Returning to activity after Covid-19 or a period of illness

For patients heading home after a hospital stay due to Covid-19, or those who have experienced a prolonged lengthy stay in hospital or their own bed for other health conditions not specifically related to Covid-19, what can they expect physically and where do they go from here?

The exact pathway for care once you leave hospital, specifically for Covid-19 patients is being discussed and created.

Current statistics (which may well change after this is written 13/04/20) state approximately 50% patients will require no intervention, 45% may require low level social or medical input for recovery and 5% may require more focused ongoing recovery.

 

  • What does a hospital stay, or prolonged bed rest do to the body?

For those who have experienced common effects of bed rest they may notice changes to the ability and functioning of their body.  This is often temporary but requires the correct guidance to build up gradually.

The longer the stay, the longer the recovery time can be.  This depends on various factors such as age, any pre existing conditions that may slow recovery, and what support you have at home to help with rehabilitation.

 

  • Muscle weakness/atrophy – a reduction in size of muscles and their strength. Sitting for more than 30 minutes may be hard.  Lifting a kettle may feel heavy.

 

  • Bone density can decline – this can lead to a higher risk of fractures in the future. Gradual bone loading activities are important to redress the balance of bone formation over resorption.

 

  • Weight loss – particularly if people have experienced time on a ventilator. The body refines the energy requirements and muscle mass becomes less, thus requiring less energy to maintain.  (if you have seen someone’s leg 6 weeks after it has been in plaster, it is often much smaller than the other)

 

  • Breathing – this can be harder work due to damage to the lungs from infection and also the decline in muscle function around the lungs/ribs. For those on ventilators or machines such as cpap or high flow nasal oxygen, recovery can take weeks/months, but improvements should be noted daily.

 

  • Fatigue – tiredness can impact how willing we are to complete activities that will help our body improve. Little and often in the early stages builds tolerance and endurance to activities.

 

  • Decline in fitness levels – aerobic capacity will be reduced, particularly after respiratory infection. Walking may feel much harder and the heart/lungs system will need time to build back up.

 

  • Low mood/anxiety/flash backs

These elements are all addressed as part of Physiotherapy rehabilitation

 

  • What will rehabilitation do for me?

Rehabilitation after routine surgery such as a hip replacement will see people offered physiotherapy to increase joint movement, improve balance and muscle memory and strength, with the aim to return to normal daily activities; work, gardening, caring for parents or children.

 

Pain management may be key in early days, good nutrition to support the systems in the body key for repair and Physiotherapy intervention to address heart/lung and muscle/bone strength.

 

Covid -19 affects the respiratory system primarily so correct breathing exercises as part of respiratory rehabilitation are key.

Equipment such as incentive spirometry which provides feedback whilst breathing.

 

A 6 week rehabilitation intervention which included a combination of specific breathing exercises, stretches and cough training found the elderly post covid-19 patients who participated improved their 6 minute walk test and SF-36 quality of life (QOL) outcome scores from 2 sessions per week for 6 weeks.  Physiotherapists can guide you through this.

Mobilising the thoracic spine (the area around the shoulder blades and ribs) will be important to encourage joint mobility and muscle activity.

 

Cardiac rehabilitation will look to improve heart muscle function through structured exercise.

There are reports that similar viral infections such as SARS/MERS see increase anxiety, depression and post-traumatic stress and reduced exercise tolerance.

 

Structured, tailored and graded exercise is one method of managing these symptoms, alongside other talking therapies such as CBT treatment which can be accessed through Bury Physio.

Other treatment = some people experience hallucinations after being on ventilation equipment, so support from other allied health professionals; speech and language therapists, psychologists and occupational therapists can be implemented also.

 

  • What else can I be doing at home?

Walking – this is a great activity that you quickly see how your fitness and daily activity improves.  Keep tabs on how far around the house you can walk.  Can you do a flight of stairs yet? If you are getting outside, use landmarks to plot distances or time.

Following a structured exercise plan prescribed by a physiotherapist.  This doesn’t have to be a lengthy list of exercises.  The focus will be on your current abilities and where you want to be over a defined period.

 

Online video or telephone consultations will enable you to put a plan together with your Physiotherapist.  We understand the impact of prolonged bed rest on the body and will guide you through exercises, breathing techniques and strengthening movements that will build the heart, lung and muscle function as you recover.

 

  • How do I access that if clinics are shut?

Bury Physio Clinic continues to offer support to the community with telephone and video call consultations.  These work in much the same format as when you come to the clinic with an assessment, diagnosis, treatment and exercise programme offered.

Our Specialist Physiotherapists will be able to guide you through a programme specifically designed to improve the issues you experience and build you back up to your usual activities.

One benefit of video consultations, whilst you are in recovery is you don’t have to leave home just yet so can continue home based rehabilitation without losing precious time for improvements in your health.

 

For short exercise videos click on the links below.  They include chair based and early rehabilitation exercises for those who need to build up gradually.

https://www.facebook.com/buryphysio/videos/1681203432030867/

https://www.facebook.com/watch/buryphysio/

 

To book a VIDEO or TELEPHONE consultation please contact the clinic as usual and we will provide the right advice to get you back on track.

Tel: 01284 748200

Email: admin@buryphysio.co.uk

 

Web: https://www.buryphysio.co.uk

Facebook: https://www.facebook.com/buryphysio/

Twitter: https://twitter.com/Bury_Physio

Instagram: https://www.instagram.com/buryphysioclinic/

Videos: https://www.facebook.com/watch/buryphysio/

Links:

https://www.sciencemediacentre.org/expert-comment-on-treatment-and-recovery-post-covid-infection/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600281/

https://www.sciencedirect.com/science/article/pii/S1744388120304278

https://journals.sagepub.com/doi/full/10.1177/2047487320915665

 

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