As a fitness professional I see it as my duty to guide our followers on how to best improve and preserve their health and the number one health issue on everyone’s mind right now is COVID 19.
This has led me to sign up for a course delivered by Dr Col Robertson and Mel Spooner two of the leading health professionals who have been working in the field of rehabilitation from COVID 19.
I plan to keep you updated on my findings on this as I go through the training, however I did not want to wait until I completed the course before I started communicating with you about what is happening with people post COVID and letting you know more about what you should be considering when it comes to exercise and COVID 19.
Admittedly I have not been following the news closely this past months as I was finding that it was having a detrimental impact on my mood (my dream of trying to outrun a fellow jogger with a cough was the big sign for me to switch the news off!), but from what I have seen and heard there does not seem to be much of a focus on what happens with people after the initial 2-4 weeks of getting COVID 19.
This is what I wanted to focus on today in this blog. I am going to discuss what Long COVID is, how it presents itself and what we should be doing if we think that we have long COVID.
It is currently estimated that around 50% of people who contract COVID 19 will suffer from some level of long COVID, this means a huge number of people are still going about their daily duties suffering from the impact of this disease. Before I go into the details of what you should be doing if you suspect that you have long COVID, I thought I best explain what long COVID is. Long COVID is basically someone who still experiences some symptoms weeks or months after contracting the disease.
Below are the symptoms that are listed on the NHS website for long COVID:
- extreme tiredness (fatigue)
- shortness of breath
- chest pain or tightness
- problems with memory and concentration (“brain fog”)
- difficulty sleeping (insomnia)
- heart palpitations
- pins and needles
- joint pain
- depression and anxiety
- tinnitus, earaches
- feeling sick, diarrhoea, stomach aches, loss of appetite
- a high temperature, cough, headaches, sore throat, changes to sense of smell or taste
The really disturbing thing that is emerging about long COVID is that it is not something that only affects someone who has had bad to severe symptoms, people who have had COVID but have been asymptomatic can develop long COVID weeks or months after initially getting it and sometimes even severe long COVID.
For many people it seems like the first month after contraction they can seem to be recovering well, but then in month 2-3 when they start to return to normal activity their symptoms can deteriorate again (or develop for someone who was asymptomatic). Below is a case study that was shown on the webinar I was watching on long COVID rehabilitation.
January loss of taste/smell, sickness, fainting
March stroke like symptoms, neurological dysfunctions, COPD- Chest Infections, chronic fatigue, tingling in limbs, brain fog, hair loss, anxiety and depression
All this leads me to believe that we could be sitting on a health timebomb in the UK at this moment in time.
The UK government has pledged to give an extra £10 million to long COVID rehabilitation, however when you look at the numbers we are talking about I fear this may just be a drop in the ocean and it will also be a postcode lottery whether or not a rehabilitation centre is in your area.
Another issue could be that the NHS rehabilitation process is likely only to be accessible to people who presented with severe symptoms to begin with. If you had little to no symptoms the chances are you did not go to your doctor or hospital as the advice is to isolate and reports are showing it is difficult for these people to get access to rehabilitation treatment.
For many people who did have severe symptoms when they get past an acute critical stage they will be put back into the community and will be left to manage this on their own.
When discussing fitness and COVID I would suggest that we split ourselves into two groups, those who have had COVID 19 and those who have not.
For those that have not had COVID 19 your aim is to try and build up a bulletproof immune system, to firstly help reduce the impact of the disease if you do get it (stronger immunes system and healthier overall starting point has been shown to reduce the symptoms you experience) and secondly to hopefully help you recover better afterwards.
To improve your immune system the guidelines are pretty much everything you would expect from a good health plan; eat a healthy diet rich in fruit and vegetables, get regular physical activity, follow a quality sleep pattern, minimise stress levels and the research seems to say supplementing with vitamin D may help in the fight against COVID 19.
An interesting side note that professor Robertson discussed was how even super fit people can sometimes really suffer badly with the disease. The reason he gave was that you can be super fit and still have a suppressed immune system. Prolonged bouts of intense exercise have been shown to suppress the immune system, and a highly driven person may also be lacking in sleep and may have high levels of stress in their lives.
The advice would be to aim to strike a balance in your life and not push the envelope too much in your workouts and keep some recovery and lighter periods in your program. Now might not be the time to train for thath marathon you wanted to do or to try and get that six pack you have always wanted. It might be better to focus on being healthy.
It is also worth noting that for the couple of hours after a hard workout your immune system is lowered slightly so be extra vigilant at this point to wash your hands and follow the guidelines more than ever.
Finally if you have not had COVID19 it might be worth establishing a picture of your current health and fitness levels that you can then use as a comparison if you do get COVID 19. One really important measurement would be your resting heart rate. If you have a watch or device that measures your heart rate, wear it to bed for 4-5 days to get a true reflection of your resting heart rate. If you do not have a device manually take your pulse immediately upon waking for 4-5 mornings in a row. Resting heart rate is a vital window into what is going on within your body.
Keep a note of this somewhere you can refer back to if you get the virus as this will be a very important indicator on how you are recovering from the illness.
Another good idea to help you navigate the journey back to fitness if you get COVID 19 is to establish a few base level fitness tests just now pre contraction. It can be very very difficult for you to objectively look at where you are at with your fitness when you are recovering from illness or injury and chances are you will be too keen to get back to where you were pre COVID as our ego often gets in the way – all of which can really cloud our decisions. So having something to compare against can help you to avoid doing anything silly or dangerous.
