In view of all the information currently available on COVID-19, let’s take a brief look at the importance of a good exercise routine and how to rehabilitate in this pandemic.
Let's take a look at what COVID-19 is
COVID-19 is a disease caused by the SARS-CoV-2 coronavirus, discovered in Wuhan, China in December 2019. COVID-19 is highly contagious and considered to be a disease that affects many systems of the body, namely the respiratory system.
In many cases, individuals infected with COVID-19 will develop pneumonia and those with more severe cases may require hospitalization.1
Does exercise help covid-19 recovery?
If you have or are recovering from a COVID-19 infection and would like to begin participating in physical activity, you must consult with a healthcare professional prior to beginning a program.2
Given the fact that COVID-19 appears to affect multiple body systems, it is important to be cleared for exercise to ensure that you remain safe while exercising, and to be referred to an exercise professional or healthcare professional, if required.
This being said, exercise is deemed safe and beneficial in the context of COVID-19, as long as adequate precautions are taken, and the exercise program is individualized to you and your needs!2
What is Pulmonary Rehabilitation?
Pulmonary rehabilitation, or PR, is a comprehensive, individualized program that involves many types of therapies, namely exercise training, education and behaviour change.3 The goal of PR is to improve the physical and psychological well-being of individuals living with respiratory conditions and help them maintain good lifestyle behaviours.3
In people with Chronic Obstructive Pulmonary Disease (COPD), PR has been shown to improve exercise capacity, quality of life, and reduce shortness of breath in their day-to-day lives.3
PR programs typically range from 6 to 9 weeks and can be done as inpatient or outpatient programs within the hospital setting, or as home-based programs with in-person or remote supervision.4 With the current pandemic, telemedicine is utilized whenever possible, and therefore any outpatient or home-based programs (also called exercise at home) are typically being administered remotely.
Is pulmonary rehabilitation effective for COVID-19 patients?
Pulmonary rehab (PR) programs have already been used as rehabilitation for some COVID-19 patients5, just as it has been used for patients infected with past pandemic viruses, and patients with pneumonias 4. COVID-19 will affect individuals differently, with severities ranging from mild to severe, and may have physical, psychological, and/or psychosocial outcomes.
The multidisciplinary nature of PR could target these and allow greater overall recovery.6 This also means that the way a PR is administered to a patient will vary. Once again, the program will need to be individualized to each patient!
Mild case of COVID-19
A mild case of COVID-19 is defined by mild symptoms and no pneumonia. In these cases, outpatient PR programs delivered remotely (telemedicine) will likely be utilized. Exercise programs will be tailored to each individual and his/her abilities and limitations, and the importance of breathing exercises will be emphasized.2
Education topics will likely focus on COVID-19 and its novelty, how it can affect one person very differently from another, how other chronic conditions may play a role in recovery, the importance of hand hygiene and the use of masks, and preventing the spread of the virus.2,4
Moderate to severe case of COVID-19
Moderate to severe cases of COVID-19 are considered to be in the “acute stage” of the disease, and typically involve hospitalization.2 Pulmonary rehabilitation can be safely administered in this stage and does not increase risk of mortality, as long as the program is individualized to every patient.2
Depending on symptoms and severity, the exercise component of PR in the acute stage may range from simply moving while laying down in a hospital bed, to walking, and will often involve stretches.2 Breathing techniques such as pursed lip breathing will be very important in PR for these patients.2
Finally, outpatient post-hospitalization PR is considered beneficial for any patient hospitalized due to COVID-19! Such participation can help improve exercise capacity and restore normal function and quality of life.2
References:
-
1. World Health Organization (2020). "Q&A on coronaviruses (COVID-19)." from WHO website. Consulted August 7 2020.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses - 2. Wang TJ, Chau B, Lui M, Lam GT, Lin N, Humbert S. PM&R and Pulmonary Rehabilitation for COVID-19 [published online ahead of print, 2020 Jun 11]. Am J Phys Med Rehabil. 2020;10.1097. doi:10.1097/PHM.0000000000001505
- 3. Rochester CL, Vogiatzis I, Holland AE, et al. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2015;192(11):1373-1386. doi:10.1164/rccm.201510-1966ST
- 4. Barker-Davies RM, O'Sullivan O, Senaratne KPP, et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020;54(16):949-959. doi:10.1136/bjsports-2020-102596
- 5. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract. 2020;39:101166. doi:10.1016/j.ctcp.2020.101166
- 6. Polastri M, Nava S, Clini E, Vitacca M, Gosselink R. COVID-19 and pulmonary rehabilitation: preparing for phase three. ERJ. Jun 2020, 55 (6) 2001822; DOI: 10.1183/13993003.01822-2020
About the author
Lauren is an accredited kinesiologist with the Fédération des kinésiologues du Québec (FKQ). She holds a B.Sc.H. in Kinesiology and a M.Sc. in Exercise Physiology, both from McGill University. She has 4 years of experience in the healthcare setting coordinating clinical trials in chronic respiratory conditions, namely COPD and idiopathic pulmonary fibrosis (IPF). Currently, Lauren is a first-year M.D., C.M. candidate at McGill University’s Faculty of Medicine.
