Policy base for activity therapy:
For people with Covid-19
The NHS has a special Covid recovery website:
As you find yourself recovering from COVID-19 you may still be coming to terms with the impact the virus has had on both your body and mind.
These changes should get better over time, some may take longer than others, but there are things you can do to help.
Your COVID Recovery helps you to understand what has happened and what you might expect as part of your recovery…
Why is getting moving again important?
After being in hospital for a period of time, your muscles will be much weaker than normal and you will certainly be less fit than you were.
It is important to get back to your previous level of activity or possibly aim to be more active!
By being active and starting some exercise you become stronger and fitter. You may notice your tiredness increase and some breathlessness at first but these should improve the stronger you get; this is a normal response to doing more exercise for all of us.
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People with ongoing symptomatic COVID-19 or post-COVID-19 syndrome.
The language about Covid 19 is, understandably evolving. Initially people simply talked about Covid-19 and Long Covid but the recent NICE guideline on Managing the long term effects of Covid-19, published on the 20th of December 2020, introduced a new classification, summarised in this extract:
This guideline covers identifying, assessing and managing the long-term effects of COVID-19, often described as ‘long COVID’. It makes recommendations about care in all healthcare settings for adults, children and young people who have new or ongoing symptoms 4 weeks or more after the start of acute COVID-19. It also includes advice on organising services for long COVID.
To develop the recommendations, we have used the following clinical definitions for the initial illness and long COVID at different times:
In addition to the clinical case definitions, 'long COVID' is commonly used to describe signs and symptoms that continue or develop after acute COVID‑19. It includes both ongoing symptomatic COVID‑19 and post‑COVID‑19 syndrome (defined above).
‘Long covid’ = Ongoing Symptomatic Covid -19 +Post Covid-19 syndrome.
Interestingly the guideline was called a ”rapid guideline” indicating not only the speed with which it was prepared but also the possibility that it may need review in the near future and indeed even this definition of the three stages was quickly criticised by the British Society for Rehabilitation Medicine in a BMJ editorial.
“NICE recommends using the term “post-covid syndrome” from 12 weeks after infection. But no evidence exists of any particular physiological changes (that predict chronicity) at 12 weeks, so it would be preferable to use the term long covid for symptoms of any duration beyond four weeks, as is strongly advocated by people with lived experience of this condition. Using the prefix “post” implies that acute infection and any active disease process are resolved, which is currently unknown.”
In March 2021 Dr Fauci publicised the term PASCs for Post Acute Sequelae of Covid and it is possible that this will become widely used.
Cause and scope for prevention:
It is not clear why some people develop this complication and other than preventing Covid-19 infection in the first place there is no agreed intervention for reducing the risk of this problem.
Diagnosis should be made by a specialist team.
Standard Medical therapy:
The standard treatment has not yet emerged but NICE guidance gives two pathways that can be followed:
1.9 Consider follow-up by primary care or community services for people in vulnerable or high‑risk groups who have self‑managed in the community after suspected or confirmed acute COVID‑19.
1.10 A healthcare professional in secondary care should offer a video or phone follow‑up consultation at 6 weeks after discharge to people who have been in hospital with acute COVID‑19 to check for new or ongoing symptoms or complications.
Benefits of exercise therapy:
There are no specific reviews yet on the benefits of exercise therapy but there is strong evidence that people recovering from an acute illness, particularly a serious acute illness benefit from rehabilitation, a clinical process delivered by a team of professionals, and from exercise. Obviously, the exercise needs to be tailored to meet the challenges posed by different conditions and this too will be the case with Covid-19 but once the person has been assessed by a rehabilitation team almost all of them would benefit from medium intensity exercise. This will have to take into account problems with particular organs or tissues because long Covid seems to attack, every body system.
The company responsible for developing training programmes for personal trainers, Future-fit, has developed a programme for personal trainers focused on the effects Covid 19.
The search strategy:
There is of course very little literature on the treatment of the effects of Covid-19 after the acute episode in the first four weeks is over. The Cochrane Collaboration has developed a method for reviewing the evidence that is published quickly and producing a ‘rapid’ review, using an approach which will allow frequent updating of the review as new evidence emerges. Such a review is called a ‘rapid living Cochrane Review’
The results are listed below and will be reviewed monthly.
