COVID patients can lose muscle mass quickly while staying in bed. Experts demonstrate safe and effective ways to keep muscles and joints flexible and strong throughout recovery.
When Jefferson doctor Kimberly Heckert learned her eight-year-old daughter had gotten COVID-19 from a visitor, she knew how to care for her while keeping the rest of the household safe from the virus. That meant bringing meals to her daughter while wearing a facemask, checking oxygen levels regularly and also showing her daughter how to do exercises so she wouldn’t lose her strength while she recovered in bed.
Recently, about 3,000 people were testing positive for the virus in Pennsylvania in a single day. Over the same time span, over 150,000 people were confirmed with the disease daily across the country. There will be many who quarantine at home, watch their symptoms, and recover with bed rest. Although not everyone will have a family member with Dr. Heckert’s expertise to guide them through recovery.
“Deconditioning, or losing muscle mass, and tightening of joints, starts right away – within days of inactivity,” says Dr. Nethra Ankam, who specializes in physical medicine and rehabilitation. “People can end up much weaker than when they started.” On the other hand, COVID-19 can cause shortness of breath and the potential for inflammation in the heart, which can make over-exertion risky. What’s the right way to exercise with COVID-19?
Dr. Ankam and physical therapy supervisor Kristen Stout led a team of physical therapists who created a short video series to help patients at home, or in the hospital, keep their muscles and joints active safely. The videos demonstrate therapy that is appropriate for the sickest patients and for those with a milder course of disease.
The group presented their work to the Jefferson research community this spring, and recently made the videos freely available online to anyone. Follow along below for explanations and pointers on each of the three videos in the series below.
Start here: Breathing and in-bed exercises while sick with COVID-19
Each video starts with breathing exercises. These are important because “as we get sicker, we tend to take shallower breaths,” says Dr. Ankam. “The breathing exercises show patients how to take deeper breaths to let their lungs aerate. They also improve patients’ ability to maintain strength in the accessory muscles surrounding their lungs, which helps improve overall lung function.”
The breathing exercises are followed by in-bed stretches and movement. “The aim of these exercises is to improve range of motion for all major joints,” says Dr. Ankam. “Everything is very gentle.” COVID-19 patients are at risk of heart inflammation, which is why the videos instruct viewers to take a pause to catch their breath, and make sure their hearts aren’t racing.
In fact, “if at any time during the exercises, a patient has more shortness of breath than before, and difficulty talking, increased heart rate or palpitations, fatigue, exhaustion, dizziness or lightheadedness, they should stop the exercises and rest,” explains Stout. “All of these exercises are meant to be relatively easy. Just doing them regularly will be enough.”
If patients can complete 10 repetitions of each of these exercises twice a day without feeling more fatigued, then it’s safe to graduate to the next level: sitting exercises.
Next up – Sitting exercises
When patients are fever free, and aren’t experiencing shortness of breath and recovering from COVID-19, they can graduate to the sitting exercises below.
The sitting exercises focus on arm and leg lifts. If patients are able to do 10 repetitions without becoming fatigued or short of breath, they can add a weight to the arm-lifting exercises, says Stout, but watch the pace. “Going at a slower pace, as demonstrated in the video, works better. Too fast, and you don’t really get the benefit.”
“There’s often a downward spiral in patients who experience shortness of breath,” says Dr. Ankam. Patients with difficulty breathing tend to be less active, and in turn lose muscle mass, which, in turn makes activity more difficult and leads to more shortness of breath. “Patients have to fight against that. These exercises are designed to help.”
Finally – Standing Exercises
Finally, viewers can try standing and chair exercises. At first, a patient might want to do these exercises with someone who can spot them, in case they get dizzy. “The last thing we want is for person to risk a fall,” says Dr. Ankam.
Once a patient feels comfortable with the standing and chair exercises and are ready to do more, Stout recommends walking and slowly getting back to daily activities. In fact, as patients begin to feel stronger, they can ease back into other normal activities of daily life. However, patients should consult their doctors before planning anything more strenuous.
Patients might not notice a big difference after doing these exercises but doing the right number of repetitions will help them maintain and improve their overall muscle strength and joint flexibility as they recover from COVID-19.