Exercise Helps Combat Deconditioning Caused by COVID-19

The recent COVID-19 pandemic has affected many Americans in the United States. Following a COVID-19 diagnosis and recovery, you may experience continued fatigue and functional limitations. After consulting your health-care provider and receiving a recommended therapy plan, a physical therapy session is extremely beneficial for your continued recovery.

Common Symptoms 

Following a COVID-19 diagnosis, new or continued symptoms may be present. Because the virus can impact your daily activities, you may experience the following symptoms:

  • Difficulty negotiating stairs
  • Inability to shower due to shortness of breath
  • Difficulty lying flat on your back
  • Trouble bending over to tie your shoes
  • Imbalance
  • Inability to rise from a chair without the help of upper body
  • Increased anxiety surrounding potential re-occurrence
  • Difficulty sleeping
  • Difficulty remembering, paying attention, solving problems and organizing or working on complete tasks

It is important to inform your physician, physical therapist and entire medical team if you are experiencing any of the symptoms above.

Referral Sources

A physical therapist can evaluate you in-person or via telehealth and create an individualized program to track your progress. A physical therapist can assess you through screenings and a musculoskeletal and neuromuscular examination. Additional reasons to seek an evaluation with a physical therapist include:

  • New oxygen guidelines prescribed from your physician
  • Decline in task completion (functional and/or physical activities)
  • Difficulty completing daily activities without improvements 
  • Questions regarding how to monitor and/or progress exercises and deciding which exercises are best for you

COVID-19 can affect multiple systems of your body, including: cognition, cardiopulmonary, integumentary, vascular, musculoskeletal and neuromuscular. Seek an evaluation from the following providers if you experience any of the described symptoms:

  • Occupational therapist: difficulty completing activities of daily living and/or cognitive tasks
  • Speech language pathologist: difficulty swallowing and/or completing cognitive tasks
  • Respiratory therapist: continued difficulties with breathing and airway clearance
  • Dietician: questions regarding appropriate nutrient intake, such as increasing protein to support regaining muscle mass
  • Counseling and psychiatric services: stress management, coping, anxiety and depression

Energy Conservation Strategies

During your recovery, it is important to get adequate nutrition, sleep and hydration.

  • Eat a well-balanced diet
  • Sleep 7 to 9 hours at night
  • Consume at least 60 ounces of water a day

How to Safely Monitor Your Exercise

Appropriate exercise can be just as important as the exercise in itself. Avoid sudden increases in your physical activity. Gradual progression will help you achieve daily, weekly and monthly progress.

In the clinical setting, a physical therapist can complete ongoing assessment of your vital signs. Measuring baseline, during-activity and after-activity objective measures can determine the appropriate level of exercise intensity for your body. Their assessment usually includes: 

  • Heart rate
  • Blood pressure
  • Respiratory rate
  • Oxygen saturation

At home, there are ways to assess your exercise intensity without requiring specific equipment and training. These methods do not replace the ones listed above but use subjective scales to interpret how the exercise makes you feel. These include the following:

  • Rate of perceived exertion or effort (RPE): an RPE is a subjective method to monitor exercise intensity 
    • The scale is a range between 0 and 10, with 0 at rest and 10 your maximal effort
    • Moderate exercise is 3 to 4/10 (Stay here!)
    • Vigorous exercise is 5 to 7/10 (Avoid here!)
  • Dyspnea: a subjective scale that assesses your difficulty breathing or shortness of breath
    • The scale is a range between 0 and 10, with 0 being no difficulty breathing while 10 is maximal breathing difficulty
    • Stay at a moderate level, 3/10
  • The talk test is an easy way to gauge exercise intensity based on your ability to carry on a conversation while exercising 
    • Moderate intensity: maintain steady conversation during exercise
  • Stay here!
    • Vigorous intensity: only a few words are sustainable during exercise
    • Avoid getting to this level! Sit and rest if you find yourself here.
  • It’s also helpful to utilize an exercise log to track your daily, weekly and monthly progress. Be specific and follow these guidelines for using an exercise log:
    • Keep track of the distance and time you spent walking or biking
    • List the level of resistance band or weight for any strengthening exercise
    • Note any modifications or progressions with each exercise (for instance, use of a handrail when completing a squat)
    • Monitor your response to activity via the RPE and dyspnea scales 
    • Keep track of the time it takes your body to recover after exercise 

Physical Activity and Exercise

Prior to starting any new physical activity or exercise program, consult with your medical providers. Following COVID-19, it’s important to gradually resume physical activity and exercise. Physical therapists are experts in developing appropriate and progressive exercise programs that meet the needs of each individual. Below are examples of factors a physical therapist considers in establishing an exercise program as well as examples they may prescribe.   

Choosing activities that are specific to your needs and are enjoyable to complete. 

  • Factors that may impact weekly progress:
    • Length of hospital stay
    • Your activity level prior to COVID-19
    • Any comorbidities (for instance, hypertension and/or diabetes)
  • Exercise amount and intensity
    • Starting with lower intensity exercises for higher repetitions while monitoring the intensity and response to exercise
  • An example of what a physical therapist may prescribe:
    • Aerobic exercise (3 to 5 days per week)
  • Completing a 10 to 20-minute outdoor walk or riding on a stationary bike.
    • Strengthening exercises (2 to 3 days per week)
  • Completing 4 to 5 exercises, performed sitting or standing, and incorporating larger muscle groups (such as squats and calf raises).
    • Exercise progression

Once you are ready to start progressing back to more advanced physical activity goals, follow the below recommendations from the American College of Sports Medicine.

  • Aerobic only
    • 3 days per week: 30 minutes per session of moderate intensity
  • Resistance only
    • 2 days per week: 2 sets of 12 to 15 repetitions for major muscle groups at moderate intensity
  • Combination
    • 3 days per week of 30 minute moderate intensity aerobic exercise in addition to 2 days per week of resistance training with 2 sets of 12 to 15 repetitions at moderate intensity

Consulting with your medical provider and physical therapist for a therapy plan are the most important. Always remember to include rest days and listen to your body when it needs a break. It is essential to stay safe during these times. Click here for more details or call 1-877-969-7342 to request your in-person or virtual therapy visit today.


About the Therapists:
Brittany Lynch, DPT is a Board Certified Specialist in Sports and Orthopaedic Physical Therapy at Penn Therapy & Fitness Weightman Hall. 

John Barry, DPT is a Board Certified Specialist in Orthopaedic Physical Therapy at Penn Therapy & Fitness University City. 

Robert Wise, DPT is an Orthopedic and Sports Physical Therapist at Penn Therapy & Fitness Arcardia.

Nicholas McCurdy, PTA is a Physical Therapy Assistant at Penn Therapy & Fitness University City. 

Tia Gray, PTA is a Physical Therapy Assistant and Certified Lymphadema Therapist at Penn Therapy & Fitness University City. 

References

  1. http://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/Patient_Care/Physical_Fitness/Members_Only/PocketGuide_PostStroke.pdf