Physiotherapy after passing COVID-19 in accordance with the guidelines of the National Chamber of Physiotherapists is a system of exercises tailored to the individual needs and capabilities of the patient. It takes place under the care of a physiotherapist who selects goals and exercises, adapting them to a specific patient. Zbigniew Wroński - vice-president of the National Council of Physiotherapists and one of the authors of the physiotherapy program after COVID-19 - tells "Poradnik Zdrowie" what the process of returning to full fitness after the disease is about and what it requires.
Physiotherapy after COVID-19 is a topic that affects more and more patients every day. That is why a group of experts from the National Chamber of Physiotherapists (KIF), led by Dr. Anna Pyszora, developed a "Physiotherapy program for people after COVID-19".
Physiotherapy after COVID-19 in accordance with the guidelines of the National Chamber of Physiotherapists (KIF)
From the document "Physiotherapy program for people after COVID-19", prepared by a team of experts: Anna Pyszora (chairperson), Piotr Szczepański, Dariusz Banik, Tomasz Maciążek, Sebastian Szyper, Tomasz Niewiadomski, Zbigniew Wroński, You can learn thatproperly conducted rehabilitation can significantly improve the quality of life of survivors- especially those who, under the influence of COVID-19, deteriorate lung function and overall fitness. On the other hand, the lack of physical therapy may cause the unfavorable changes to last for months or even years, limiting the activity of these people in social and professional life.
The long-term effects of COVID-19, which physiotherapy is particularly good at, are :
- decreased tolerance of physical exertion,
- reduction of muscle strength,
- shortness of breath,
- chronic fatigue.
From the "Physiotherapy program for people after COVID-19" you can also learn that experts from the two largest scientific societies in the field of treating respiratory diseases: the American Thoracic Society (ATS) and the European Respiratory Society (ERS) indicate that that physiotherapists, as specialists professionally involved in the assessment of cardiovascular and respiratory fitness and fitness of patients, can create individual rehabilitation programs for postovid patients, using the experience of working with patients with chronicrespiratory diseases (including pulmonary rehabilitation programs used in patients with COPD). These programs, however, require modification due to the complexity of the problems faced by people after COVID-19.
Studies conducted in the population of patients with a history of acute respiratory distress syndrome (not related to COVID-19) indicate the high effectiveness of physiotherapeutic interventions in improving the physical efficiency and quality of life of patients after staying in intensive care units. Similarly, in the case of patients with chronic respiratory diseases, in whom physical training and education - implemented by physiotherapists as part of pulmonary rehabilitation programs - are characterized by high effectiveness.
What is the rehabilitation of a pocovid patient?
Zbigniew Wroński : We conduct physiotherapy for postovid patients in accordance with the guidelines of the National Chamber of Physiotherapists. This physical therapy first consists of an interview and a physical examination, which is the basis. And based on the parameters or the patient's results, the loads are selected.
This is mostly moderate-intensity cardio training. The proposed level is 50-65 percent of the so-called VO₂ max. It is such a load calculated on the basis of the patient's abilities. Physiotherapists calculate and select them depending on the patient's age and abilities. And on this basis, the heart rate is constantly monitored during training. And the loads are selected so that this patient is constantly stimulated to the appropriate level of activity.
What exercises are performed during rehabilitation after undergoing COVID-19?
The most essential form of the entire recovery program after COVID-19 is performance training. Efficiency training can be carried out in various ways, but it is really about a person having a given load that he will carry out for some time. Five minutes, ten minutes, fifteen minutes straight. The load is selected according to the patient's abilities, as I have already mentioned - it should be a moderate load of 50-65 percent of the VO₂ max for a given patient. The simplest form of load and the safest is a stationary bicycle, a bicycle ergometer. And the patient simply pedals at a given load under pulse control at a certain speed for a certain period of time. And this is part of this training.
A supplementary form or a substitute form can be entering a step. It is a form of training that can be used at home. You can use a step, a stepper you have, a box, but alsoan ordinary staircase in the staircase in virtually every building. And just go up and down this step for a while too.
How can I diversify this training?
