{"id":9635,"date":"2020-12-18T06:00:00","date_gmt":"2020-12-18T05:00:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=9635"},"modified":"2020-12-07T17:35:09","modified_gmt":"2020-12-07T16:35:09","slug":"return-to-exercise-helping-patients-to-overcome-the-long-tail-of-covid-19","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2020\/12\/18\/return-to-exercise-helping-patients-to-overcome-the-long-tail-of-covid-19\/","title":{"rendered":"\u201cReturn to exercise\u201d \u2013 helping patients to overcome the long tail of covid-19."},"content":{"rendered":"

Exercise remains a key component of rehabilitation for patients recovering from covid-19. However, there is limited guidance on how to start and progress exercise in non-athlete populations in the post-acute period of infection. We discuss if specific \u201creturn to exercise\u201d protocols could help to solve this problem and return patients in the general population back to normal function.<\/p>\n

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Why do we need return to exercise guidance post covid-19?<\/span><\/p>\n

Current data suggests that the majority of patients will have short (<2 weeks) self-limiting covid-19 infections that are managed in the community by primary care physicians. For a small yet significant number of these patients however, the road to recovery is more protracted, with patients suffering from \u201clong covid\u201d. One symptom study app revealed that at 4 weeks (1 in 7 patients), and 8 weeks (1 in 20 patients) are still suffering from at least one debilitating covid-19 related symptom (1). This includes fatigue, dyspnoea, chest pain, muscle pains, amongst other multisystem symptoms that can last for many months (2).<\/p>\n

The burden of these \u201clong covid\u201d symptoms can be significant to patients, both physically and economically, as many patients are left unable to work, and at risk of losing their livelihoods. In the absence of clear guidance on safe rehabilitation and how to return to exercise, many first contact practitioners are left advising patients to undertake periods of prolonged rest, which risks physical deconditioning. This is particularly important for patients with pre-existing Long-Term Conditions (LTC) or those living in low\/middle income countries disproportionately affected by covid-19 due to fewer healthcare resources (3).<\/p>\n

We propose that new \u201creturn to exercise\u201d guidelines for the general population (non-athletes) are needed to help return patients back to full function and prevent long term disability post covid-19 infection (4). This will require a shift in perspective from medical and non-medical stakeholders to prioritise rehabilitation alongside survivorship and rapidly expand our existing capacity to supervise physical rehabilitation in the community.<\/p>\n

Figure 1. Illustration of the return to exercise model in the non-athlete including safety advice and exclusion criteria.<\/p>\n

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Return to exercise model<\/strong><\/span><\/p>\n

We propose a draft version of a 5-stage protocol to assist clinicians in returning patients to exercise. This protocol aims to bring together time and progress-based intervals during rehabilitation, alongside holistic advice to address; sleep, nutrition, social support strategies, and mental health complaints. Due to the complexity of rehabilitation needs in some subgroups of patients, we propose that the following groups of patients be excluded from the return to exercise protocol:<\/p>\n

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  1. Patients hospitalised, or bedridden during the course of illness (moderate and severe illness).<\/li>\n
  2. Patients on long term oxygen, or who require cardiac \/ respiratory evaluation prior to starting exercise.<\/li>\n<\/ol>\n

    Challenges<\/span><\/p>\n