“It seemed to take forever”: Getting back into aquatic exerciseafter recovering from COVID-19

 Although we are sick of the pandemic, the pandemic is still making us sick. COVID-19 infections are all around us.

For a couple of our aquatic exercise programs, the prevalence of being unwell with COVID-19 continues to be a significant disruption to getting back into regular exercise for many. Within our recent Kickstarter digital aquatic exercise program, 40% of participants had COVID-19 within the six-week program and needed to pause exercise for a number of weeks. Within one of our JointFIT classes, 65% of participants had battled COVID-19 within the past two months. Most people with chronic conditions have already had significant disruptions to getting back on track, with healthcare delayed due to the pandemic, thousands waiting for surgery with ongoing pressures on the hospital systems and “struggles” and “stress” reflected in people’s day-to-day lives (1). Reviewing the current advice on exercise when recovering from a COVID-19 infection seemed timely and was a good way for us to ensure we were giving out the right advice. We also reflected on feedback from participants in our programs and the pros and cons of aquatic exercise after having a respiratory illness related to the physics and physiology of exercise in water.

Most people with COVID-19 will experience mild illness and recover within a few days. This has certainly been the case for most of the people in our aquatic programs. Despite this, it can take many weeks to fully recover “it seemed to take forever to get over COVID” reflected one frustrated participant. Recovery can depend on a few different factors - fitness levels, age, general health and how severe your symptoms are. About 10-20% of people have longer term effects after getting COVID-19. There are a range of tips in getting back into exercise from the research to date and experts in the field (2-9) including the following

·      return to exercise or sporting activity after experiencing no symptoms for at least seven days

·      if you still have symptoms two weeks post-diagnosis, you should seek medical advice.

·      you will be weaker after a period of inactivity and likely to feel breathless more easily

·      if you’ve been in hospital, get advice for returning to exercise from healthcare professionals like your doctor, physiotherapist or exercise physiologist as you may also need to exercise with someone keeping an eye on you to start with

·      feeling breathless can be stressful and provoke anxiety, which may make your breathlessness work. Stay calm as much as you can and find a position leaning forward with support in sitting or standing. Try to use as little effort as possible and make your breaths slow, relaxed and smooth

·      start gently with low intensity exercise (walk, stretching, slow moves) - start at a level that it’s easy to breathe and speak full sentences in a conversation for 15 mins , don’t push until you’re tired, as in the early stages of recovery it might set you back

·      phase in higher intensity exercise slowly(weights, jogging) - aim to slowly build up to 20-30 minutes of fitness exercise, five days a week.

·      strength training (even just using your bodyweight) can help your immune system so don’t forget to add in body weight exercises like squats, step ups, standing up and down from a chair, heel raises and push ups at some stage - start with 3 sets of 5 repetitions, then build up to 3 x 10  

·      if you do feel too breathless to speak, slowdown or stop to rest until your breathing feels more controlled

·      have a rest day, see how you pull up and make sure you’re fully recovered before your next exercise session

·      On the safety front - stop exercising immediately and seek healthcare advice if you have chest pain , feel sick, become clammy or sweaty, feel dizzy, signs of blood clotting, such as swollen calves or have unexpected difficulty with breathing during exercise. Find medical advice immediately if symptoms persist after exercise. If you think you have ongoing tiredness after exercise, beyond what you’ve experienced in the past, catch up with your local doctor, physiotherapist, or exercise physiologist.

Getting back into exercise in the pool after recovering from COVID-19 has it’s pros and cons. The pros related to the physics of exercise in water (10)  –you are weightless and taking less of your body weight which can make low intensity exercise easier as long as you don’t work at maximal speeds against high levels of drag force. The physiology of being immersed in water gives us some additional work to our breathing. The pressure of the water compresses our legs and pushes fluid back up to our chest and pushes our diaphragm, the base of the lungs, upward too (11). Both of these changes reduce our lungs volumes and make our work of breathing a little bit harder. It’s usually not a big issue for people and we know those with other respiratory issues find water exercise comfortable, enjoyable and safe (12) … so jump in! Just follow these few tips in addition to the general advice for returning to exercise

·      stay in the shallow end where the physiological changes to increasing work of breathing won’t be as significant

·      move slowly in the water to start with, keeping drag resistance low

·      increase speed of movement to increase intensity in a steady, incremental way over a number of sessions

·      keep a check on the right depth and right speed of movement with your exercise that doesn’t lead to significant shortness of breath

·      You might be keen to get back into exercise, as one of our participants told us “I was so looking forward to getting back to the pool as my joints were starting to get sore again” but start slowly as you’ll be deconditioned after your time out of exercise and you’ll need to build up your tolerance again slowly, from a fitness and a joint and pain system perspective.

Best wishes for getting back into your exercise routine. Slow and steady wins the race (and reach out to your local doctor or health professional if you have any questions).

REFERENCES

1.      https://www.abc.net.au/news/2022-08-10/toll-elective-surgery-delays-from-pandemic-on-australians/101318108

2.      Décary S, Gaboury I, Poirier S, Garcia C,Simpson S, Bull M, Brown D, Daigle F. Humility and acceptance: working withinour limits with long covid and myalgic encephalomyelitis/chronic fatigue syndrome. journal of orthopaedic & sports physical therapy. 2021May;51(5):197-200.

3.      https://www.healthdirect.gov.au/covid-19/recovery-and-returning-to-normal-activities

4.      https://www.healthdirect.gov.au/blog/what-happens-after-you-recover-from-covid-19

5.      Tang, C. Regaining fitness after COVID infection can be hard. Here are 5 things to keep in mind before you start exercising again. The Conversation, 2022. https://theconversation.com/regaining-fitness-after-covid-infection-can-be-hard-here-are-5-things-to-keep-in-mind-before-you-start-exercising-again-180588

6.      Twomey R, DeMars J, Franklin K, Culos-Reed SN,Weatherald J, Wrightson JG. Chronic fatigue and post exertional malaise in people living with Long COVID: An observational study. Physical Therapy. 2022Apr 1;102(4).

7.      World Health Organization Regional Office for Europe. Support for Rehabilitation Self-Management after COVID-19-RelatedIllness. 2020 https://www.who.int/europe/publications/i/item/WHO-EURO-2021-855-40590-59892

8.      World Physiotherapy response to COVID-19 Briefing paper 9 SAFE REHABILITATION APPROACHES FOR PEOPLE LIVING WITH LONG COVID: PHYSICALACTIVITY AND EXERCISE 2021. https://world.physio/sites/default/files/2021-07/Briefing-Paper-9-Long-Covid-FINAL-English-202107.pdf

9.      Wright J, Astill SL, Sivan M. The Relationship between Physical Activity and Long COVID: A Cross-Sectional Study.International journal of environmental research and public health. 2022 Apr22;19(9):5093.

10.  Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. Pm&r. 2009Sep;1(9):859-72.

11.  Hall J, Bisson D, O'Hare P. The physiology of immersion. Physiotherapy. 1990 Sep 10;76(9):517-21.

12.  McNamara RJ, McKeough ZJ, McKenzie DK, AlisonJA. Acceptability of the aquatic environment for exercise training by people with chronic obstructive pulmonary disease with physical comorbidities: additional results from a randomised controlled trial. Physiotherapy. 2015 Jun1;101(2):187-92.

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