EXERCISE PRESCRIPTION IN A MULTIDISCIPLINARY LONG COVID CLINIC: METHODOLOGY FROM AN AUSTRALIAN EXPERIENCE

Abstract

The University of Canberra Hospital Post-COVID Recovery Clinic is one of Australia’s few multidisciplinary outpatient clinics. Our model includes personally-prescribed exercise of both inspiratory and peripheral muscles. We have treated > 200 people with Long COVID with no serious adverse events, and our model is highly acceptable to consumers. This paper offers a detailed description of our methodology capturing how we achieve safe, tailored personal exercise, and carefully manage post-exertional symptom exacerbation (PESE). Initial screening appointments last 2 hours, and clients are referred for medical review if they have signs or symptoms of an acute or life-threatening complication (e.g. unexplained chest pain). Individualised exercise programs are prescribed, progressed, and monitored by an Exercise Physiologist or Physiotherapist initially on an individual basis, then in a supervised group setting. The group program consists of twice weekly sessions of 60 minutes duration. Clients attending group therapies are provided with a home exercise program to enable self-management. Clients are screened at baseline assessment for PESE triggered by participation in activities of daily living. All clients receive education about activity modification and pacing strategies. For clients experiencing PESE, activity is not progressed until they can tolerate 2 weeks of activity without PESE. For peripheral muscles, progressive resistance exercises are prescribed at a submaximal intensity (RPE 4-6/10), with 4-6 exercises completed 3 days/week. Once able to tolerate ADLs, low intensity cardiovascular exercise is gradually introduced with increased monitoring from a clinician. For patients with dyspnoea, high-intensity inspiratory muscle training is prescribed as 5 sets of 6 breaths at least 50% of their maximal inspiratory pressure (30 breaths total) 5 days per week. Our experience indicates that it is possible to safely prescribe exercise in people with Long COVID, incorporating both peripheral and inspiratory muscle training, while carefully monitoring and managing PESE.