To make it more interesting, we have complementary forms. We have exercises with weights, with various types of weights, which the patient exercises with one hand, two hands. You can use a bar, a barbell, you can use kettles, which are becoming more and more popular recently.
Weight training, dumbbell exercises can be developed over time. One of the simpler progressions is the use of an unstable base, i.e. a Swiss ball, which allows … increases the activity of the trunk muscles, and thus also activates the muscles weakened as a result of the COVID-19 disease.
Another form that is often used can be exercises in various types of suspension systems - whether with the use of gymnastic rings or with the use of TRX, very popular and often used. You can do a lot of different exercises with them.
What is the best way to end the exercise?
At the end it is usually good to supplement the program with relaxing exercises, simple breathing exercises, calming exercises, maybe stretching a little. So as to activate the chest, thoracic spine and finish the training in such a way, so that the patient comes back to us with a smile for the next day.
How soon does rehabilitation after COVID-19 start?
Post-COVID-19 training usually begins four to six weeks after recovery. This is such a pan-European guideline that is in force now. We know that patients heal on their own, everyone heals on their own after an illness. This period of two to four weeks is the recovery time. You can try to start earlier, but these are individual cases. Typically, it's about four to six weeks.
How long is a single patient training after COVID-19?
Standard training lasts between 30 minutes and an hour, depending on the patient's condition and abilities. Usually it starts shorter, 30-40 minutes, ultimately up to 50 minutes. And that's how it is planned. However, it depends simply on the patient's abilities. One time to make sense, it is 10-15 minutes at a time, which is such a period of exercise that it can be said that it gives some effects. Maybe if someone is very weak, has a very low level of efficiency, at least just to last five minutes.
How long should physical therapy last after COVID-19?
It is considered that training to have some effect -And it is practically irrespective of whether we are talking about a he althy or a sick patient - it is considered that such a minimum training period is about six weeks. And we also planned this training program for six weeks. You can continue it and we encourage you to do so. However, let's be honest - I would consider four weeks as the minimum of reasonable training where a change can be noticed.
What is the effectiveness of pocovid physiotherapy?
Why is it working? This is interesting in itself, because there are many unfavorable changes after COVID-19, but today we do not know 100% whether they are the result of a virus, or whether the virus impairs the respiratory functions of the body, and secondarily impairs the circulatory system or the brain. We do not know yet one hundred percent, where is the source, where is the cause. And that is what the scientists are wondering about. We'll wait, see what they tell us. On the other hand, we can see and observe that long-term training with moderate loads is safe for patients, improves circulation, allows - in simple terms - more blood to pass through the brain, oxygenates the brain more, so the brain regenerates faster and returns to fitness faster. And this also applies to the rest of the body.
This is also good for the psyche of these people. Because when they exercise in such more gym conditions, they do not perceive themselves as sick so much. This is also such an element, research also shows that such non-medical environment accelerates treatment, because people think of themselves as he althy people training, and not as sick people during rehabilitation.
Additionally, we certainly have a lot of research that people who are more fit, stronger people who exercise systematically, generally mentally, are also stronger and feel better. Anyway, imagine it that way, imagine a situation where someone has a problem to walk 200-300 meters, because he is out of breath. Or someone has a problem saying two or three sentences because he is out of breath. And now we have a situation where, after three, four, five weeks of training, someone is able to talk and is not out of breath, or someone is able to climb the first, second, third floor and is not out of breath. Automatically people see the effects and the effect they see makes them mentally feel much better. They are stronger. It stimulates them.
Goals of the "Physiotherapy program for people after COVID-19"
Main goal of the program:
- Supporting the full recovery and activity (including professional activity) of people after COVID-19.
Specific goals of the program:
- Improvement of exercise tolerance.
- Reducing the intensity of troublesome symptoms related to COVID-19 (e.g. shortness of breath, chronic fatigue).
- Education of convalescents in the field of independent coping with bothersome symptoms related to COVID-19.
More information on post-COVID-19 physiotherapy is available from trained physiotherapists who rehabilitate pocovid patients and the WHO Guide for People with COVID-19.