Physical training

Exercises for endurance, strength, posture and coordination

Physical training in Long Covid treatment

The Long Covid therapy programme is complemented by endurance and strength training as well as postural and coordination exercises in accordance with the recommendations of the German Society for Respiratory Medicine (DGP) concerning the rehabilitation of Covid-19. Oxygen saturation is determined regularly during training using pulse oximetry, and exercise intensity is determined using the Borg scale.

It is important for Long Covid patients with fatigue symptoms to dose the intensity of exercise well in order to prevent over-exhaustion following exercise.

The following are examples of what is used in Long Covid rehabilitation:

  • Ergometer training
  • MOTOmed training
  • Individual physiotherapy
  • Coordination and posture exercises
  • Outdoor gait training
  • Indoor gait training
  • Walking
  • Group exercises
  • Strength training
  • Movement in water (aqua aerobics)

Additional leisure activities are also offered, depending on the performance capacity of the patients:

  • Open swimming
  • Cycling outdoors
  • Table tennis

Individual forms of training in Long Covid rehabilitation are discussed in more detail below.

Regular ergometer training (three to five times a week) is an essential element of endurance training for our Covid-19 patients. It offers a high level of therapeutic effectiveness and safety due to the fact that the intensity of the training can be individually specified.

Training lasts between 10 and 40 minutes depending on the level of fitness. Scientific studies suggest that especially patients with limited exercise capacity (e.g. after long-term ventilation) can benefit from interval training and tolerate this form of exercise better in terms of dyspnoea sensation. In this case, training is performed with short load intervals (30 to 180 sec.) in a load range of e.g. 50 to 100 % of the maximum power measured in the initial test. A load interval is followed by a recovery interval with low load intensity at a ratio of load to recovery between 2:1 and 1:1.

MOTOmed training is particularly suited for people with limited mobility and for wheelchair users. Training is possible both passively, with motor support, and actively, with the user's own muscle power. It has a positive effect on lung function, muscle mass and quality of life. MOTOmed training allows training to begin slowly and the load to be increased gradually. During training, oxygen saturation is monitored by means of pulse oximetry and, where necessary, oxygen (LTOT) can be administered.

Gait training is one of the most important forms of training for everyday life. It takes place both outdoors and inside the clinics as individual or group training in a sports hall, so that Covid-19 patients with different abilities can train simultaneously with the help of walking triangles, for example.

Patients with long-term effects of Covid-19 who can cope well with loads can benefit from walking (brisk walking with the use of arms) or Nordic walking (with the use of two poles) as a beneficial form of exercise with little risk of excessive strain. Due to its lower impact load, it is more suitable than running for patients who are overweight or have orthopaedic problems.

  • General movement exercises (mobilisation)
  • Coordination exercises with / without sports equipment
  • Partner exercises
  • Breathing and relaxation exercises
  • Circuit training

Long Covid rehabilitation makes use of dynamic, concentric, systematic strength training. Strength training should consist of at least 8 different exercises involving the major muscle groups. Examples for the major muscle groups include:

  • Bench press
  • Bench pull
  • Leg press
  • Leg extender
  • Vertical traction apparatus
  • Cable pull (upper limb/torso)
  • Cross-trainer

The number of repetitions per exercise should be between 8 and 15. The minimum intensity is set at approx. 40 % of the repetition maximum. Starting with one set per muscle group a week and increasing by one set per muscle group a week, aim to complete 3 to 4 sets per muscle group a week. A break of 2 to 3 minutes is observed between the sets for a muscle group. The frequency of strength training is about two to three sessions a week.

Oxygen substitution is a prerequisite in order for patients with respiratory insufficiency to be able to exercise safely. Providing oxygen reduces respiratory work and improves performance. The varying oxygen demand at rest, at night and under physical load must be taken into account by adjusting the dose individually.

Vibration training on special vibration platforms is a possible training method for Covid-19 patients according to the recommendations of the AWMF guideline "Covid-19 and (early) rehabilitation". Various studies in recent years have shown that whole-body vibration has beneficial effects in respiratory care patients with muscular weakness or after immobilisation-induced muscle atrophy and can, for example, improve the walking distance in the 6-minute walking test.

Neuromuscular electrical stimulation can be used in individual cases in Long Covid rehabilitation for patients with severe exertional dyspnoea, muscle atrophy and extended immobilisation. Here, for example, the thigh muscles are stimulated to contract using skin electrodes, with the intensity being increased to the individual' s tolerance limit. Training can lead to an increase in strength and power with little metabolic and ventilatory stress.