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Carron Manning, chartered physiotherapist and clinical director of EXi, looks at how fit pros can use exercise as medicine to help people recover from COVID-19.

COVID-19 continues to throw a shadow across the leisure industry with the nation’s health still fragile. The social-distancing restrictions and worry among people with an underlying health condition are keeping those most in need of physical activity away from the gyms and exercise referral specialists who can help them.

Post-acute COVID-19 symptoms

Post-acute COVID-19 symptoms vary widely and most commonly include fatigue and persistent coughing. Other symptoms include shortness of breath, chest pain and muscle aches and pains. Fitness professionals should take this into account when planning a client’s recovery programme and even consider breaking daily exercise targets into shorter sessions with rest periods in between, such as splitting a recommended 10-minute walk into two five-minute walks.

COVID-19 rehab

Starting clients on rehabilitation as soon as they are able can help to improve physical, psychological and emotional recovery from COVID-19. It also prevents deconditioning, in which strength, fitness and functional capacity are lost (CSP COVID-19 Community Rehabilitation Standards September 2020).

So where do you start?

  • Start small with perhaps even just a few minutes’ exercise each day: as with any client programme, listen to how they’re feeling and adapt your plan accordingly.
  • Build a graduated aerobic programme starting at a low intensity and building to moderate.
  • Walking is ideal, as it can be gradually increased as fitness returns.
  • Gradually building exercise time, intensity and frequency over 12 weeks will help clients progress in increments.

Contraindications for exercising post-COVID

Anyone who has been critically ill or hospitalised in intensive care should consult their GP or medical practitioner before embarking on an exercise programme. Likewise, if they had a significant cardiac issue during their COVID-19 infection – such as myocarditis, pericarditis, dysrhythmia or pulmonary embolus – they must speak to their doctor before starting any fitness programme (BMJ [2020], 307: m3026). Other contraindications include:

  • chest pain (across chest or in one or both arms, in neck)
  • shortness of breath at rest or worsening respiratory symptoms
  • signs of a deep vein thrombosis (redness, heat, swelling and pain, commonly in the calf)
  • very high heart rate at rest (over 120bpm)
  • uncontrolled blood pressure (resting SBP >180mmHg, resting DBP >110mmHg)
  • uncontrolled palpitations
  • body temperature above 38°C (fever).


Clients who experience any of these symptoms should stop exercising and reduce the intensity or duration of the exercise:

  • Dizziness
  • Fatigue
  • Confusion
  • Unusual shortness of breath
  • Onset of angina
  • Unusual palpitations

Managing expectations

EXi has incorporated the complexities of 23 conditions, including COVID-19 rehab, into its algorithm so fit pros can train people with confidence and with the latest medical guidelines.

Following COVID-19, some clients may be anxious about returning to exercise, while others may be champing at the bit. Manage expectations by:

  • starting with an ‘anything is everything’ programme
  • tracking their activity using the NHS-approved EXi app to adhere to all the latest medical guidelines, empower, encourage motivation and acknowledge progress
  • explaining that EXi enables people to start exercising safely at the level they can achieve and gradually increase the time and intensity, based on the evidence for their risk/condition/co-morbidities
  • encouraging at least 10 minutes outdoors each day to benefit from fresh air and sunlight, plus profound mental and physical benefits
  • building a daily programme that clients can follow between their face-to-face sessions.

COVID-19 prehab

Two of the best ways to build resilience to COVID-19 are reducing obesity and improving physical fitness, landing this opportunity fair and square at the feet of fitness professionals.

COVID-19 prehab can help reduce the risk among those most vulnerable to contracting the illness, namely those with chronic conditions including diabetes, arthritis, heart disease, obesity and depression. A staggering 90% of people who have died from COVID-19 this year had at least one underlying health condition: obese patients have a 33% greater risk of dying from a COVID infection, while 27% of people who died from COVID-19 in England between March and May had diabetes. A recent study of 20,133 UK patients in hospital with COVID-19 found that at least 31% had heart disease.

Exercise referral recovery from COVID-19

We must avoid COVID-19 increasing inactivity among those who lose the exercise habit or fear a relapse by returning to activity. In the UK, more than 20 million people are classed as living an inactive, sedentary lifestyle, and almost as many are diagnosed with at least one chronic disease. However, regular exercise can cut an individual’s risk of breast cancer by 25% and the risk of bowel cancer by 45%. It can reduce the chances of ever getting dementia or having a stroke by 30% according to the report by the Academy of Medical Royal Colleges. It also cuts the risk of high blood pressure or type 2 diabetes by 50%.

Currently being used by the Everyone Active GP referral teams in conjunction with their face-to-face exercise referral programme, EXi is helping to implement the health and fitness industry collaboration that is necessary now more than ever. Its COVID-19 rehabilitation programme – devised by renowned British physician Sir Muir Gray – restricts people to low-/moderate-intensity activity until their health profile improves, at which point it will unlock higher intensity activity as an option.

COVID-19 may have had the upper hand in 2020 but it won’t have the last laugh. If the fitness industry delivers exercise as medicine, we can not only help people recover from COVID-19 but also manage other long-term health conditions. And, by improving their health and building their resilience, we can help keep them out of hospital.

Where to next? Listen to our podcast with Carron to explore why they set up their exercise prescription app, EXi

Author Bio

Carron Manning Headshot

Carron Manning is a chartered physiotherapist and clinical director of EXi with an MSc in sport and exercise medicine. She has a wealth of experience in the NHS and has worked for the British rowing team, Tottenham Hotspur FC and the English women’s rugby team. She most recently worked with Team GB athletes at the English Institute of Sport.