You Had COVID now What?
What to know about getting back into activity following a diagnosis of COVID
With the most recent spread of Covid across the country, The Journal of the American Medical Association has recently released guidelines on the safest way to return to exercise following all levels of Covid infection. As physical therapists, we are responsible to help our patients return to safe exercise, and should be taking responsibility for returning our patients safely to exercise following COVID. Here are some things to consider for best practice when returning to activity following a COVID diagnosis depending on severity of symptoms.
Asymptomatic Clients and Athletes Recovering from COVID:
When it comes to “asymptomatic” Covid cases, myocarditis (inflammation of the heart muscle) is still possibly a hidden symptom. The recommendation is to take a break from exercise for 2 weeks after a positive test. If you remain asymptomatic through those two weeks, you may return to exercise and gradually increase intensity over the following 2 week period. Monitor yourself for any abnormal responses to your increase in exercise intensity.
Mild Symptoms for Clients and Athletes Recovering from COVID:
You have a mild case of COVID if you are symptomatic but do not require hospitalization. During the period that you are symptomatic, rest from exercise is recommended. If you develop cardiac type symptoms, be sure to check in with your doctor for more testing. Once symptoms resolve, an additional 2 week break from heavy exercise is recommended to allow for heart recovery. Once you complete your 2 week recovery, it is recommended that you check in with your physician for cardiac testing. If testing is normal, a gradual return to exercise is advised under the supervision of a health team. Your physical therapist is uniquely equipped to help guide you on the return to exercise process. If the testing is abnormal, you will need to work with your doctor to determine when your heart is healthy enough to return to exercise. They will likely follow Return to Play Myocarditis guidelines. There is a link below to those guidelines.
Significant Symptoms During your COVID Case now what should you do?
You are classified as having significant symptoms of COVID-19 if you needed to be hospitalized during your infection. During your hospitalization, your heart will likely be monitored closely by your care team. If your heart testing was normal, you will still want to take a minimum of 2 weeks of rest from exercise once you become asymptomatic. Following this 2 week rest period, you may gradually resume exercise if your cardiac testing is normal. It is recommended that you work with a health care team to appropriately increase exercise dosage and monitor your response. If at any time you start to have a negative response to the increase in exercise, you will need to contact your medical team. Negative responses may include but are not limited to abnormal shortness of breath, unexplained fatigue, heart palpitations and excessively high heart rate. If you did have cardiac involvement when in the hospital, you will be monitored closely by your medical team and likely follow the Return to Play Myocarditis guidelines.
Summary of How to Best Rehab and Exercise Post-COVID:
It is very important to monitor your response and progressively return to prior exercise level following COVID infection and other viral infections for that matter. Dr. Ghislaine Robert points out that another consideration when recovering from infection is that you could suffer from extreme fatigue. She quotes “the [exercise] intensity should be monitored. Aiming for no more than 70% of your Maximum heart rate initially and avoiding strenuous exercise at first to allow for full recovery . The body will take longer to recover after illnesses. Sleep is very important at this stage and you will need more than usual.”
Covid is consistently labeled as an “invisible enemy” for how it is transmitted among people. The “invisible enemy” label also applies with regards to COVID’s potential impact on your heart. Take the current guidelines seriously. 2 weeks of rest is worth potentially a lifetime of permanent heart damage. Odds are that if you had a mild or severe case of COVID-19 you will be referred to a physical therapist. Most often you will be sent to PT for a musculoskeletal condition you developed during your battle with COVID-19. However, another great way to utilize your physical therapist is as a guide to get you safely back to exercise.
You have Had COVID, What Do Your Therapists Suggest for Getting Back into Activity
As the pandemic recedes, people are recovering from COVID and physical distancing/social gatherings opportunities open back up, here are some tips to get back to an active lifestyle.
After COVID Start slowly back into your routine, but start
You’ve been inactive for a bit. Your body may not have been moving in a consistent manner for quite a while. Don’t expect to start out at the level you were prior to having COVID or prior to the pandemic.
Assess where your fitness levels are on a regular basis
Establish a baseline so you can plan where you want to go and make changes to your activity levels/movement as needed. Whether it’s a complete 13 point health and wellness assessment like is offered at Fitness Together or the Selective Functional Movement Assessment offered by Lake Washington Physical Therapy, know where you are starting so you can see progress and make changes to your program. You need to know where you are to get to where you want to be.
After COVID Know the difference between pain and soreness.
Soreness is usually traced to muscles moving in ways they haven’t for a bit. Soreness is usually felt between the joints. Delayed Onset Muscle Soreness (DOMS) usually peaks 36-48 hours after exercise. The best thing you can do to ”cure” DOMS is to keep moving. Pain usually occurs suddenly and at one point of the body. Pain normally doesn’t go away after 48 hours. The best treatment for pain is to get to Lake Washington Physical Therapy and get it checked out.
A physical therapist will be able to perform an examination and assess the cause of pain and provide corrective exercises to address mobility, motor control, and/or stability impairments that are contributing to dysfunctional movement patterns causing the pain. The goal of the physical therapist is to collaborate with your trainer to get you back to activity as quickly as possible.
Consistency is key when Re-engaging your fitness routine after COVID
You want to maintain a movement lifestyle. Exercise/movement has been shown to improve mental health, physical well being and the immune system. You are going to have good days and not so good days. Don’t allow the not so good days to sidetrack you.
You planned to go for a mile run but your body (or mind) isn’t quite there. Scaling it back to a half mile run or a half mile walk is OK. Be aware of what your body is telling you and take a rest day if needed. A good program is divided into higher levels of intensity followed by recovery.
All movement is good.
Use these tips to get back to enjoying movement and your favorite activity.
““As a physical therapist, I am always looking for personal trainers and gyms who have the same passion for helping patients achieve their goals. Steve and his team at Fitness Together have been fantastic to collaborate with. They are very communicative with regards to patient progress and ensure that everyone is working together as a team to achieve the patient’s goals.””
AUTHOR:
Matt Sato, PT, DPT, SFMAc, TPIc
LWPT Houghton Manager & Owner
Shawn Brenneman, PT, DPT, FAFS, FGS
LWPT Redmond Manager & Owner
CONTRIBUTORS:
Dr. Ghislaine Robert, MD
Frm Canadian Track & Field Physician & Sports Medicine Physician
Steve Dempsey, Personal Trainer, NASMc, ACSMc
Fitness Together Houghton
Dr. Bob Adams, DO
Ret. USA Track & Field Head Medical Physician & Sports Medicine Physician
Ben Wobker, PT, MSPT, CSCS, CFSC, SFMA
Founder & Director LWPT
References
Dermot Phelan, MD, PhD1; Jonathan H. Kim, MD, MSc2; Eugene H. Chung, MD. A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection MSc3 JAMA Cardiol. 2020;5(10):1085-1086. doi:10.1001/jamacardio.2020.2136
Antonio Pelliccia, Erik Ekker Solberg, Michael Papadakis, Paolo Emilio Adami, Alessandro Biffi, Stefano Caselli, Andrè La Gerche, Josef Niebauer, Axel Pressler, Christian M Schmied, Luis Serratosa, Martin Halle, Frank Van Buuren, Mats Borjesson, Francois Carrè, Nicole M Panhuyzen-Goedkoop, Hein Heidbuchel, Iacopo Olivotto, Domenico Corrado, Gianfranco Sinagra, Sanjay Sharma. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal, Volume 40, Issue 1, 01 January 2019, Pages 19–33, https://doi.org/10.1093/eurheartj/ehy730