An example of a good test would be a 1 mile walk. Walk it briskly and record your heart rate before, during and after. Then if you are returning after COVID you will know what a simple thing like a 1 mile walk previously used to be like for you. You will now have data to compare against which will make it a safer way for you to gauge where you are at. If you try the walk and your heart rate is much higher and or it takes you longer than it did pre infection then chances are you have not fully recovered.
Please, please though if you do use this method do not do the retest like you were trying to beat your parkrun PB, it is just a brisk walk and if you are feeling it tough at all terminate the test straight away and return home slowly. You are not trying to prove anything to yourself here, you are only trying to establish what is happening with you. Pushing yourself to do this test too early (if you are not even sure if you could walk 1 mile yet then you are certainly nowhere near ready to retest yourself) pushing yourself at this point could really set back your recovery!
Reflecting back on my own experience, last March I may have contracted COVID (there was no testing at this point) and I remember taking Joseph a walk down the woods with the buggy and went far too far on a really challenging terrain and knowing what I know now, this was not a wise thing to do. I was treating COVID like a normal cold or flu and was just keen to get back to normal life ASAP which is absolutely not what I would recommend doing now.
For those that have had COVID 19 the broader points I wanted to make are: Assume nothing; be patient; do not treat it like a normal cold or flu, show it respect and be very cautious on returning to exercise and normal life.
There is no way of knowing how you are going to respond to COVID 19, it really is a mindfield when it comes to returning to exercise. Just because you start to feel better a few weeks after contracting the virus it does not mean you are out of the woods just yet. Be ever vigilant as the after effects of COVID can hit you months down the line. The virus can lie dormant for months and reinfection can occur the minute your immune system is suppressed again. This can be due to over working, training too hard or another cold or flu causing you to lower your immunity guard.
A general rule of thumb is for every week you have symptoms, multiply it by three before thinking about returning to anything resembling your normal workload in life and before you even consider trying to push yourself in workouts.
It is vital that you try and listen to your body the best you can, track your workouts and heart rate, be mindful of your fatigue levels and just be kind to yourself.
If you are showing signs of regressions in your fitness and performance such as workouts feeling harder or a raised heart rate, these are big red flags. Don’t do what most people do in these circumstances, don’t try to fix the problem by training harder or more often. Back off your training load straight away and take it down to really light basic movements. If you still don’t feel great, cease exercising and rest up.
When first returning to fitness you must not think that you can jump right back into where you left off. The aim of your first few weeks back to exercise is to gently turn the wheels. Do very short and basic workouts that lightly get you moving and gently raise your heart rate. Put your ego to one side for this, you have the rest of your life to get fit again. Rushing this process could be a very dangerous game to play. Aim to also do gentle cardiovascular exercise most days to gradually repair the damage and make sure it is a very gently graduated approach that you take and it is advisable the only variable you increase to begin with is time and not intensity
It would be advisable to get some professional advice to guide you through this process also and this advice goes to both experienced exercisers and those that have never really exercised before. For the experienced exercise having another set of eyes and ears on what you are doing may be a good idea because chances are you will not take a progressive graduated response to your return and having someone help you keep the brakes on a little and show you how to gradually build back up may be a more sensible approach. For the non exerciser I would always recommend having someone holding your hand during the starting phase as this can be vital for helping you stick with it and helping you avoid the usual beginner mistakes. But now more than ever having some expert help would be very advisable.
When first getting back into exercise, try to avoid instructor led classes that are designed to really motivate you and push you. Chances are you will get caught up in the music and the instructors infectious and motivating cues and will end up working harder than you had planned to. Returning from COVID this could be a dangerous position to put yourself in. You are better keeping it personalised for the first while as you can control your effort better this way, at least until you are sure you are through the recovery phase.
If you do choose to work with a trainer please stay away from the trainers that wear their clients hard workouts on their sleeves as a badge of honour, the ones who are not happy unless their clients are barely able to move the days after workout.
Chances are they are not going to adapt the sessions to the level you need right now, as I mentioned earlier this is not the time to get super fit, this is a time to nurse yourself back to being healthy again and a cautious approach is very much what is recommended. Many of theses hardcore trainers can’t help themselves from pushing clients hard and this could be a dangerous road to go down (this is a rant for another day).
I am not saying because you have COVID you will never get back to the levels you were at previously. If all things go well then following a well structured graduated program will lead you back to where you previously were and maybe even to a higher level of fitness and health, you just need to be a bit more patient and remember that there will be different phases in your program; rehabilitation phase; rebuild phase and peak fitness phase.
I look forward to getting through this course on Rehabilitation after COVID and we aim to ensure that the Get Results team of trainers are in a good place to help our community navigate these difficult times together. Keep your eyes on our social media as I will share the information as we learn it and I may update you in this newsletter if there is anything I need to add.
To finish, there is some research emerging that has shown that people’s interest in health related topics has increased by 70% during the pandemic. It is now undoubtedly proven that anyone who is overweight, deconditioned or has underlying health conditions is going to have a more difficult time with COVID 19. So hopefully this will be a major positive that will come from these hard times we have suffered through.
My wish is as a nation we will take our health more seriously and constantly strive for a lifestyle that supports great health and vitality that makes us more robust to deal with whatever the world has to throw at us.
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