Category: Exercise

Overcoming COVID stigmas

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In 2020 I started looking for ways to make a difference in the midst of a frightening new pandemic. I read books about the Spanish flu of the last century that took the lives of some in my family tree, and learned that the annual flu shots we have available today stave off the evolving ancestors of that flu, saving the lives of many to this day. There have been historic global illnesses in the distant past, but it is good to remember that we have been through a pandemic just a couple of generations ago and we have learned to build tools to deal with it.

I then took an online contact tracer certification course, but soon sadly found that practicing my new skill would be difficult due to surprising responses on opposite ends of the spectrum. One place where I spend time chose not to provide any opportunities for this job which involves sharing news no one wants to hear, and another only offered full time positions, which was more than I felt I could handle.

Then came the realization that COVID did not end after a couple of weeks of illness for some of the survivors. Part of the population experiences a wild roller coaster ride of a broad array of continuous or intermittent symptoms, impacting their daily lives profoundly. This prompted me to explore the mounting research on the ill-defined phenomena that has been called long COVID, post-acute sequelae of SARS CoV-2 (PASC) or post-COVID syndrome, and I realized that Ai Chi could be helpful in addressing some of the more prominent symptoms. *Look for a manuscript I wrote about this in the December 2022 special COVID edition of the Journal of Aquatic Physical Therapy entitled “Ai Chi for Long COVID: Transitioning to a Post-Rehab Community Program.”

I then proposed a session on community Ai Chi for post-rehab COVID long haulers for an aquatic conference in early 2022, however it did not draw enough interest to hold the class. I then collaborated with an aquatic physical therapist knowledgeable in subacute rehab for long COVID and an aquatic expert in PTSD for a COVID Long Haulers Roundtable discussion at a larger aquatic conference later in the year. We were excited that it brought a high number of attendees from the United States and from around the world for the final class of the conference. They listened attentively and gave positive feedback on our presentations, but there was little discussion on behalf of the participants. Why is there such hesitancy around this topic?

I believe it comes down to a social stigma associated with COVID-19. We all want COVID to just go away, which has resulted in some minimizing its presence and others becoming hyper-vigilant, (a difficult task as best practices for dealing with this brand new virus emerged very slowly over time). The diversity of responses to COVID has made even talking about it a taboo for the majority of people who are tired of a world already filled with conflict. One person in our audience shared with me that she did not want to ask any questions or make comments because she did not want to risk upsetting anyone else.

This stigma is so strong that those who contract COVID worry about others judging them. Will people think they were socially irresponsible, without regard for other people’s health? Will they be villainized or ostracized by acquaintances, friends and family? This can lead to feelings of personal shame and a tendency to hide a positive test or illness from others, or to downplay their experience and not seek help when they need it. And because of this, we can only guess at the true prevalence of COVID or long COVID.

So what can we do in the face of these stigmas, as community aquatic exercise providers? Be aware that these stigmas exist. Set an example by being compassionate, non-judgmental and mindful in your communications with all. Use comforting, inclusive language and avoid terms which could be interpreted as marginalizing. One aquatic provider shared that she feared that her classes would shrink if they were marketed for COVID long haulers. While Long COVID is not a contagious disease that would preclude participation with others, her realization of the impact of this stigma is an important one.

COVID long haulers who want to improve breath, attention and focus, energy levels, strength and balance will find their way to Ai Chi classes, along with those with many other conditions who share these goals. Yes, we need to be aware of and support necessary adaptations for the special needs of each of our clients, but marketing and working from a goal oriented approach rather than a diagnostic one preserves personal privacy and offers protection against stigmatization. And if you find yourself in the midst of a discussion about long COVID, acknowledge the feelings your clients express, listen attentively and feel empowered to correct misconceptions with proven scientific data. Sharing Ai Chi is a gift you can give to everyone.

More information on this important topic is available from The World Health Organization (WHO) in their briefing, “Social Stigma associated with COVID-19.”

