Dr Rui Cintra

Physiotherapist

Physiotherapy in the management of long covid  

HPA Magazine 17

Long COVID is a term to describe the effects of COVID-19 infection that continue and persist for weeks or months beyond the initial illness. The disease is usually classified as acute when patients maintain symptoms for up to 4 weeks and subacute if they persist for up to 12 weeks. Currently, it can be robustly stated that one in ten COVID patients will present symptoms for a period of 12 or more weeks.

After six months the most frequent symptoms are extreme tiredness (fatigue), memory and concentration problems, which worsen after exercise. About 75% of patients suffer from these long-term effects. Patients report exhaustion, mental confusion, pain, shortness of breath, palpitations, fever and sleep disturbances, which can continue after exertion for a period between 12 and 48 hours and, in some cases, can even last for days or weeks.
Physiotherapy may play a preponderant role in the monitoring of these patients, but it needs to be carefully prescribed and focused on the following objectives:
Preventing oxygen desaturation during exertion, helping in the presence of extensive increased respiratory rate and/or respiratory distress.
The therapeutic proposal of progressive exercise should not be used when there is exacerbation of symptoms after exertion, short periods of activity and more frequent rest periods should be preferred, the object being to conserve energy.
The Physiotherapist has other strategies for Long COVID patients, namely in the process of learning how to manage the energy needed during the day for various activities - learning to preserve energy reserves - and also in helping the patient to build a diary of activities and symptoms.

This diary is a fundamental tool, as it guides the patient in terms of the amount of activities and daily symptoms, by having as a "maximum reference" a good day and as a "minimum reference" what he can do on a bad day.
The importance of breaks during activities should be reinforced, and these rest periods should occur before feeling tired. This process requires learning and understanding the body and its responses.
It is fundamental to know how to recognize the initial signs of post-exercise exacerbation symptoms and to STOP immediately, without trying to exceed limits, REST and CONTROL daily cognitive activities and their symptoms. It is extremely important to know how to define priorities, plan periods of occupation and rest, grade the demand for activities and above all enjoy each day.
A simple reference for monitoring exercise is to measure your heart rate when you wake up; during activities this should not exceed 15 beats above the basal value measured on awakening.