fatigue, chest pain, cough or fever should avoid exercise (>3METs) for between 2-3 weeks after the cessation of those symptoms
  • With very mild symptoms, consider limiting activity to light activity (≤3METs) but limit sedentary periods, with an increase in rest periods if symptoms deteriorate and prolonged exhaustive or high intensity training should be avoided.
  • On return from mild COVID-19 illness to exercise, 1 week of low-level stretching and light muscle strengthening activity should be trialed prior to targeted cardiovascular sessions

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References:

Barker-Davies, R. M et al. (2020). The Stanford Hall consensus statement for post-COVID-19 rehabilitation. British Journal of Sports Medicine

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