Number of systematic reviews in the last year: 30
Number of systematic reviews in the last year deemed irrelevant: 15
Number of systematic reviews in the last year deemed relevant APPENDIX 2: 15
In preparing a systematic review the reviewer:
1. Prepares a protocol conforming to one of the standard protocols eg that of Cochrane.
2. Defines a search strategy with the support of a librarian.
3. Uses explicit quality criteria to include or exclude primary studies.
4. Combines the data from the primary studies (a process called meta-analysis).
5. Prepares a report including the references to the excluded studies as well as to the included studies.
The term ‘overview of systematic reviews’ describes an article in which all the available systematic reviews are combined.
Cochrane has pioneered and promoted this methodology and has a clear protocol for conducting a systematic review but it has adapted this method to take into account the need to react with speed to the unfolding pandemic in the creation of what is called a Rapid Living Cochrane Review.
In March 2020, the Cochrane Methods Rapid Reviews group launched guidance about how to undertake a rapid review. This group will continue to develop guidance as we learn more about the most efficient and useful approaches. They also introduced new systems to produce rapid reviews about COVID-19 quickly and provided advice and training to teams conducting rapid reviews, living evidence mapping and living systematic reviews
Exercise therapy for people with COVID-19
The National Library of Medicine www.nlm.gov was searched for ‘Systematic Review’, in the last year. 30 reviews were identified. These were reviewed by Muir Gray for relevance eg some systematic reviews were focused on drug therapy, this removed 15 reviews from the database and the remaining 15 are listed below.
USING THE DATABASE
To read the abstract or the full text simple copy the doi, for example
doi: 10.1016/j.bjpt.2017.06.004. and paste it into your web browser
NCBI Literature Resources MeSH PMC BookShelf
long covid treatment Search
Save Email Send to Sorted by: Computed author
Filters applied: Systematic Review, in the last 5 years. Clear all
Results are displayed in a computed author sort order. Results by year timeline is unavailable.
Effect of neuromuscular electrical stimulation on the recovery of people with
COVID-19 admitted to the intensive care unit: A narrative review.
Burgess LC, Venugopalan L, Badger J, Street T, Alon G, Jarvis JC, Wainwright TW, Everington T,
Taylor P, Swain ID.
J Rehabil Med. 2021 Feb 26. doi: 10.2340/16501977-2805. Online ahead of print.
PMID: 33634830 Free article.
The rehabilitation of patients with COVID-19 after prolonged treatment in the intensive care unit is often complex and challenging. ...Practical recommendations for using electrical muscle stimulation in patients with COVID-19 are provided, and …
Treatment, Persistent Symptoms, and Depression in People Infected with
COVID-19 in Bangladesh.
Islam MS, Ferdous MZ, Islam US, Mosaddek ASM, Potenza MN, Pardhan S.
Int J Environ Res Public Health. 2021 Feb 5;18(4):1453. doi: 10.3390/ijerph18041453.
PMID: 33562427 Free PMC article.
In Bangladesh, initial treatment (self-administered, hospitalized), persistent COVID-19 symptoms ("long COVID-19"), and whether COVID-19 leads to changes in mental state, such as depressive symptoms, of people are not known. …
Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four
Months After Hospital Discharge. Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Avanzi GC, Baldon G, Bartolomei G, Battaglia M, Battistini S, Binda V, Borg M, Cantaluppi V, Castello LM, Clivati E, Cisari C, Costanzo M, Croce A, Cuneo D, De Benedittis C, De Vecchi S, Feggi A, Gai M, Gambaro E, Gattoni E, Gramaglia C, Grisafi L, Guerriero C, Hayden E, Jona A, Invernizzi M, Lorenzini L, Loreti L, Martelli M, Marzullo P, Matino E, Panero A, Parachini E, Patrucco F, Patti G, Pirovano A, Prosperini P, Quaglino R, Rigamonti C, Sainaghi PP, Vecchi C, Zecca E, Pirisi M.
JAMA Netw Open. 2021 Jan 4;4(1):e2036142. doi: 10.1001/jamanetworkopen.2020.36142.
PMID: 33502487 Free PMC article.
IMPORTANCE: Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of …
Developing services for long COVID: lessons from a study of wounded healers.
Ladds E, Rushforth A, Wieringa S, Taylor S, Rayner C, Husain L, Greenhalgh T.
