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The year 2020 introduced a new enemy, a threat to mankind that in a matter of a few months brought the world to its knees and changed the meaning of life as we knew it. A silent assassin with no remorse and emotions hidden in plain sight, it could be standing beside you and wouldn’t even know it. The corona-virus disease 2019(Covid-19), an emerging worldwide infectious disease pandemic that is caused by severe acute respiratory syndrome 2(SARS-Cov-2). By April 27, 2020, the virus had spread to at least 185 countries or regions and infected 3 million people causing at least 210 000 deaths.

SARS-CoV-2 belongs to the corona-virus family of positive-sense, single-stranded RNA viruses. In addition to SARS-CoV-2, there are 6 other strains of corona-virus that are known to infect humans, including 4 less severe strains that cause mild symptoms, as well as the more pathogenic viruses SARS-CoV-1, which causes severe acute respiratory syndrome (SARS), and MERS-CoV, which is responsible for the Middle East respiratory syndrome (MERS).

Studies from patients who contracted moderate and severe SARS infections have indicated a substantial musculoskeletal burden of this disease, including skeletal muscle, neurological, bone and joint disorders. Extended ventilator times are also known to induce pro-inflammatory conditions that lead to muscle and bone frailty which can reduce the overall quality of life. In addition to directly infecting cells outside of the respiratory tract, the inflammatory response in the airway can also lead to systematic inflammation that can impact nearly every organ system including, the musculoskeletal system.

Exercise is one of the most frequently prescribed therapies in both health and diseases. However, people may feel unsure of how and when to return to physical activity after covid-19, and whether it is safe.

The risks of physical activity after covid-19 include:

  • Potential for cardiac injury, including from viral myocarditis.
  • Thromboembolic complications such as pulmonary embolism.
  • Primary psychiatric phenomena such as psychosis have also been identified as a potential presenting feature of Covid-19.

Some of these potential risks, viral myocarditis in particular, understandably leads to caution when advising a return to physical activity or exercise after infection. . A consensus statement from sports clinicians of the European Federation of Sports Medicine Associations from July 2020 recommends a review with a sports and exercise medicine physician after mild symptomatic infection and investigations including echocardiography and lung function testing where cardiopulmonary symptoms were present. Guidance from the Netherlands Society of Cardiology states that, for those with systemic features including fever, electrocardiography testing should be considered before the resumption of activity. However, the incidence of myocardial injury or thromboembolic complications after mild or moderate covid-19 in the community is currently unknown but thought to be low. A risk-stratification approach can help maximize safety and mitigate risks, and a number of factors need to be taken into account. We should first ask if the person is physically ready to return to activity? In the natural course of covid-19, deterioration signifying severe infection often occurs around a week from symptom onset. Therefore, consensus agreement is that a return to exercise or sporting activity should only occur after an asymptomatic period of at least seven days. English and Scottish Institute of Sport guidance suggests that, before re-initiation of sport for athletes, activities of daily living should be easily achievable and the person able to walk 500 m on the flat without feeling excessive fatigue or breathlessness. However, it is recommended to consider the person’s pre-illness baseline, and tailoring guidance accordingly.

In conclusion, there are risks associated with exercise after covid-19 however, there are guidelines set by medical experts that maximize safety and mitigate risks, and for those people wondering about physical activity after covid-19 and the risks this article is meant for you as a brief summary encouraging you to do research and find out more about the guidelines and risks before returning to physical activity.

References

1. David Salman,Dane Vishnubala,Peter Le Feuvre et al. 08 January 2021. Returning to physical activity after covid-19.[online]. Available from: http://dx.doi.org/10.1136/bmj.m4721 [Accessed 02 July 2021].

2. Disser at el. 15 July 2020. Musculoskeletal Consequences of COVID-19. The Journal of Bone and Joint Surgery 2020.[online]. Available from: http://dx.doi.org/10.2106/JBJS.20.00847 [Accessed 02 July 2021]

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