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Montefiore in the News

July 1, 2020

En español | As more people recover from COVID-19 across the country, many are facing another uphill challenge: rebuilding the physical strength and cardiorespiratory endurance lost during long hospital stays or weeks in bed.

Depending on the severity of their illness, this can take weeks to months, says Anne Felicia Ambrose, M.D., an associate professor of physical medicine and rehabilitation, and director of research at the Montefiore Medical Center's Department of Physical 

In many cases, those over 65 will be on the longer end of that time frame. “Older adults are different in many respects, compared with younger adults, and that affects recovery,” Ambrose says. For one thing, the health and functionality of various organ systems — including the cardiovascular and respiratory systems — start to decline after age 35, and the rate of decline increases more in the 60s and 70s.

"So older adults are starting at a different baseline with COVID,” she notes. In addition, the prevalence of hypertension and diabetes increases as people get older, and these conditions can both worsen COVID-19 and make recovery more challenging.

The prolonged inactivity that can occur with a severe illness such as COVID-19 can also accelerate the natural loss of muscle strength in older adults, Ambrose says. And “with prolonged bed rest, people can lose range of motion and their sense of balance.”

The good news: With the right physical activities — and time — these abilities can be regained. While those coming back from the most severe cases will face rehabilitation in a care setting, others will be sent home to get stronger on their own. Here, doctors and physical therapists share what the process involves.

Start with breathing exercises

Many COVID-19 patients will need to start with breathing exercises, at least twice per day, before moving on to other types of exercise. The goal, Ambrose explains, is to strengthen the muscles involved in respiration, which COVID-19 has weakened.

Each session should include two minutes of deep-breathing exercises (slowly breathing in through your nose, allowing your belly to fill with air, then slowly exhaling through your nose) and two minutes of pursed-lip breathing (inhaling through your nose for two seconds with your mouth closed, then exhaling through pursed lips for four seconds, as if you were blowing out candles).

Once you've been fever-free and without shortness of breath or leg swelling for at least seven days, you can start with walking or using an exercise bike to strengthen your cardiorespiratory system, says Robert Gillanders, a physical therapist and spokesman for the American Physical Therapy Association who is based in the Washington, D.C., area.

Start with 10 minutes at a comfortable pace — so you're not out of breath, Ambrose advises — then gradually increase to 20, then 30 minutes at a time. Once you start feeling stronger, you can intersperse 30-second bouts of faster walking throughout your routine.

"When someone is really debilitated, it can be hard to see measurable changes from exercise,” Gillanders says. “Keep an activity log — it helps you see incremental changes” that can help you stay motivated to continue the physical activity.

To rebuild physical strength and functionality, it's especially important to target the hips and legs, says Andrew DeLeon, a home health physical therapist with Stella Maris, a long-term care and nursing home facility in Timonium, Maryland. To do that, start with these exercises:

Ankle pumps: Lie on your back with your legs fully extended. Point your toes straight up toward the ceiling, then point them down so your toes are parallel to the floor or bed. Repeat, gradually building up to eight repetitions at a time.

Sit-to-stand: Start by sitting on the edge of a chair or bed, with your feet flat on the floor, and place the back of a sturdy chair in front of your knees. Stand up while reaching for the back of the chair, pause at the top, then sit down again. Start with two to three repetitions, gradually increasing to eight.

Bridges: Lie on your back on a bed or the floor, with your knees bent, your feet flat on the bed or floor and your arms by your sides. As you tighten your core, lift your hips off the floor until they are in line with your knees and shoulders; pause at the top, then lower your hips again. Start with two to three repetitions, gradually increasing to five.

Partial squats: Stand facing a countertop or the back of a sturdy chair, with your feet shoulder-width apart. Slowly bend both knees, pushing your hips back as if you were going to sit in a chair behind you, but stop when your butt gets halfway to knee level. (Use the counter or chair in front of you for balance, if you need to.) Hold the squat for eight seconds, then slowly stand up again. Start with two to three repetitions, gradually increasing to eight.

Once these moves become easy for you, it's time to add more strengthening exercises that will support the activities you do in daily life. To help people improve their strength and functionality after having COVID-19, Ambrose and her colleagues created the free manual "Patient and Caregiver Guide to Managing COVID-19 Recovery at Home."