Getting Fit After COVID

The level of physical activity and exercise is significantly impacted after contracting COVID. Many people continue to experience breathlessness months after being declared negative and throughout their recovery. This is why most people prefer to sit/lie down after recovery, in order to avoid or minimize their difficulty in breathing. This is because the more you exert yourself the harder it is to breath - however, this can lead to social isolation and loss of independence.

Physical activities like walking or mowing the garden can help improve breathing and slowly improve your activity after COVID. Then, you can gradually build up to doing exercises to get back to your own level of fitness prior to contracting COVID.

The difference between physical activity and
exercise :

Physical activities are any body movements requiring energy like work, household chores or recreational activities. It is important for general health and well- being.

Exercise is a structured, repetitive activity that targets to improve certain or all aspects of physical fitness. Exercise can help improve breathing after COVID but it must be specific to the individual and must accommodate the feeling of breathlessness, fatigue and psychological needs. It should be integrated into the daily routine by discussing the persons expectations, fears, goals and reality.

Many people will find that their tolerance to physical activity is lower following COVID 19 infection. Here are some strategies to manage energy levels as their recovery progresses.

1. Plan a range of both physical activity and exercise specific to the person. Make each session short (about 30 mins) aiming to accumulate a total of 150 minutes every week.

2. Eat a balanced diet to fuel the body well. Potatoes, bread, rice, pasta and cereals provide fibre and energy. Low GI (glycemic index) foods such as oats and whole grains

release energy slowly to keep energy levels stable.

3. Aim to eat more fruit and vegetables (5 portions a day).

4. Eat 2 portions a day of protein-rich foods (beans, pulses, fish, meat and eggs) and aim for less processed meat (ham, sausages and burgers).

5. Dairy, calcium-enriched milk alternatives and soya based products are an important source of calcium for good bone health

6. Aim to drink 6-8 mugs or glasses per day, having too little fluid can lead to headaches, constipations and lessen alertness. Any type of fluid as squash, juice, water, tea and coffee all count.

How do you know if you’re ready to exercise?

As a general rule you have to perform the exercises slowly and gradually to assess you level of tolerance for the activity - however, there are a few rare cases of joint and muscle problems after COVID that may indicate serious medical conditions and would require a check up from your doctor before doing any exercises. These are:

New symptoms of feeling unwell, pain at night that causes problems sleeping or significant joint swelling
Symptoms such as pins and needles, worsening weakness in the arms or legs or problems with balance

Some symptoms are even more serious and require urgent treatment and you should go to the hospital on the same day if you have:

A new hot, red, swollen joint that may be an infection in the joint
New bladder and bowel problems in the presence of back pain with leg pain that could mean the spinal nerves supplying the bowel and bladder are affected.

Split your exercise training into 2 components; endurance training and resistance training. This combination will improve function by increasing exercise capacity and muscle strength. Many people recovering from COVID 19 will need both in varying proportions.

People recovering from COVID-19 should be encouraged to exercise daily. This can be a combination of attending face-to-face or online exercise classes and exercise at home.

Endurance training is when you exercise for longer but in gradual progression. Many people will not achieve this so start with a few minutes, slowly progressing. Aim for at least 30 minutes of continuous exercise each session.

Interval Training best suited for people who are not progressing much or those who feels breathless quickly during exercise. This is when you alternate between exercising hard for a very short time (40 seconds) and resting (20 seconds). Repeat as many times as you can tolerate, aiming for 5 sessions per week.

Examples of this are:

Walking
Swimming
Marching on the spot
Step ups
Rowing
Cycling
Cross Trainer
Heels Digs
Skipping
Half Jacks

Resistance Training is exercises using weights or restraints to increase muscle mass and strength. This is important because the period of immobility in hospital can result in decrease in muscle size and strength. These include exercises for upper limb, lower limb and trunk with 3 sets of 10 repetitions for each exercise. Aim for 3 sessions per week with rest days to allow for muscle recovery from micro trauma. Your starting load should be based on strength testing results, and pre-COVID-19 physical capabilities.

The following exercises are good for building strength:

Bicep curls
Sit to stand
Squats
Upright row
Step ups

The following items can be used for resistance training and range from professional equipment to household items:

Dumbbells
Plastic bottles filled with water
Food tins
Static arm bike
Fixed resistance machines
Resistance bands
Barbells
Kettle bells

Warming Up and Cooling Down

Warming-up is important to prepare the body for exercise, increase blood flow to skeletal muscle by increasing heart rate and dilating the coronary arteries.

Cooling down enables safe and gradual recovery from exercise by controlled reduction in heart rate to normal resting level over 5 minutes.