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When returning to exercise after Covid we need to take into consideration all the systems of the body that Covid has affected. For example, if you just had mild respiratory symptoms then returning to exercise will be relatively straight forward, you just need to make sure that you do it slowly and steadily, building intensity in small increments, not dissimilar to returning to exercise following the flu or other respiratory infections.
However, the big difference with Covid and common viruses is that Covid normally effects multiple organs and in particular the cardiac system which, if you return to exercise too quickly can be life threatening. This is why a key part of my assessment of patients is considering all of the symptoms they have had, as well as the ones they are still experiencing, and to work alongside their GP to make sure we are treating every aspect.
We have recently been quoted in The Times on this subject, you can read the full article here: https://www.thetimes.co.uk/article/how-and-when-to-return-to-exercise-safely-after-having-the-flu-n6zqsbnjk
One of the main symptoms of cardiac involvement is breathlessness which people can often think is just part of the respiratory response. Therefore, if you have ongoing breathlessness then you should see your GP who my refer you for further investigations. However, this will only be the case in the minority of cases.
Even in the early days of recovery the first exercise should be breathing exercises which provides a solid platform for recovery. People should start with these that can be done in bed or sitting in a chair: https://www.youtube.com/watch?v=C1oNinlXqtA&list=PLv4_eynOXCvDosMxHeKBfHs6WMr2ie126&index=5
The the most common, and most life debilitating symptom I see is severe fatigue.
There are two key points to consider when returning to exercise with severe fatigue. The first is to write down all of the activities that trigger the fatigue and the second is to pace your return to exercise taking all of these triggers into consideration. For example, as Covid-19 commonly affects the central nervous system, many of my patients find their fatigue is triggered by cognitive or psychological exertion, for example doing things like reading, watching TV, listening to the radio, talking to friends and family or (at later stages of recovery) working. I ask my patients to write an activity diary so that they can monitor all of these alongside their exercise levels. This is the key to pacing. We set clear limitations on the amount of each activity and prioritise building up whichever one is most important to them.
One of the most common reasons for people struggling to return to exercise is that they push themselves to return to cognitive activities that they would previously have found easy which leads to fatigue and stops them being able to exercise.
The type of exercise that is most beneficial depends very much on the severity of their symptoms. If severe then starting with some simple exercise like sit to stand, going up and down on your tiptoes, gentle knee rolls and upper back twists are a good start. Or simply gradually increasing walking distance or time.
The most important thing is for me to find ways of people returning to exercise they enjoy, we may mean to hugely modify it but the sooner people can do activities that make them feel like themselves again the better. This is far more important than whether they should be doing weights vs cardio exercise. As soon as people can reconnect with their pre-Covid identity, the better their road to recovery will be. For example if someone was a keen runner I’d prioritise walking, then walking fast, then jogging, first for a couple of minutes as part of a walk and build from there.
However, we know there are huge physiological benefits to strength training, including benefits to the immune system, so I would try to encourage a graduated return to body weight strength worth and progress to weighted exercise if possible.
How much time it takes to return to these activities depends more on how badly your body was affected by Covid-19 rather than your previous fitness levels. Age is also a factor that slows down the speed of return to exercise.
You can book in for a 1:1 video consultation with Lucy Macdonald on email@example.com.
We have a YouTube playlist dedicated to those recovering from Covid 19 with lots of free advice and you can get free individualised advice at our Friday Facebook Live Q and A sessions @octopusclinic.
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