COVID-19 is a complicated virus. Many people who contract the virus are asymptomatic or have symptoms of a common cold or flu, while others become very sick. Though known risk factors often play a role in the severity of the reaction to the virus, COVID-19 often affects healthy people without a clear understanding of the exact pathology. Now over two years since the first known case of COVID-19 in the United States, and with vaccinations and boosters available, the severity and daily impact of the disease has overall lessened, and the medical community continues to learn more about COVID-19. Though the long-term effects of COVID-19 are still being researched and much is unknown, we are aware of the respiratory complications and effects of Long COVID. It is likely personal trainers will train someone who has contracted COVID-19. Returning to exercise is recommended but there are a few considerations trainers should be aware of when working with these clients.
Dr. Michael Schwartz, a pulmonologist and critical care doctor and Professor of Medicine at National Jewish Health, takes care of patients with COVID-19 in the intensive care unit at Rose Medical Center, and sees patients in his pulmonary clinic at National Jewish Health, both in Denver, Colorado. Dr. Schwartz has experience treating respiratory complications due to COVID-19 and is a huge advocate of returning to exercise for the health and well-being of the patient.
As stated previously, symptoms of COVID-19 can vary widely from person to person and respiratory complications can last from a few days to months. Beyond the known populations at higher risk, Dr. Schwartz is not seeing respiratory complications in patients follow a specific pattern but does emphasize that vaccinations decrease the likelihood of contracting and severity of the disease, so those who are vaccinated might be able to return to exercise sooner.
Dr. Schwartz believes patients should return to exercise unless they have a clear-cut medical reason to avoid exercise. One contraindication to returning to exercise would be if the patient had a heart-attack due to contracting COVID-19 or has been diagnosed with myocarditis or inflammation of the heart muscle. He explained that many physicians are promoting early mobilization even in ICU care. This includes having patients start walking even if on a ventilator. Exercise at this time is likely beneficial and studies are suggesting that though this type of intensive care management does require more staffing, it can improve outcomes for the patients.
When personal trainers are working with clients who want to return to working out after having COVID-19, there are a few considerations to be aware of prior to training the client. Unlike returning to exercise after a common injury or procedure, there is a huge variability in both symptoms and the severity of symptoms with COVID-19. Personal trainers should understand how severe the disease was for the client. Trainers should be aware of what kind of shape the client was in prior to contracting the disease. Other questions to ask include what treatments did they receive? How long did their symptoms last?
Some clients develop acute respiratory distress syndrome from contracting COVID-19. This is a lung condition that causes low blood oxygen. Though this will likely get better over time, it can take up to a year and these clients will have some scarring and therefore have less lung function. A certain number of patients will also develop Long COVID. Long COVID includes lingering symptoms such as brain fog, malaise, and general weakness. Dr. Schwartz believes that the sicker patients are with COVID-19, the more likely they are to develop Long COVID symptoms. He also referenced some studies that show exercise tolerance is worse with COVID-19 patients than from other viruses and there can be some defects in muscle and muscle metabolism and general weakness in exercise ability. Dr. Schwartz says many will be disappointed in their exercise tolerance.
As a trainer, help your client set realistic expectations for themselves and know that they can return to their previous fitness level, but it will likely take weeks or even months. Recovery from COVID can affect muscle strength but medical professionals are not quite sure if this weakness is due from being critically ill and being on a ventilator or what they call “ICU associated weakness” or from another surgery or trauma. They do know that steroids can weaken muscles but are a powerful intervention for really sick patients. Regardless, patients need strong diaphragm muscles to breathe on their own. Similar to any return to physical activity after a long time off, injury or illness, trainers should progress their clients slowly and tolerance should be based on symptoms. Programs should include aerobic and strength work. Dr. Schwartz recommends focusing on upper extremity exercises, specifically the chest and intercostal muscles to help with breathing.
COVID-19 has a multi-faceted impact on health and exercise ability. Trainers and clients should expect some setbacks when returning to exercise but the good news is that with a smart, progressive, and individualized approach, clients can regain their strength and fitness levels.