In response to COVID-19, a global epidemic in recent years, Taiwan Cardiopulmonary Rehabilitation Association formed an expert group to hold a consensus meeting and draw up rehabilitation plans for patients. Patients were divided into five categories according to the severity of the disease, and different pulmonary rehabilitation guidelines were given.

  1. Outpatient patients with mild disease and no risk factors
  2. Out-patients with mild disease and epidemiological risk factors
  3. Inpatients with moderate and severe diseases
  4. Ventilatory support for conscious patients
  5. Ventilator-supported unconscious patients

The following two articles, we will be introducing rehabilitation and treatment in each categories respectively.

1. Outpatient patients with mild disease and no risk factors

  • At least 10 days after onset of symptoms
  • No fever within 24 hours without taking antipyretic medicine
  • There are no other COVID-19-related symptoms.

The pulmonary rehabilitation plan for such mild patients is mainly to prevent complications through physical training. Training should consist of three parts: warm-up, exercise, relaxation and stretching.

First, warm up with light endurance activity for at least 5 to 10 minutes before entering the main workout, which includes cardio and resistance training:

  1. Aerobic exercise: rhythmic exercise that stimulates large muscle groups, such as treadmill, cycling and swimming, while training breathing and boosting lung capacity.
    • Frequency: more than 5 days per week
    • Intensity: Maintain 40% to 59% reserve heart rate (reserve heart rate = maximum predicted heart rate - calm heart rate)
    • Training time: 30-60 minutes
  2. Resistance training: for specific limbs or core muscles (biceps, triceps, pectoralis, gluteus, quadriceps, etc.) to carry out single-joint or multi-joint movement, without weight bearing or using heavy training equipment to increase training intensity.
    • Frequency: 2-3 days per week, at least 48 hours apart.
    • Intensity: Strength training uses 60%-70% of 1RM weight; Endurance training uses less than 50% of the 1RM weight. (1RM stands for "one repeated maximum weight", which refers to the maximum muscle force generated by a single muscle contraction).
    • Training time: strength training 8-12 times per group, 2-4 sets; Do endurance training 15 to 25 times per set, up to 2 sets.

After exercise, patients should perform 5 to 10 minutes of low-intensity, moderate exercise followed by at least 10 minutes of stretching.

At present, self-regulated home lung rehabilitation is recommended as the main method. As long as proper environmental disinfection is carried out and family monitoring is safe, patients can also achieve the effect of lung rehabilitation by self-training at home without going to clinical units in hospitals. It is important to note that training should be stopped immediately in the event of unstable vital signs or respiratory distress.

In addition, based on what is currently known about COVID-19, pregnant women can follow the ACSM's recommendations to maintain exercise and implement a rehabilitation program, but after the 16th week of pregnancy, supine exercise should be avoided to avoid blocking maternal venous return due to fetal weight compression. In addition, unlike adults, children need at least 60 minutes of aerobic exercise a day, but should avoid training in hot and humid environments because of their immature thermoregulation mechanisms.

2. Out-patients with mild disease and epidemiological risk factors

People with chronic COVID-19 conditions, such as hypertension, cardiovascular disease, chronic respiratory disease or diabetes, have a higher chance of becoming severe and of dying compared to those without comorbid conditions. However, under careful supervision and stable conditions, such patients can still be engaged in a rehabilitation program including aerobic exercise and resistance training:

Hypertension: Patients should be specially monitored for hypotension after exercise, especially in older patients receiving antihypertensive medications.

Cardiovascular disease: Exercise training is safe and effective for most patients with cardiovascular disease. After cardiopulmonary exercise test or physician evaluation, adjust the training intensity to the range of body can compound, and do lung training step by step. And monitor for symptoms such as dyspnea, dizziness, palpitations, chest tightness or chest pain.

Pulmonary disease: Patients with chronic pulmonary disease have more respiratory secretions than those without lung disease. Airway clearance techniques should include flutter breathing, postural drainage, effective cough technique and chest physical therapy such as Huffing. Patients can also carry out abdominal breathing health education, reduce the use of auxiliary muscles to breathe hard, normal life that is to develop a correct and good way of breathing. Specific exercises, such as yoga, tai chi and core muscle training, can also help stabilize the torso to promote effective breathing. In addition, inspiratory muscle training has been shown to reduce dyspnea and improve exercise performance and quality of life in COPD patients. Resistance is recommended to start at 30% of the maximum inspiratory pressure (MIP) and to avoid training in cold environments and environments with allergens or contaminants that may cause tracheal constriction.

Diabetes: Blood sugar should be evaluated before and after exercise for symptoms of hypoglycemia, including tingling in the mouth and fingers, tremors, abnormal sweating, anxiety, confusion, forgetfulness, hunger and visual disturbances. In addition, patients with retinal disease should avoid strenuous exercise and continuous air holding force (Valsalva) to avoid raising blood pressure. Patients with polyneuropathy need to pay attention to foot care to prevent foot ulcers and the risk of amputation.

Although such patients can be rehabilitate at home under the above conditions, their health needs to be closely monitored. If any adverse events occur, exercise training should be stopped immediately. If symptoms are severe or do not recover, medical assistance should be sought immediately.

In our next article, we will introduce a lung rehabilitation program for patients with moderate to severe COVID-19 whose symptoms are well suited.

Article source:

  • Cheng Y-Y et al., Rehabilitation programs for patients with CoronaVirus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation, Journal of the Formosan Medical Association, https://doi.org/10.1016/j.jfma.2020.08.015

Reference:

Author : Jasmine Chen, Clinical Respiratory Therapist

Jasmine Chen is a clinical respiratory Therapist. As a Certified Respiratory Therapist, she works with product and marketing teams to help develop solutions and analyzing product market trends to improve product efficiency. Jasmine co-worked a marketing excellence program called GaleMed 3.0 Project.

Author : Adina Su, Market Watcher and Trend Monitor

Adina Su is a market watcher and trend monitor at GaleMed. With a background in Respiratory Therapy, she provides technical solution support across the care continuum. She has a passion for product training, and likes to share her knowledge that contributes to the clinical environment.