TY - JOUR
T1 - Personalized Exercise Prescription in Long COVID
T2 - A Practical Toolbox for a Multidisciplinary Approach
AU - Maher, Allison
AU - Bennett, Michelle
AU - Huang, Hsin-Chia Carol
AU - Gaughwin, Philip
AU - Johnson, Mary
AU - Brady, Madeleine
AU - Patterson, Kacie
AU - Buettikofer, Tanya
AU - Morris, Jo
AU - Rainbird, Veronica Mary
AU - Mitchell, Imogen
AU - Bissett, Bernie
N1 - Funding Information:
The research team acknowledges the support of the Canberra Hospital Private Practice Fund, and the Exercise and Sports Science Australia research grant in the projects referred to in this paper.
Publisher Copyright:
© 2024 Maher et al.
PY - 2024/8
Y1 - 2024/8
N2 - OBJECTIVE: To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature.BACKGROUND: There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia's few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation.METHODS: Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer's presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4-6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual's progress, at an intensity 4-6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥50% of their maximum inspiratory pressure).DISCUSSION: We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts.CONCLUSION: In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual's symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.
AB - OBJECTIVE: To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature.BACKGROUND: There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia's few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation.METHODS: Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer's presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4-6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual's progress, at an intensity 4-6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥50% of their maximum inspiratory pressure).DISCUSSION: We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts.CONCLUSION: In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual's symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.
KW - COVID
KW - multidisciplinary care
KW - physiotherapy
KW - rehabilitation
KW - respiratory muscle training
UR - http://www.scopus.com/inward/record.url?scp=85202550743&partnerID=8YFLogxK
U2 - 10.2147/JMDH.S465946
DO - 10.2147/JMDH.S465946
M3 - Article
C2 - 39161542
SN - 1178-2390
VL - 17
SP - 3981
EP - 3991
JO - Journal of Multidisciplinary Healthcare
JF - Journal of Multidisciplinary Healthcare
ER -