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Phased Programming Advised For A Safe Return To Exercise After Covid-19

As gyms and clubs reopen to the public, many members will be keen to resume their workout routines. Many can expect to regain their fitness and strength quite quickly, despite the long lockdown break.  But those members returning to exercise after having COVID-19 should be very careful and follow a phased approach, advises Dr Dane Vishnubala, Consultant in Sport and Exercise Medicine and Chief Medical Advisor at Active IQ.

“People who had severe COVID-19 illness, such as those who were hospitalised, are thought to be at higher risk of cardiac, respiratory or circulatory complications as they recover,” says Dr Vishnubala. “While exercise is very much recommended to restore cardiorespiratory fitness and strength, anyone who had COVID-19 should view their return to the gym as part of their rehabilitation and manage their fitness routine in conjunction with post-COVID-19 medical services,” he advises.

Even people who didn’t require hospital treatment for COVID-19 should exercise caution, especially if they had symptoms during their illness suggestive of any damage to their heart – such as chest pain, severe breathlessness or palpitations. “Anyone who had any of these symptoms during COVID-19 – even if they managed their illness at home – should check with their GP that they’re able to resume exercise before starting back slowly and gradually.”

Finally, anyone whose symptoms are prolonged and are not settling could be suffering from Long Covid, a long-term health condition that can be worsened by taking exercise. Once again, seeking advice from a GP or healthcare professional is of paramount importance.

To support people’s return to exercise, gym instructors, group exercise instructors and PTs should all be vigilant.  While it may be tempting to get straight back to pre-lockdown routines and sessions, the fact is many people will have been away from structured exercise and not encountered the intensity levels usually reached under instruction at the gym or studio.

Dane advises PTs and instructors to take their lead from the team of medics who together researched and presented the article Returning to physical activity after covid-19 (bmj.com). Their multidisciplinary experience in sports and exercise medicine, rehabilitation and primary care, combined with current evidence and consensus statements, has resulted in the following phased programme guidance for people returning to the gym after having COVID-19.

  • Firstly, ensure your client has been symptom free for at least seven days.
  • Use the Borg Rating of Perceived Exertion (RPE) Scale – ranging from 6 being ‘no exertion’ to 20 being ‘maximal exertion’. 
  • Ensure each phase lasts at least seven days.
  • Phase 1 would aim for an RPE of 6-8
  • Phase 2 – RPE 9-11
  • Phases 3 & 4 – RPE 12-14
  • Phase 5 – RPE of 15.  
  • Allow clients to take longer at each phase or go back a phase, depending how they feel.

“I definitely recommend a very conservative approach to working with clients returning to the gym post-COVID-19,” says Dr Vishnubala.  “People who are essentially well can expect to regain their fitness quite quickly using a phased progression programme. The best fitness instructors know when to reduce or regress an exercise programme and this has never been more important than it is today.”

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