Bronwyn Cottrell BSc Physio (Wits)
2020 will go down in history as the year the world was pushed out of its comfort zone. A pandemic has rocked the universe, and all anyone can talk about is a virus none of us can see. One thing for sure is that this virus has consumed all of us.
The problem is no one understands fully what we are dealing with. The experts are working endlessly to try make sense of it however it seems that Covid-19 does not behave as one would expect. The reality is it simply has not been around for long enough for anyone to grasp a thorough understanding of it. But one thing we do know is it is highly contagious and for some can be violently dangerous. Many people have lost their lives, not all of them having had any comorbidities or fitting the ‘profile’ of someone who is at risk. And so, we have been locked away to keep ourselves, our loved ones and those around us safe.
As our numbers rapidly climb, we are coming into contact of people who are infected with the virus more regularly, more and more of us are getting first-hand experience of what Covid-19 really means. While for some they sadly will not win the fight against the virus for many however the opposite is true, many people are recovering from illness and starting to return to ‘normal’ life, many desperate to get back to the road or trail.
I have been asked by several people to set out a plan for return to running following illness from Covid. The difficulty here is I do not believe there is a standard program one can follow, as this virus is so diverse and affects so many in so many ways, the program needs to be designed for the individual. There is also so much not known about the virus at this stage and the long-term effects have not been studied. What has been evident however, is that those who have been ill from Covid-19 have in many cases experienced cardiac injury, neurological symptoms, musculoskeletal deconditioning and weakness, impaired balance, and impaired pulmonary function. All this needs to be considered prior to starting any form of exercise again.
When starting to train again one needs to consider several different factors. Cardiac and respiratory function is vitally important, and it is essential that one does not put either of these systems under too much strain too quickly, as the results may be fatal. If you were extremely ill and needed to be hospitalised, I do not recommend you start any training without consulting a doctor or physiotherapist first. Other factors one needs to consider prior to training include baseline fitness prior to falling ill, any comorbidities that one may have, physical dysfunction and weakness as a result of being ill and the emotional effects that being ill may have had on an individual.
As mentioned, one cannot start training if the cardiac system and or respiratory system are under stress. This can be evaluated, and it is recommended that one keeps a daily check on those systems by evaluating temperature, oxygen saturation, cough, shortness of breath and respiratory rate at home.
While exercise is medicine and exercise has been proven to improve all the above-mentioned functions, one needs to ensure that return to exercise is gradual and slow to avoid too much too soon overload. It is recommended that one works on increasing exercise demand gradually. Start with low intensity exercise and gradually increase that as your body gets stronger and manages to withstand the demand. An easy way to evaluate if you are pushing too hard while exercising is by using a heart rate monitor. Most runners now days have watches that can read your heart rate while running, use this and be hyper aware as to where your ‘safe zone’ is while trying to get back to running. In an article by Wanda van Niekerk, Covid 19: post -acute rehabilitation, it is advised to start with 30-45min exercise at 60-75% of predicted heart rate max. Your heart rate max can be worked out by subtracting your age from 220. This will keep your heart rate low and in a ‘safe zone’ one can then gradually build from there.
While you need to assess your heart rate while running do not ignore what the respiratory system is telling you. Take note of your breath, try keep your breathing. You should be able to have a conversation comfortably while running. If you find you are breathless stop and slow down. When taking note of it you will notice that your heart rate and respiratory rate are intricately linked, therefore by keeping your heart rate low your respiratory rate should be easy as a result.
I would advise starting to get back to running by walking. Get comfortable with a decent brisk walk before you start to push the run. Do not increase activity too quickly, after all there is nothing to train for. So be kind to you and allow your body the time it needs to recover take the slow road. There is so much we still do not know and as mentioned previously we do not know what the long-term effects this virus may have on your body. There has however been speculation that there may be long term cardiac and respiratory side effects.
As the virus has affected so many different people in so many different ways the return to running is completely individually based. I highly recommend that one consults a doctor or physiotherapist for an individually designed program that can be closely monitored and progressed safely.
Stay safe, stay sane, enjoy your runs, and wear a mask.
Credit: Wanda Van Niekerk, Covid 19: Post-acute rehabilitation. Physiopedia