March 8, 2021-New research suggests that once patients with COVID-19 are asymptomatic for at least 7 days, doctors can determine if they are ready for an exercise program and help them start slowly.
David Salman, an academic clinical researcher in primary care at Imperial College London, and his colleagues published a guide on how doctors can guide patient safety campaigns after COVID-19 was published online on BMJ in January.
The author is concerned with patients who have been inactive for a long time but have no chronic COVID-19 disease.
The authors pointed out that patients with persistent symptoms or severe COVID-19 or a history of cardiac complications will require further evaluation. But otherwise, exercise can usually start for at least 2 weeks with minimal exertion.
This article is based on an analysis of current evidence, consensus opinions, and researchers’ experience in sports and sports medicine, rehabilitation, and primary care.
The author writes: “There is a need to strike a balance between preventing people who are already inactive from exercising at a recommended level that is good for their health, and the potential risk of heart disease or other consequences for a small number of people.”
The author recommends a phased approach, each phase requires at least 7 days, starting with low-intensity exercise and lasting at least 2 weeks.
The author points out that using the Berger Perceived Exercise (RPE) scale can help patients monitor their work effort and help them choose activities. Patients rated shortness of breath and fatigue from 6 (no exertion at all) to 20 (maximum exertion).
The author recommends 7 days of exercise and flexibility and breathing exercises in the first phase of the “extreme light intensity activity (RPE 6-8)”. Activities may include housework and light gardening, walking, light enhancement, stretching exercises, balance exercises or yoga exercises.
Phase 2 should include 7 days of light intensity activities (RPE 6-11), such as walking and light yoga, with an increase of 10-15 minutes per day with the same allowable RPE level. The author points out that at these two levels, a person should be able to have a complete conversation without difficulty during the practice.
Stage 3 may include two 5-minute intervals, one for brisk walking, up and down stairs, jogging, swimming, or cycling-one for each rehabilitation. At this stage, the recommended RPE is 12-14, and the patient should be able to have a conversation during the activity. The patient should increase an interval per day if tolerance allows.
The fourth stage of the exercise should challenge coordination, strength and balance, such as running but in a different direction (for example, shuffling the cards sideways). This stage can also include body weight exercise or touring training, but exercise should not feel difficult.
The author writes that at any stage, patients should “monitor for any unnoticeable recovery 1 hour and the next day after exercise, abnormal breathing, abnormal heart rhythm, excessive fatigue or lethargy, and signs of mental illness.”
The author pointed out that psychiatric complications, such as psychosis, have been identified as a potential feature of COVID-19, and its symptoms may include post-traumatic stress disorder, anxiety and depression.
The author writes that after completing the four stages, patients may be ready to at least return to their pre-COVID-19 activity levels.
This article starts from the perspective of a patient who was able to walk and swim for at least 90 minutes before getting COVID-19 in April. The patient is a health care assistant, and he said that COVID-19 “makes me feel weak.”
The patient said that stretching exercises are most helpful: “This helps to enlarge my chest and lungs, so it becomes easier to perform more vigorous exercises. It helps to do more vigorous exercises such as walking. These stretching exercises because my lungs feel that they can hold more air. Breathing techniques are particularly helpful and I often do some things. I find that walking is also the most beneficial because it is an exercise that I can control. I can Walking at a certain speed and distance is controllable for me and me. Gradually increase it while checking my heart rhythm and recovery time using the “fitbit”.”
Salman told Medscape that the exercise program in the paper is designed to help guide doctors “and explain to patients in front of doctors, not for general use, especially considering the widespread disease and recovery trajectory infection after COVID-19.”
Sam Setareh, a cardiologist at Mount Sinai in New York, said that the basic message of the paper is a good one: “Respect the disease.”
He agreed with this approach, which is to wait a full week after the last symptom appears, and then slowly resume exercise after COVID-19.
So far, most heart disease risk data are based on athletes and hospitalized patients, so there is little information on heart risk for patients who return to sports or start sports after mild to moderate COVID-19.
Setareh, an affiliate of the Post-COVID-19 Heart Clinic in Mount Sinai, stated that if a patient has severe COVID-19 and the cardiac imaging test is positive, they should recover with the help of a cardiologist at the Post-COVID-19 Center activity.
If the patient is unable to return to baseline exercise or has chest pain, they should be evaluated by a doctor. He said that severe chest pain, beating heart or heart needs to be reported to a cardiologist or post-COVID clinic.
Setareh said that while too much exercise may be harmful after COVID-19, too much exercise time may also be harmful.
A report released by the World Obesity Federation on Wednesday found that in countries where more than half of the population is overweight, the rate of death from COVID-19 is 10 times higher.
Setareh said wearables and trackers cannot replace medical visits, they can help people track progress and intensity levels.
Post time: Mar-09-2021