Return to Exercise after COVID-19

The symptom spectrum of COVID-19 is very broad, ranging from mild-moderate to severe symptoms that require supportive care. The majority fall into the mild-moderate category but COVID-19 can affect multiple systems in the body such as cardiac, pulmonary, hematologic, musculoskeletal, and GI1. Many people have been affected by this virus either personally or have a close family/friend who have tested positive. In addition, due to lockdowns and quarantines many people have not been able to keep up with regular exercise and are unsure of a safe way to re-introduce exercise into your life. This blog post will focus on steps to return to exercise post COVID-19 and even how physical therapy can help you reach these goals.

Physical inactivity is a risk for mental and physical health and can have negative effects on your metabolism. It has been well documented that since the virus has caused fear and safety concern that peoples’ daily walking volume/steps have reduced significantly. However, with the vaccines being administered nationwide over the next few months many people are planning on returning to a normal exercise routine. So how is best to get motivated and safely go about exercising?

Cardiac: Regular exercise improves cardiovascular health in the long-term but also stresses the heart. Most people; if not hospitalized, will not have any cardiac manifestations and Hull et al. suggests for athletes to rest for 10 days from symptom onset and 7 days after symptom resolution without additional testing2. Baggish et al. recommends 2 weeks of rest and then a gradual return to exercise with a supervised medical team and possible EKG testing3.

Respiratory: Most young people will have no pulmonary effects and will recover with a gradual onset of exercise where respiratory systems should be monitored after a 2 week rest period. Severe cases of COVID-19 can develop acute respiratory distress syndrome. We do not have data at this time in terms of recovery for ARDS, and they should be monitored by a pulmonary specialist4.

Musculoskeletal: There are few known orthopedic issue related to COVID-19, but your joints do have receptors that serve as potential targets to the virus that causes COVID-19. There may also be a secondary effect due to inflammatory cytokines; however, this appears to resolve within the two week period5. Acetaminophen may help reduce these symptoms acutely. The use of NSAIDs such as Ibuprofen is controversial with COIVD-19 as there is some data to suggest it can increase severity of infection. Low intensity exercise is recommended for one week before returning to more rigoruous exercise. Due to inactivity and deconditioning some may be at an increased risk for injury. Consult your physical therapist at Willow Grove Physical Therapy – Glenside – Hatboro if you are experiencing pain/discomfort returning to exercise or just need guidance developing a program!

Hematological: Some patients with COVID-19 are at an increased risk for hypercoagulability and thus for thrombosis, in mostly hospitalized patients. Less is known about clotting in the asymptomatic patients and there is no data to suggest the need for getting DVT screenings. Low intensity exercise is indicated to offer some protection for clotting tendencies.

Gastrointestinal: Some patients will develop these symptoms such as nausea, vomiting, diarrhea. The main considerations with the exerciser/athlete is staying hydrated consistently.

After the SARS_CoV-1 pandemic in 2003 research was done to monitor patients for return to exercise and after 6 months it was shown that exercise capacity was much lower than those without the virus. Research and data collection is ongoing for COVID-19 but the current guidelines recommend a slow, gradual, stepwise return to exercise6. Exercise should be stopped if a patient develops fever, shortness of breath, cough, chest pains or palpitations. Most importanty, contacting your physician prior to beginning an exercise program is recommended especially if you have a history of cardiac or pulmonary issues. Healthy patients with mild cases of COVID may resue physical activity after 7 days of being asymptomatic at 50% normal activity level.

How can physical therapy help? If you decide to schedule an evaluation our therapists will take a full assessment of your fitness level depending on your goals and tailor a home exercise program to your needs. Your physical therapist will address issues such as pain, stiffness, weakness, fatigue and injury prevention to name a few. We have three clinics in Willow Grove, Glenside and Hatboro with experienced therapists on staff. In addition, we are practicing safety guidelines in accordance with CDC for preventing the spread of COVID-19 and our therapists wear the proper PPE. All of our clinics have private treatment rooms and a large open gym making practicing social distancing possible.

Where to begin? Our contact page has each clinic’s phone number and e-mail address, so please feel free to call or e-mail to schedule an appointment or with questions. We accept most insurances and also offer direct access or self pay. Remember to contact your physician as well if you have concerns about returning to exercise.

Finally, goal setting is very important in starting off an exercise routine and for keeping motivated to consistently perform physical activity. We recommend writing down goals for yourself whether it is weight loss, reaching a certain mileage, or becoming stronger to perform specific tasks. Writing goals is a great way to feel motivated when you achieve them and then you can incorporate new goals as the year progresses. Our physical therapists can work alongside you to help you achieve these goals or help rehabilitate if injury or limitations arise.

References

1. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med. 2020;382(24):2372–2374. https://doi.org/10.1056/ NEJMc2010419.
2. Hull JH, Loosemore M, Schwellnus M. Respiratory health in athletes: facing the COVID-19 challenge. Lancet Respir Med. 2020;8(6):557–558. https://doi.org/10.1016/S2213- 2600(20)30175-2.
3. Baggish A, Drezner JA, Kim J, Martinez M, Prutkin JM. The resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes [blog post]. BJSM Blog. 24 April 2020. Available at: https://blogs.bmj.com/bjsm/2020/04/24/theresurgence-of-sport-in-the-wake-of-covid-19-cardiac-considerations-in-competitive-athletes/.
4. Disser NP, De Micheli AJ, Schonk MM, et al. Musculoskeletal consequences of COVID-19 [published online ahead of print, 2020 May 25]. J Bone Joint Surg Am. https://doi.org/10.2106/ JBJS.20.00847.
5. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;
6. Hui DS, Joynt GM, Wong KT, et al. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax. 2005;60(5):401–409. https://doi.org/10.1136/ thx.2004.030205.