COVID-19 Recovery: An early plan

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IMPORTANT NOTE! Your healthcare professional can suggest exercises mentioned in this article that are suitable for you. The exercises and the tips listed here should not substitute any individualized therapeutic exercise programs nor the advice given to you by your health professionals during your discharge from the hospital or at any other point during your COVID-19 Recovery phase.

Since we are – first and foremost – a webpage dedicated to Good Health and General Wellbeing, we could not help dedicating a special COVID-19 Recovery article to the effort required fully recover from this terrible disease that has hit humanity over the last 1,5 yrs.

It is important to follow the rules of spread prevention and hygiene, as defined by infectious disease specialists, and to observe them with strict reverence and with absolute individual responsibility, while practicing social distancing.

Prolonged stay at home – and any sedentary behaviors – have the effect of reducing physical activity and inactivity of our immune system and, in addition, worsening stress and changes in our mental performance.

Exercise is directly related to the strengthening of our immune system and its shielding against the coronavirus too. Given that COVID-19 causes an inflammatory reaction (waterfall effect) with the activation of cytokines and especially with the activation of interleukin-6, which are a key part of our immune system, we understand how critical exercise is even in the recovery phase. Additionally, several scientific studies, point out the anti-inflammatory effect of exercise.

Therapeutic Exercise Program during the COVID-19 Recovery phase

Exercise is an important part of recovering from severe COVID-19 disease.

Systematic Exercise will lead to:

  • Improvement of physical condition
  • Improvement of mental function
  • Reduced shortness of breath
  • Reduced stress and improved mood
  • Increase in muscle strength
  • Increased self-confidence
  • Improved balance and coordination
  • Increased energy

It is strongly recommended to find a way to stay motivated
to exercise.
It is advised to help yourself keep track of your progress with a
diary or a mobile phone application or smartwatch etc.

Safety First!

Exercise safety is important, even if you were consistently exercising before you got sick.

This is especially important if:

– You had difficulty moving before going to the hospital
– You fell either before you went to the hospital or during your hospitalization
– You have any other condition or injury that may affect your health during exercise
– You were discharged from the hospital with prescription oxygen therapy

 In these cases, you may need to exercise with someone else for security reasons. Anyone receiving oxygen therapy MUST discuss the use of oxygen during exercise with a health care professional before starting the exercise program.

The following simple rules will help you train safely:

 – Always warm up and leave time for recovery after  exercise
– Wear loose, comfortable clothes and suitable shoes
– Wait at least 1 hour after a meal before exercising
– Drink plenty of water
– Avoid exercise in very hot environments (indoors or
outdoors)
– Exercise indoors when it is very cold outside

 If you experience any of the following symptoms do not Exercise or stop exercising and communicate with a health care professional:

 – Nausea or tendency to vomit
– Dizziness or tendency to faint
– Shortness of breath
– Intense sweating
– Tightness in the chest
– Severe pain

 Remember to keep your distance when exercising outdoors if relevant rules apply in your place of residence.

Exercise at the appropriate level

 To check if you are exercising at the right level, you can follow the below rule of thumb:

 – If you can say a whole sentence without interruption and without panting, then you can exercise more intensely
– If you cannot even speak or can only say one word at a time and then you pant, then maybe you exercise very intensely
– If you can say a sentence, taking a couple of pauses to breathe and your shortness of breath is moderate to almost severe, then you are most likely exercising at the appropriate level

Remember that it is normal to gasp when exercising and this is neither harmful nor dangerous. Gradually your fitness level improves, and this will help you breathe more slowly without panting.

To make sure you are improving your physical condition you need to feel a moderate to almost severe shortness of breath when exercising.

If you really feel that you are too short of breath to speak at all you should slow down or pause to rest until you feel better, and your breathing is more controlled.

Warm up

Warming up prepares your body for exercise to prevent it from getting injured. The warm-up should take about 5-10 minutes. The goal is to reach a point where you feel a little out of breath. You can do the exercises to warm up while sitting or standing. If you do warm up in an upright position, lean on a stable surface, if necessary.
Repeat each movement 2-4 times.

 Sample foundational warm up moves:

1. Shoulder lift
2. Shoulder rotation
3. Lateral bends
4. Knee lift
5. Foot lift
6. Ankle Rotation

 

Main Exercises to Improve your Physical Condition (Cardio focused)

To be able to complete your COVID-19 Recovery you need to aim to do exercises to improve your physical condition for 20–30 minutes, ideally 5 days a week.

Below you will find some examples with different exercises for good fitness, but any activity that makes you have moderate to almost severe shortness of breath can count as exercise for good physical condition and will help your recovery.

Aim to keep the time when you exercise to achieve better results by gradually increase the time for longer workout sessions as much as you can handle. You can slowly add 30 seconds or 1-minute of additional exercise. Full COVID-19 recovery may take a significant time and effort to return to the levels of activity you did before you got sick.

Stay focused on the end goal and don’t give up!

