Investigating Sports Activity and Training During the COVID-19 Era, Sports Care for Individuals Who Have Recovered From COVID-19, and Exercise Prescription for Special Groups

Abstract

Context: A major challenge faced by patients after recovery from COVID-19 is reduced physical performance. This review examined whether individuals can safely participate in sports and exercise during the pandemic to maintain a minimum level of physical fitness and, if so, how such activity should be performed. Evidence Acquisition: To address the review objective, we examined recent Persian- and English-language publications from reputable local and international scientific databases and journals. PubMed, ACSM, ScienceDirect, Google Scholar, and Elsevier journals were searched for studies published from 2010 to 2023 using keywords such as COVID-19, exercise, and physical activity. The search identified 73 articles, of which 10 were excluded because they were not relevant to the study aims. Results: For post-COVID-19 syndrome, a combination of aerobic physical activity (70%) and resistance training (30%) is proposed. Aerobic exercise is recommended on most days of the week, whereas resistance training is advised 2 - 3 days per week. Aerobic intensity should be 40% to < 60% of heart rate reserve (HRR), or 11 - 13 on a 20-point rating-of-perceived-exertion scale, with progression toward ≥ 60% of HRR. Resistance training should be performed at 60%-80% of the 1-repetition maximum for at least 1 set of 8 - 12 repetitions for the major muscle groups to help prevent disruption of blood homeostasis. Conclusions: Evidence from patients with acute respiratory distress syndrome indicated that, after 6 months, performance on the 6-minute walk test reached 88% of predicted aerobic capacity, spirometric lung volumes normalized, and supplemental oxygen was no longer required. In patients recovering from COVID-19 with pulmonary complications, exercise intensity may be limited to less than 30% of maximum inspiratory pressure for no more than 30 minutes per day, or to two 15-minute sessions per day, in accordance with protocols for pulmonary obstruction. Rapid, high-intensity activity is discouraged because it may cause an excessive increase in heart rate.