Simon Harling explains how exercise professionals can ensure a safe return to exercise for post-COVID patients

As we look for ways to co-exist with COVID-19, fitness professionals face the prospect of managing the increased risk to the exposure to the virus for themselves, their clients and those clients who have previously been infected with COVID-19.

With considerable pressure being placed on routine medical and rehabilitation services for the foreseeable future, fitness professionals can play a significant role in providing knowledge in the form of education content, skill in the rehabilitation and care planning process and emotional support.

The illness severity pattern so far observed for COVID-19 is as follows:

1. Asymptomatic infected patients.

2. Symptomatic patients isolating at home.

3. Symptomatic patients admitted to hospital

4. Symptomatic patients requiring ventilatory support in critical care.

Clients who have received hospital treatment
During community reintegration, post COVID-19 patients should be supported with a long-term care plan that includes supported self-exercise and a return to work schedule.

Adaptation of clinical experience to a post-COVID rehabilitation programme to meet the occupational and environmental needs of the patient, will be our challenge.

Clients who have not received hospital treatment
In the UK, the numbers of post-COVID patients present in the community who did not require hospitalisation is unknown.

What we can be sure of is that many post-COVID patients based in the community will require rehabilitation aimed at relieving symptoms of dyspnoea, psychological distress and improving participation in rehabilitation, physical function and quality of life.

When is it safe to return to exercise?
COVID-19 is associated with cardiac complications, in particular, arrhythmias and myocardial injury, putting all patients exposed to COVID-19 at an increased risk of a cardiovascular event. The cause of the cardiovascular complications are likely multifactorial and include viral myocardial injury, elevated systemic inflammatory burden and hypotension.

Higher risk groups include those patients who have been hospitalised, required ventilatory support and those with co-existing diseases such as diabetes, hypertension and cardiovascular disease.

Aside from rehabilitation of post-COVID symptomatic patients there will be many post-COVID asymptomatic patients who will be unaware of the risk of a cardiovascular event on their return to strenuous physical activities.

It is imperative, therefore, that fitness professionals play a significant role in identifying, educating and managing the risk of both asymptomatic, symptomatic cardiovascular disease clients and those with co-existing diseases.

Key points:
• Any patient who has had COVID-19 should complete an assessment of their cardiac symptoms, recovery, function and potential impairments.

• Particular attention should be given to patients with underlying disease.

Patients returning to high-level sport or physically demanding occupation following confirmed myocarditis require a three- to six-month period of complete rest.

Exercise rehabilitation programme recommendations
It’s important to remember that exercise is considered an important element of pulmonary rehabilitation and when considering the prescription of exercise for post-COVID clients, the same principles of duration, intensity, frequency, specificity and reversibility apply.

Low intensity exercise (≤3 METs or equivalent) should be considered initially in all post-COVID patients. Patients with COVID-19 who experience the following symptoms: severe sore throat, body aches, shortness of breath, general fatigue, chest pain, cough or fever should avoid exercise (>3 METs or equivalent) for between two and three weeks after the cessation of those symptoms.

Clients requiring rehabilitation following COVID-19 should have a functional assessment to determine residual musculoskeletal impairments in order to determine appropriate rehabilitation.

Key points:
• Exercise training is effective when used as a tool in the treatment of pulmonary disease patients.

• Low intensity exercise (≤3 METs or equivalent) should be considered initially in all post-COVID patients.

• Clients with COVID-19 who experience the following symptoms: severe sore throat, body aches, shortness of breath, general fatigue, chest pain, cough or fever should avoid exercise (>3 METs or equivalent) for between two and three weeks. Resumption of training (>3 METs or equivalent) once the symptoms have cleared.

• Post-COVID clients with new-onset shortness of breath or chest pain, should have a full medical review.

With every client having a unique response to exercise, exercise prescription should be based on individual tolerance thresholds and workloads. Previous exercise tolerances and workloads should not be taken into consideration. It’s important to prescribe exercise on what the client can tolerate now.

The choice we face as an industry
The opportunity exists now to demonstrate the ability of the fitness industry to make a tangible difference. To have a bigger conversation.

The fitness industry is faced with a choice – we can ignore the inconvenient truth surrounding the increased risk of return to exercise for post-COVID-19 clients, or we can reach out to over-stretched medical and rehabilitation services, listen to their needs and those of their patients and offer our time, empathy – and our facilities.

We can essentially make a generous decision to engage a large section of the community that have been affected by COVID-19.

Well managed fitness programmes can restore health, but if we go down this road, they won’t all be well managed initially. The rehabilitation may be clumsy in some cases and the health service may be wary. Yet our intentions will be unquestionable and in time our knowledge, skills and relationships will flourish.

The alternative is to wait for a budget, a marketing plan or a campaign strategy.

What will you do? Wait, ignore or engage?