Sample key exercises to boost your cardio fitness level and regain strength of major muscles: 

1.  Walking on the spot

– If necessary, hold a sturdy chair or a support surface and you have a chair nearby to rest
– Raise your knees, one at a time
To gradually make the exercise more difficult:
– Increase the height at which you raise your legs in order to raise them to its height basin if possible
When can you choose this exercise:
– If you cannot go out for a walk
– If you cannot walk very far before you need to sit down

2. Steps

Use the last step of a ladder to climb on the spot
– If necessary, hold the handrail for support and you have a chair nearby to rest
– Go up and down the stairs, changing the foot with which you start every 10 “steps”
To gradually make the exercise more difficult:
– Increase step height or speed with which you go up and down the stairs
– If you have a good enough balance to do this exercise without holding on to somewhere,
you can also hold weights as you do it
When can you choose this exercise:
– If you cannot go out
– If you cannot walk very far
before you need to sit down

3. Walking

– Use a walker (“pi”), crutches or a cane, if necessary
– Choose a route that is relatively flat
To gradually make the exercise more difficult:
– Increase speed or distance or, if possible, include uphills on your route
When can you choose this exercise:
– If you can go out to exercise
Only jog or bike if it is safe for you from a medical point of view
When can you choose this exercise:
– If walking does not make you gasp enough
– If you could jog or bike before you got sick

4. Jogging or Cycling

Only jog or bike if it is safe for you to from a medical point of view
When can you choose this exercise:
– If walking does not make you gasp enough
– If you could jog or bike before you got sick

Strength Training

Strengthening exercises are also critical for successful COVID-19 Recovery. They will help strengthen your muscles who lost mass due to the disease. You should aim to do three workouts with strengthening exercises every week. Strength training will not make you gasp like the cardio exercises for good physical condition. Instead, you will feel that your muscles are strained.

You should aim to complete 3 sets of 10 reps for each exercise, with a short break after each set.

Do not worry if these exercises are difficult for you. If this happens, start with fewer repetitions in each set and increase them gradually until you reach a set of 10 repetitions. When you feel you want to make the exercises harder use heavier weights to strain your muscles more. Any objects you can lift can have a positive impact in your muscle strength, if you cannot find professional weights.

 Below you will find some strengthening exercises for the arms and legs, which you can do while sitting or standing. You can execute them in any order. Remember to keep your body upright, with straight back and flexed belly and do the exercises at a slow pace.

Remember to inhale as you prepare to execute the difficult part of the exercise and you exhale while applying strength.

Main exercises for re-building Arm strength

 1. Bicep Curls

– With your hands next to your core, hold a weight in each hand with your palms facing forward
–  Try holding your elbow as stable as possible to isolate the biceps
– Gently lift the lower part of your arms (bending the elbows) bringing the weights close to the shoulder and slowly lower them again
– You can do this exercise while you are sitting down or in a standing position
To gradually make the exercise more difficult:
– Increase the weight you use when doing the exercise

2. Pushing a wall with your hands (standing push-ups)

– Place your palms on a wall at shoulder height, with fingers pointing upwards
– Feet at a distance of approx. 30 cm(1ft) from the wall
– Always keep your body upright, lean slowly bend your body towards the wall at your elbows and then push it lightly
– Then move away from it until your arms are completely stretched
To gradually make the exercise more difficult:
– Stand farther and farther away from the wall

3. Abductions

– Hold a weight in each hand, with your hands by your torso and palms facing in wards
– Raise both arms sideways, at shoulder height (but not higher) and then lower them slowly
– You can do this exercise while you are sitting or in standing position
To gradually make the exercise more difficult:
– Increase the height to which you raise your hands, but this should not exceed shoulder level
– Increase the weight you use when doing the exercise

Main exercises for re-building Leg strength

1. From Sitting to Standing Position

– Sit with your feet slightly apart. You have your hands on the side of the trunk or crossed on the chest.
– Get up slowly, stay in this position until to count to 3 and sit slowly again on chair. Keep your feet firmly on the floor throughout the exercise.
– If you cannot get up from the chair without using your hands, try exercise using a taller chair.
If you still have difficulty exercising at the beginning, you can put a little strength in your hands  to push.
To gradually make the exercise more difficult:
– Move as slowly as you can
– Do the exercise using lower chair
– Hold a weight near the chest while doing the exercise

2.    Knee Extensions

– Sit in a chair with your legs together.
Stretch one knee and hold for a while outstretched leg. Then you lower it.
Repeat with the other leg.
To gradually make the exercise more difficult:
– Do the exercise more slowly
– Increase the time period during which you keep the leg outstretched until you count to 3

 3.    Squats

– Stand with your back to the wall or something else stable surface and legs slightly open.
– Bring your feet about 30cm (1ft) apart from the wall. Alternatively, rest your hands on the back of a fixed chair.
– While holding your back against the wall or leaning against the chair, bend your knees slightly slowly.
Your back will slide against the wall downwards until your pelvis is just above knee level
– Pause before stretching your knees slowly again.
To gradually make the exercise more difficult:
– Increase the distance you cover with knees bent (remember to hold
the pelvis above knee height)
– Increase the pause time until you count to 3 before stretching the knees again

4.    Calf lifts

– Rest your hands on a firm surface to keep your balance
– Slowly get up on your toes and then slowly return the heels to the floor
To gradually make the exercise more difficult:
– Stand on your toes until you count to 3
– Stand on one leg at a time

Cooldown Exercises

Recovery exercises allow your body to return to normal before exercise is stopped. Recovery should last about 5 minutes and your breathing should return to normal levels until it is completed. Try all the following suggestions, but, if you cannot do all the exercises or all the stretching, do as much as you can.

1.       Slow walk
2.       Repeat Warm-up exercises
3.       Muscle stretching

Scientific Reference: World Health Organization (Europe)
https://www.euro.who.int/en

 

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