3 Steps For Returning To Physical Activity After COVID-19

The following tips are designed to help people return to fitness after a typical case of COVID-19. Around 10% of people infected with COVID-19 will have problems that linger for months after the infection is gone. These individuals are called long-haulers, and the condition is known as "long COVID" or PASC, which stands for Post-Acute Sequelae of SARS-CoV-2. If you have symptoms of long COVID, contact your primary care doctor before starting an exercise program. Long COVID may include other health complications that require labs, tests, or imaging, before being referred to a physical therapist for an evaluation and treatment specific to your condition. Note: Exercise may not be appropriate for everyone living with long COVID.

A mild to moderate bout with COVID-19 can leave you feeling weak, with a loss of balance and coordination, a lack of endurance, and sometimes problems with memory. Physical activity can help you recover.

Exercise may be the last thing on your mind, but it is key to regaining your fitness. Regular physical activity benefits your physical, mental, and social health. It's important for COVID-19 survivors (after their initial recovery) to get moving. Physical activity helps to improve:

• Strength.

• Endurance.

• Breathing capacity.

According to an article in BMJ, it's important to return to exercise after at least seven days free of COVID-19 symptoms, and to begin with at least two weeks of minimal exertion.

Listen to your body (and your doctor or physical therapist) for when it's safe to return to exercise. Then, take things slowly and follow this advice for returning to physical activity after a typical case of COVID-19.

1. Just Move, Even a Little

Your body has been through a lot. Take things slowly. For some, a trip from the bed or couch to the bathroom may be as much as you can handle in the early days. A flight of stairs may make you want to plop on the nearest easy chair. Get up and move as many times throughout the day as you can, even if it's just to stand from sitting several times in a row. Stretch for the sky with both arms and take several deep breaths each time you rise. Doing this light movement several times a day will help you start to build back strength. 

2. Take a Walk

If a little movement is not too challenging, try taking a brief walk. Begin at first by walking down the hall several times or around your house or apartment building. If that feels good, try a five-, 10-, or 15-minute walk around your neighborhood.

At this stage in your recovery, your intensity should be very light to light. At a light intensity, you should be able to easily carry on a conversation. If your intensity causes you to gasp for breath, you are pushing yourself too hard. The CDC provides a helpful description of Borg's Rating of Perceived Exertion to help you measure your intensity.

If you're a regular fitness fanatic and light intensity sounds too easy, be careful not to overdo it. It is important to allow your body time to get back to doing activities at your pre-COVID-19 pace. Gradually increase the intensity and length of your walks. With each day and each week, you'll be preparing your body to return to the full demands of a vigorous workout.

3. Ready To Run

If you tolerate walking, you may be ready to begin jogging, swimming, biking, or other activities. First, start your chosen activity at a slow pace for 10 minutes. Then, increase your pace for one minute before returning to the slower pace for another five to 10 minutes. Then repeat. When you're able to do these intervals for 30 minutes or more, you're ready to progress. Safely ease back into physical activity by slowly increasing the amount of intense exercise each day or week.

At this phase of recovery you may be ready for a higher intensity level. Aim for moderate intensity in which the exercise is somewhat hard, but not too hard. You should be breathing faster and deeper, but still be able to speak a full sentence and not be gasping for breath.

Everyone, regardless of age, condition, or ability should try to get the amount of daily physical activity recommended by the Department of Health and Human Services.

If you struggle with lingering side effects from COVID-19 and have trouble doing even minor physical activity, contact your doctor or a physical therapist experienced in treating COVID long-haulers. They can work with you on pacing, conserving energy, and addressing breathing pattern disorders to help you reach your goals.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement.

Avoid Chronic Disease With Regular Physical Activity→

Most Americans don’t move enough despite proven benefits, such as reduced risk of cancer and chronic diseases, and improved bone health, cognitive function, weight control, and overall quality of life.

The second edition of the Physical Activity Guidelines for Americans, reports that approximately 80% of US adults and adolescents are insufficiently active. As a result, many Americans currently have or are likely to experience chronic diseases, including heart disease, diabetes, obesity, and depression.

The good news is that regular physical activity can prevent and improve many chronic conditions. America, it's time to get moving!

How Much Physical Activity Should I Do?

According to the guidelines, the following is recommended:

1. Preschool-aged children (ages 3 through 5 years) should be physically active at least for 3 hours, if not more. Adult caregivers should encourage active play that includes a variety of activity types and limits sitting-around time, such as screen time.

1. Children and adolescents (ages 6 through 17 years) need at least 60 minutes or more of activity a day. This includes activities to strengthen bones, build muscles, and get the heart beating faster.

1. Adults should do at least 150 minutes of moderate-intensity aerobic activity a week, and at least 2 days for muscle-strengthening activities. Adding more time provides further benefits.

1. Older adults (ages 65 and older) should do at least 150 minutes of aerobic activity a week and include muscle-strengthening activities 2 days a week. You should also add components, such as balance training as well. If you have limitations due to preexisting conditions, consult with a health care provider and be as physically active as your abilities allow.

1. Pregnant and postpartum women who were physically active before pregnancy can continue these activities during pregnancy and in the postpartum period, but they should consult their health care provider about any necessary adjustments.

1. Adults with chronic health conditions and disabilities, who are able, should do at least 150 minutes of moderate-intensity activity a week. You should consult with a health care provider about the types and amounts that are appropriate for you.

How a Physical Therapist Can Help

Physical therapists are movement experts who optimize quality of life through prescribed exercise, hands-on care, and patient education.

After making a diagnosis, physical therapists create personalized treatment plans that help their patients improve mobility, manage pain and other chronic conditions, recover from injury, and prevent future injury and chronic disease.

Physical therapists empower people to be active participants in their own treatment, and they work collaboratively with other health professionals to ensure patients receive comprehensive care.

Resources

US Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. Washington, DC: US Dept of Health and Human Services; 2018. Accessed November 14, 2018.

US Department of Health and Human Services. Are My Kids Getting Enough Physical Activity. Move Your Way. Washington, DC: US Dept of Health and Human Services. Accessed November 14, 2018

US Department of Health and Human Services. 60 A Day! Move Your Way. Washington, DC: Dept of Health and Human Services. Accessed November 14, 2018.

US Department of Health and Human Services. What’s your move? Move Your Way. Washington, DC: Dept of Health and Human Services. Accessed November 14, 2018.

Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report."

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends nonopioid approaches including physical therapy.

Patients should choose physical therapy when ...

• ... The risks of opioid use outweigh the rewards.
  Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, "risks are much lower" with non-opioid treatment plans.
• ... Patients want to do more than mask the pain.
  Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
• ... Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
  The CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
• ... Opioids are prescribed for pain. 
  Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with nonopioid therapies, such as physical therapy.
• ... Pain lasts 90 days.
  At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are "preferred" for chronic pain and that "clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

"Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions," the CDC states.

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.