The COVID-19 virus is affecting many Americans at a societal level. Current stay-in-place orders and social distancing have resulted in a cycle of physical deconditioning, reduced functional capacity, and increased effects of chronic disease and stress. Unfortunately, this has led to a higher risk for falls, muscle weakness, pain, depression, and decreased quality of life. Physical therapists are very confident in treating the aforementioned issues, but one condition that physical therapists are treating now is post-viral fatigue syndrome from COVID-19 infections.
For many individuals who are recovering from COVID-19, they may be experiencing symptoms such as fatigue and decreased lung capacity that may linger long after they are out of quarantine.To mitigate the risk of complications, once patients have been discharged from the hospital, post-COVID-19 patients should establish early intervention through physical therapy rehabilitation. Before starting an exercise program, it is important to notify your primary health care provider if you are experiencing any aforementioned symptoms and to consult them for a recommendation for physical therapy. Physical therapy interventions can monitor response to exercise after recovery from COVID-19 complications and address deficits of aerobic capacity and strength, fatigue, balance and coordination, and emotional well being.
Our physical therapists are experts in developing appropriate and progressive exercise programs that meet the needs of each individual. We perform thorough evaluations to establish a baseline of function and develop a plan to progress safely to the highest level of function and to prevent long term effects of deconditioning.
The initial assessment, treatment, and activity plans
During the initial assessment, our physical therapist will begin to monitor your vital signs (heart rate, blood pressure, breathing function) at baseline, during activity and after activity to determine the appropriate level of intensity for your body. By closely monitoring vital signs (heart rate, oxygen levels, etc.), patients can safely progress toward their goals. Our physical therapists teach strategies to minimize stress on the cardiopulmonary system and the rest of the body.
Physical therapy interventions utilized may include manual therapy to address lung capacity and to improve chest and stomach expansion, corrective exercises to improve lung function and to strengthen the diaphragm and postural muscles to optimize breathing for daily tasks, balance and coordination for reintegrating safely into the community, and functional activities that focus on patient-specific goals to improve quality of life and to safely discharge back into the community.
In addition, a physical therapist will provide education and gradual progression of activities to achieve daily, weekly, and monthly progress. Topics of education include monitoring prescribed oxygen guidelines, energy conservation strategies and task modification for daily activities, and suggestions for the most appropriate exercises and how to monitor and progress your home program.
While completing your program at home, you can assess your exercise intensity by utilizing subjective scales to interpret how exercise makes you feel. By observing your elevated heart rate, increased breathing, and muscle fatigue, you can accurately monitor and guide your exercise intensity. The rate of perceived exertion (RPE) scale is a range from 0 and 10, with 0 indicating rest and 10 indicating maximal effort. When exercising, stay between a 3-4/10 for moderate intensity, avoid exercise at a more vigorous intensity to monitor your post COVID-19 symptoms.
In addition, it is helpful to log your exercise to track daily, weekly, and monthly progress. It can be helpful to track the distance and duration of exercise, the level of resistance band or weight used for strength exercises, and any modifications or progressions such as utilizing a support surface to complete a squat such as the back of a chair or a handrail.
Below is an example of an initially prescribed home program:
The intervention should last for at least 6 weeks, five times a week, 30–60 min/day, and start with low-intensity exercise.
Aerobic exercise: 10 to 20-minute outdoor walk, 10 minutes of walking up and downstairs, dancing at home or riding on a stationary bike.
Start with low intensity and increase by 10% each week. A limit of 70% of the maximum heart rate is set.
Strengthening exercises (2 to 3 days per week)
Completing 4 to 5 exercises, performed sitting or standing, and incorporating larger muscle groups (such as squats and calf raises), intensity 8–12 repetition maximum, for at least 6 weeks, 2–3 times/week.
Before participating in exercise, consult with your medical provider and physical therapist for a therapy plan. Always remember to include rest days and listen to your body when it needs a break. It is essential to stay safe during these times. If you experience any of the following symptoms, terminate therapy and contact your primary medical provider at once: (1) Temperature> 102.5 F degrees; (2) difficulty or shortness of breath with no relief after resting; (3) chest pain, chest tightness, dyspnea, aggravated cough, dizziness, headache, blurred vision, palpitation, night sweat, unable to maintain balance, etc.
Our ultimate goal is to return patients to their prior levels of function, improving their quality of life by getting them back to normal. We look forward to working with you soon.
Zhu, Y., Wang, Z., Zhou, Y., Onoda, K., Maruyama, H., Hu, C., & Liu, Z. (2020). Summary of respiratory rehabilitation and physical therapy guidelines for patients with COVID-19 based on recommendations of World Confederation for Physical Therapy and National Association of Physical Therapy. Journal of physical therapy science, 32(8), 545–549. https://doi.org/10.1589/jpts.32.545
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443542/