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    A Doctor's view: Returning to exercise after a Covid infection

    on August 05, 2022

    Emergency medical doctor, David Haunschmidt (pictured above), is an accomplished ultra-runner based in New Zealand who follows evidence-based science in health and sports nutrition.

    David juggles daily training with his busy shift-work as an A&E doctor. This often leaves less time for optimal exercise and recovery, leading him to explore other ways to naturally boost his potential.

    A CurraNZ advocate, here David shares his medical insights and experience on recovering from Covid, with additional advice for athletes.

    Returning to exercise post COVID-19 infection, by David Haunschmidt

    World Health Organisation research suggests 25% of people who have had the virus will continue to have symptoms for at least a month whilst 10% will still feel unwell three months on.

    This is often known as “long COVID”. These persistent symptoms, including cough, elevated resting heart rate and fatigue, can last for weeks to months after COVID-19 infections.

    It is important to remain active. A mild-to-moderate bout of COVID-19 can leave you feeling weak, with a loss of balance and coordination, a lack of endurance, and sometimes problems with memory.

    Physical activity can help you recover. In addition, regular physical activity benefits your physical, mental, and social health and wellbeing.

    It is important to treat your body well during this time, with plenty of quality sleep, good nutrition and avoidance of stress.

    I would add into this the addition of CurraNZ to aid recovery and help boost immunity.

    These superfoods have been shown to have antiviral and anti-inflammatory affects, as well as improve recovery times. Plus, there are early studies looking at anthocyanin direct effects on the COVID-19 virus.

    Determine your level of risk when returning to physical exercise after Covid

    The American College of Sports Medicine has issued guidelines for returning safely to exercise based on level of risk.

    Doing too much too soon after Covid-19 can be harmful. It is clear that a graduated return to physical activity is the best approach. 

    1. LOW RISK: Individuals under the age of 50, who had an asymptomatic infection or mild respiratory symptoms that resolved within seven days are considered low risk.

    2. MEDIUM RISK: Those with symptoms or fatigue lasting for more than seven days, prolonged shortness of breath, or chest pain that did not require hospitalisation, are deemed intermediate risk.

    3. HIGH RISK: Defined as those who required hospitalisation, experienced shortness of breath or chest pain at rest or while performing activities of daily living.

    RECOMMENDATIONS:

    ➔ LOW-RISK
    o Minimal activity for at least ten days after being diagnosed (see below – stage 1)
    o Only begin a gradual return to physical activity after at least seven days free of symptom (see below - stage 3)
    o Begin with at least two weeks of minimal exertion, before gradually increasing volume and load.


    ➔ MODERATE AND HIGH RISK
    o A more cautious approach is needed.
    o Recommended to speak with your regular healthcare provider before returning to exercise.

    ➔ RED FLAGS:

    Stop exercising immediately and contact your healthcare provider if you have any:
    o Chest pain or palpitations
    o Excessive breathlessness
    o Feeling like you are going to faint
    o Any other worrying symptoms

     

    SUGGESTED RETURN TO EXERCISE:

    1. Just Move, Even a Little
    ➢ First, return to a normal routine (daily activities/work/school) and sleep patterns without experiencing fatigue or shortness of breath. You may find that simple things may make you feel short of breath.

    2. Low-Intensity Activity
    ➢ If a little movement is not too challenging, try taking a brief walk, or perform
    household/gardening tasks.
    ➢ You should be able to breathe easily and have a conversation throughout.
    ➢ Gradually increase the intensity and length of your walks. You’ll need to spend at least 7 days
    in this phase before moving on to the next phase.

    3. Moderate-Intensity Activity
    ➢ After 7 days, and still feeling good.
    ➢ Begin jogging, swimming, biking, or other activities. First, start at a slow pace for 10 minutes.

    Then, increase your pace for one minute before returning to the slower pace for another five to 10 minutes. Then repeat. When you're able to do these intervals for 30 minutes or more, you're ready to progress.
    ➢ You should be breathing faster and deeper, but still be able to speak a full sentence and not be gasping for breath or be overly fatigued.

    4. Return to Baseline Activity
    ➢ You should now be able to do the types of exercises, sports or other activities you could do before you got COVID-19.
    ➢ Increases in volume (time performing activity) and load (intensity) should be gradual.
    ➢ Heavier resistance and HIT/sprint training can follow.

    TAKE HOMES:
    ❖ Only return to exercise after at least seven days free of symptoms
    ❖ Athletes should engage in at least two weeks of minimal exertion before resuming their sport with gradually increasing volume and load.
    ❖ Gradually ease back into pre-Covid exercise levels
    ❖ Be mindful and use daily self-monitoring to track progress
    ❖ Seek medical advice for any severe symptoms.
    ❖ Give CurraNZ a try to support your immune system and recovery


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    References:
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    2. Anti-viral and anti-bacterial activities of two extracts of the blackcurrant from New Zealand and Poland, Fukushima Journal of Medical Science, Vol 59, No1, 2013
    3. Anti-viral and anti-bacterial activities of an extract of blackcurrants, Microbiology and Immunology 56: 805–809
    4. The Signalling Pathways and Therapeutic Targets of Antiviral Agents: Focusing on the Antiviral Approaches and Clinical Perspectives of Anthocyanins in the Management of Viral Diseases, Frontiers in Pharmacology, 2019
    Nov 8.
    5. Anti-Influenza Nutraceuticals: Antiviral and Anti-Inflammatory Effects, Advances in Complementary Alternative Medicine 4(3). ACAM.000590.2019. DOI: 10.31031/ACAM.2019.04.000590.
    6. Fakhar Z, Faramarzi B, Pacifico S, Faramarzi S. Anthocyanin derivatives as potent inhibitors of SARS-CoV-2 main protease: An in-silico perspective of therapeutic targets against COVID-19 pandemic. J Biomol Struct Dyn. 2021
    Oct;39(16):6171-6183.
    7. Salman D, Vishnubala D, Le Feuvre P, Beaney T, Korgaonkar J, Majeed A et al. Returning to physical activity after covid-19 BMJ 2021; 372 :m4721
    8. Carfì, A., Bernabei, R., Landi, F., & Gemelli Against COVID-19 Post-Acute Care Study Group (2020). Persistent Symptoms in Patients After Acute COVID-19. JAMA, 324(6), 603–605.
    9. Baggish, A., Drezner, J. A., Kim, J., Martinez, M., & Prutkin, J. M. (2020). Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes. British Journal of Sports Medicine, 54(19), 1130–
    1131.
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    11. Elliott, N., Martin, R., Heron, N., Elliott, J., Grimstead, D., & Biswas, A. (2020). Infographic. Graduated return to play guidance following COVID-19 infection. British Journal of Sports Medicine, 54(19), 1174–1175.

    12. Kingstone, T., Taylor, A. K., O'Donnell, C. A., Atherton, H., Blane, D. N., & Chew-Graham, C. A. (2020). Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID. BJGP open, 4(5),
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