The COVID-19 health crisis is currently the most serious global threat to our way of life alongside climate change. Worryingly, mounting evidence shows this virus not only causes respiratory issues but can also affect vital organs (brain, kidney, liver, pancreas), a fact which wasn’t fully appreciated at the beginning of the outbreak. Further, COVID-19 can lead to blood clots and brain inflammation resulting in neurological problems, such as strokes, confusion and dementia like symptoms, as well as rare and debilitating conditions such as Guillain-Barre syndrome.
People over the age of 65 and those with underlying heath conditions (cardiovascular disease, diabetes, chronic respiratory disease, cancer), are most at risk of poor outcomes from the virus. While largely true, this may lead to a mistaken view that only the elderly and less well need to worry. However, 50% of COVID-19 deaths in America have been among people under the age of 80, which is due in part to at least half of the population there living with at least one underlying health condition. Worryingly, Department of Health figures indicate that approximately one quarter of the UK population have a long-term condition.
Our knowledge about the virus is growing and has improved medical care. Further research will hopefully yield a vaccine in the future, but this is of little comfort to many people who have already had COVID-19 and been left with lasting physical difficulties. A large proportion report:
- Persistent fatigue and shortness of breath due to reduced heart and lung function
- Loss of muscle mass and strength making it harder to get up and about
- Longer than expected time getting back to doing activities of daily living easily
- Reduced quality of life
- Neurological problems: – loss of taste or smell, headaches, dizziness, confusion, difficulty concentrating, seizures, delirium, stroke
- Reduced mental health and quality of life
Researchers at King’s College London report that Covid-19 symptoms have a long tail lasting up to 30 days or longer while an Italian study found 87 percent of people who had recovered from the virus were still experiencing at least one symptom two months later.
The Chartered Society of Physiotherapy (CSP) has emphasised that rehabilitation is “an unmissable part recovery from COVID-19” to help save lives and enable life to return to normal. Clearly, people with COVID-19 symptoms severe enough to require hospitalisation will need an extended period of rehabilitation. Dramatic declines in leg strength of up to 41% and can occur with extended periods of bedrest, reducing balance, mobility and confidence.
As well as the direct health impact on people with COVID-19 the silent effects of the lockdown period and restriction of physical activity on the general population may soon become apparent. According to the World Health Organisation low physical activity is a leading risk factor for premature death worldwide and is linked to cardiovascular disease, cancer and diabetes, health conditions which are also associated with increased risk of death among people who catch COVID-19. Worryingly, Scottish Government records going back to 2012 show that a high proportion of older adults (65+ years) are physically inactive.
Health experts fear that being forced to stay indoors for three months during the lockdown period will have made the problem of physical inactivity much worse and give rise to an increase in disability, frailty and falls among older adults. Being inactive for as little as two days can start the muscle wasting process, which becomes more noticeable with a 6-10% decline in muscle size during longer periods (10 to 30 days) of inactivity. As well as muscle loss the nerves supplying the muscles start to wither resulting in noticeable weakness of large leg muscles necessary for walking and balance.
Being generally more active now that restrictions have been lifted is the best way to reverse the harmful effects of indoor confinement on health and physical function and prevent frailty, as well as return a sense of wellbeing. To enhance health and wellbeing the UK Chief Medical Officer and WHO recommend 150 minutes of moderate intensity activity per week (30 minutes on most days), together with strengthening and balance exercises. Importantly, even light intensity physical activity can have very beneficial effects on health and wellbeing of older adults.
These recommendations can be quite daunting for some who are still recovering from COVID-19 and others who are simply trying to get back to a more active lifestyle. There is also a risk of disappointment if health goals/challenges are not achieved (ie couch to 5K) due to symptom relapse or injury as a result of trying to do a bit too much too soon. The process of recovery and becoming more active to restore health and a sense of wellbeing is not always a straight path that leads ever upwards. The journey can be quite often punctuated with bumps and wobbles in the road. Applying principles of planning and pacing activity, balancing exercise and rest periods, as well as preparing for times when things don’t quite go as expected can help set someone up for success.
Authors: Dr. Maria Peer, Dr. Sean Prescott
Reference list available upon request.