Contributed By:
Dr Ariane Mangar
Director- Disability and Rehabilitation Services
Ministry of Health

ONE of the worst long-term side-effects of Covid-19 is general weakness. Although most symptoms of COVID-19 disappear after recovery, most people complain of a lingering sense of fatigue, with limited ability to exercise or even perform daily activities. Several patients also experience muscle pain long after recovery.

The University of California recently conducted a study which found that people who have been less physically active are more likely to experience severe COVID-19 outcomes if they contract the virus. The study showed that physically inactive people require intensive care as compared to those who exercised constantly.

This doesn’t mean exercise can substitute in any way for immunisation but an active body with a strong immune system can certainly give a tough fight to the COVID-19 virus.

Regular exercise, whether it’s going for a swim, walk, run or bike ride, can substantially lower our chances of becoming seriously ill if we do become infected and it also releases endorphins that help relieve stress and pain from the body.

With Guyana experiencing a third wave of Covid-19, many people are apprehensive about going to the gym and exercising outdoors. Also, many of us are staying at home more in self-imposed quarantine and social distancing. According to the World Health Organization (WHO), staying at home for prolonged periods can lead to sedentary behaviour that can have negative effects on one’s health, well-being and quality of life. Moreover, self-quarantine can cause additional stress to one’s mental health.

During such times, any kind of physical activity can work as a valuable tool to protect you and encourage relaxation. Physical activity increases the exchange of vital white blood cells between peripheral tissues and the bloodstream, which aids the body’s immune response (blood and lymph vessels).

This increases the activity of immune cells in the bloodstream. A boost to the immune system helps in fighting infections, prevents bacteria from growing and reduces stress and inflammation.
Benefits of staying physically active in the time of COVID-19

– Strengthens the immune function
– Decreases inflammation
– Reduces the risk of heart disease and diabetes
– Aids in stress management by reducing symptoms of anxiety and depression
– Helps in weight management
– Improves bone and muscle strength, balance and flexibility

How to stay safe while exercising during the pandemic
– Do not exercise if you have a fever, cough or difficulty breathing
– Practice social distancing when exercising outdoors
– Practice good hand hygiene before and after your workout
– If you’re new to physical activity, begin with low-intensity activities like walking or low-impact workouts for shorter periods of time and progressively build up over time
– To minimise the risk of injury, choose the right activity; the strength of the exercise should be appropriate for your fitness level and health status.

Anyone who had severe illness or was hospitalised with COVID-19 needs to consult a doctor about whether it’s safe to exercise. But even people who experienced mild illness or no symptoms need to take precautions before exercising again.

Recommendations
1. Don’t exercise if you’re still sick. Do not exercise if you have active symptoms, including a fever, cough, chest pain, shortness of breath at rest, or palpitations.
2. For sports persons returning to exercise:
* After recovery from mild illness: one week of low level stretching and strengthening before targetted cardiovascular sessions.
* Very mild symptoms: limit activity to slow walking or equivalent, increase rest periods if symptoms worsen, avoid high-intensity training.
* Persistent symptoms (such as fatigue, cough, breathlessness or fever): limit activity to 60 percent maximum heart rate until two-three weeks after symptoms resolve.
* Patients who had lymphopenia or required oxygen: need respiratory assessment before resuming exercise.
* Patients who had cardiac involvement: need cardiac assessment before resuming.

Even if you’ve never been diagnosed with COVID-19, be mindful of how you are feeling. Many people with COVID-19 don’t know they have it, or have general symptoms like gastrointestinal upset, fatigue or muscle aches. So if you’ve been feeling “not your usual self” during exercise, listen to your body, ease up and check with your doctor.

COVID-19 is an aggressive virus that spreads easily and carries significant morbidity and mortality. Cardiac risk in particular is greater with COVID-19 than with other viral diseases, so it makes sense to return to activity with caution.

Exercise routines that you can follow after you would have recovered from COVID-19 and if you wish to regain your physical strength
Soon after recovery, it is important for you to understand that you must not rush with your fitness session since COVID-19 makes your body weak. Do not exert yourself. Go for a slow and steady exercise schedule which will not exhaust your oxygen reserve in the lungs.

You may resume your routine work at home but do not stress yourself. You may also do brisk walking for 15-30 minutes on every alternate day at home itself.
Walk or brisk walk: Even in small spaces, walking around or walking on the spot, can help you remain active. Ideally, aim to interrupt sitting and reclining time every 30 minutes.

If you have a call, stand or walk around your home while you speak, instead of sitting down. Brisk walking can be done in a corridor, balcony, or reachable areas. Around 20-25 mins of brisk walking can improve the metabolism of the body and energize you.

If you enjoy doing intense workouts, hold on for a month. Around 30 days after recovering from COVID-19, you can do push-ups and muscle-building exercises.

FOR ASYMPTOMATIC PATIENTS
To begin with, it is crucial to assess the impact of the virus on the individual and the body. “If the patient has been asymptomatic, then start off with brisk walking for 15-20 minutes as this can get your muscles moving. This is also a good form of exercise since the intensity can be regulated by the individual.

HYDRATE YOURSELF
Don’t forget to drink 8-10 glasses of water every day. The most important thing is to keep you hydrated (200 ml water every half an hour). Also, exercise according to your own limitations and don’t overdo.

There are Physiotherapists working in rehabilitation departments in every region in Guyana and, for more information, please call the Georgetown Public Hospital Rehabilitation Department, 225-3294.