Commonly asked questions are ‘When is it safe for patients to resume exercise post-COVID?’ and ‘what are suitable exercise programs for patients not working due to long-COVID?’
Physical activity is a key component of long-term recovery from illness, and it has profound physical and mental health benefits. Patients recovering from COVID will require guidance through a gradual reintroduction of activity, with due consideration given to possible complications.
The RACGP has developed guidelines for all primary care practitioners to assist with safe return of patients to physical activity. In a study of 3000 Australians diagnosed with COVID-19, it was found that approximately 5% continued to experience symptoms after three months.
Defining post-COVID-19 conditions
The World Health Organization has developed a clinical case definition for ‘post–COVID-19 condition’:
Post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of symptoms that last for at least two months and cannot be explained by an alternative diagnosis.
Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.
Another suggested definition that describes a range of post-acute COVID-19 symptoms is ‘chronic COVID-19’ or ‘post–COVID syndrome’; that is, illness extending beyond 12-weeks from initial symptoms. The term ‘long-COVID’ has been commonly used to describe COVID-19 symptoms following acute illness, irrespective of how long the symptoms take to resolve, and could be used in referring to either of the above two conditions.
Studies have identified that patients are at higher risk of post-COVID-19 conditions if they;
- have experienced severe illness during their acute COVID-19 illness
- have pre-existing comorbidities
- are of older age
- are female
- are high performing in their sport or work role where activities can be taxing
A GP consultation within six weeks of release from isolation is recommended for all patients, in particular those of higher risk as noted. These consultations provide an opportunity to assess for any reoccurring or ongoing symptoms, the need for additional supports, and to update management of pre-existing conditions or screening that might have been impacted by their illness. This provides an opportunity for early referral to allied health professionals if required
Why is exercise important?
We agree that COVID-19 is multisystem impacting therefore we are aware of the multitude of factors which may present for individuals. The health benefits of being physically active in recovering from illness are well established. Conversely, the harms of physical inactivity have also been well documented since the pandemic began, driving the necessity in provision of guidance, advice and supervision with exercise prescription and gradual return to pre-illness activities.
Exercise is important in recovery for patients with either long-COVID or post-COVID-19 conditions but must be done gradually and safely. The following phases may be implemented if close consideration is given to the intensity and duration of activity prescribed based on the severity of symptom experiences. An individual’s Rate of Perceived Exertion (RPE via the 20-pt Borg Scale) is globally used to monitor such intensity within each phase and can dictate fluid progression or regression through stages during an exercise program as needed.
Key messages
- Physical activity is important in recovering from COVID-19 and the harms of inactivity during recovery well documented
- A GP consultation within six weeks of release from isolation is recommended for all patients providing opportunity for early referral to allied health professionals if required
- Exercise prescription for patients with long-COVID or post-COVID-19 conditions but must be done gradually and safely.
Author competing interests – nil