Clin Med (Lond). 2021 Jan;21(1):59-65. doi: 10.7861/clinmed.2020-0962.
PMID: 33479069 Free PMC article.
No formal guidelines exist in the UK for treating patients with long COVID and services are sporadic and variable, although additional funding is promised for their development.In this study, narrative interviews and focus groups are used to explore the lived experi …
Surviving COVID-19 in Bergamo province: a post-acute outpatient reevaluation.
Venturelli S, Benatti SV, Casati M, Binda F, Zuglian G, Imeri G, Conti C, Biffi AM, Spada MS, Bondi E, Camera G, Severgnini R, Giammarresi A, Marinaro C, Rossini A, Bonaffini PA, Guerra G, Bellasi A, Cesa S, Rizzi M. Epidemiol Infect. 2021 Jan 19;149:e32. doi: 10.1017/S0950268821000145.
PMID: 33461632 Free PMC article.
Bergamo province was badly hit by the coronavirus disease 2019 (COVID-19) epidemic. We
organised a public-funded, multidisciplinary follow-up programme for COVID-19 patients
discharged from the emergency department or from the inpatient wards of 'Papa …
NICE guideline on long COVID.
Lancet Respir Med. 2021 Feb;9(2):129. doi: 10.1016/S2213-2600(21)00031-X. Epub 2021 Jan
13. PMID: 33453162 Free PMC article. No abstract available.
6-month consequences of COVID-19 in patients discharged from hospital: a
cohort study. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, Kang L, Guo L, Liu M, Zhou X, Luo J, Huang Z, Tu S,
Zhao Y, Chen L, Xu D, Li Y, Li C, Peng L, Li Y, Xie W, Cui D, Shang L, Fan G, Xu J, Wang G, Wang Y,
Zhong J, Wang C, Wang J, Zhang D, Cao B.
Lancet. 2021 Jan 16;397(10270):220-232. doi: 10.1016/S0140-6736(20)32656-8. Epub 2021 Jan 8.
PMID: 33428867 Free PMC article.
Quality of life, functional status, and persistent symptoms after intensive care of
COVID-19 patients. Taboada M, Moreno E, Cariñena A, Rey T, Pita-Romero R, Leal S, Sanduende Y, Rodríguez A, Nieto C,
Vilas E, Ochoa M, Cid M, Seoane-Pillado T.
Br J Anaesth. 2021 Mar;126(3):e110-e113. doi: 10.1016/j.bja.2020.12.007. Epub 2020 Dec 10.
PMID: 33413976 Free PMC article. No abstract available.
NICE guideline on long covid.
Sivan M, Taylor S.
BMJ. 2020 Dec 23;371:m4938. doi: 10.1136/bmj.m4938.
PMID: 33361141 No abstract available.
Persistent symptoms after Covid-19: qualitative study of 114 "long Covid"
patients and draft quality principles for services.
Ladds E, Rushforth A, Wieringa S, Taylor S, Rayner C, Husain L, Greenhalgh T.
BMC Health Serv Res. 2020 Dec 20;20(1):1144. doi: 10.1186/s12913-020-06001-y.
PMID: 33342437 Free PMC article.
Could Cognitive Behavioural Therapy Be an Effective Treatment for Long
COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study
for Q-Fever Fatigue Syndrome.
Vink M, Vink-Niese A. Healthcare (Basel). 2020 Dec 11;8(4):552. doi: 10.3390/healthcare8040552.
PMID: 33322316 Free PMC article. Review.
An increasing number of young and previously fit and healthy people who did not require
hospitalisation continue to have symptoms months after mild cases of COVID-19. Rehabilitation
clinics are already offering cognitive behavioural therapy (CBT) as an effective treatme …
Long COVID: A Primer for Family Physicians.
Greenhalgh T, Knight M.
Am Fam Physician. 2020 Dec 15;102(12):716-717.
PMID: 33320511 No abstract available.
Meeting the challenge of long COVID.
[No authors listed]
Nat Med. 2020 Dec;26(12):1803. doi: 10.1038/s41591-020-01177-6.
PMID: 33288947 No abstract available.
"Long covid": the Dutch response.
Burgers J. BMJ. 2020 Aug 14;370:m3202. doi: 10.1136/bmj.m3202.
PMID: 32816711 No abstract available.
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