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COVID Long haulers

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Darren’s story began in March 2020 when he arrived home from a long day of work as a hospital physical therapist, so exhausted that he fell into bed. He awoke the next morning with fever, shortness of breath, and pain. Recognizing these as COVID-19 symptoms, he isolated himself for 10 days before returning to work. For the next six months, Darren worked at the hospital with lingering fatigue and shortness of breath before finally embarking on a graded exercise program to increase his activity levels. But instead of getting stronger, Darren struggled to walk on his work commute and arrived sweating, short of breath, dizzy, and pale. Then simple activities like showering, walking from the bed to a sofa and even watching tv or reading left him exhausted.

Heather-Elizabeth is a 36-year old corporate trainer who started having a fever and feeling fatigued in April, 2020. Her fever rose to 103F and she developed gastrointestinal issues over  the next several weeks. Then she began to have trouble breathing and her blood oxygen levels dropped dangerously low. When advanced COVID-induced pneumonia showed up on X-ray, Heather-Elizabeth was admitted to the hospital and was placed in a medically induced coma on a ventilator for a month. In the process, blood clots formed in her leg and she developed left-sided body weakness with walking difficulties. Now over a year later, she still has a chronic lung condition and experiences chronic pain and mobility issues.  She has been diagnosed with type 2 diabetes with visual changes requiring insulin injections several times per day. While she once had an excellent memory, she now posts sticky note reminders everywhere to accommodate for brain fog.

April from Boise, Idaho was young and healthy and had been vaccinated for COVID-19 in January, 2021, but in July she was diagnosed with coronavirus. She was relieved that the course of illness was short, but as time went on she became increasingly fatigued and was unable to do even simple housekeeping tasks without sweating, and her pulse raced to 160 beats per minute. Then muscle and joint pain and dehydration began. The more active she was, the worse she felt the following day.

Darren, Heather-Elizabeth and April’s real-life stories are a sampling of the experiences of the growing number of COVID survivors. These “long haulers” are no longer contagious and test negative for COVID, but experience persisting function-limiting symptoms, uncertainty, and stress.

Studies show that more than one-half of unvaccinated COVID survivors and almost one-fifth of those few who have had vaccine break through experience one or more of a broad array of persisting physical and psychological symptoms, regardless of the severity of their initial illness. Many can only return to work part-time and some cannot work at all. (No data is available yet for the Omicron or future variants-stay tuned, I am following this!) The good news is that physical therapists have the expertise and tools to help guide long haulers along the road to recovery. Furthermore, exercise practitioners who are well-versed in the challenges long haulers face can offer help and hope for medically stable “graduates” of these programs who have lingering symptoms. Collaboration between therapists and community exercise providers can enhance a smooth transition for COVID long haulers from a rehab setting to community-based exercise venues. Community exercise providers need to be aware of the special considerations impacting this population as they work with them in personal training and group situations, to avoid triggering acute symptoms, set backs and relapse.

Please join me and Mary Wykle at the ATRI National Aquatic Therapy Conference in Chicago on April 9, 2022 as we share important information about the transition to safe and effective post-rehab long COVID interventions. Our presentation will highlight the gentle aquatic body mind practice of Ai Chi as a tool for addressing many of the most common persisting sequelae facing individuals with Long COVID.

https://www.atri.org/1020-covid-long-haulers.html

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More or less

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As a physical therapist, I have found that many clients assume that faster recovery is dependent on longer therapy sessions or more vigorous exercise. This is in fact a myth. The truth is that while there are times when the best results come by pushing limits, there are also times when pacing is the key to success. In Scandinavia this middle ground is referred to as “lagom,” not too much, not too little. With attention to known information about disease processes, health professionals are tasked to listen to and observe their patients to determine that “sweet spot” of lagom for best outcomes.

Our world is now consumed by a novel virus that we are still learning about. We do not have a complete picture of the disease processes involved, but our understanding of it is emerging. Thankfully, an array of relatively quickly developed vaccines have been successful in curtailing the spread and severity of COVID-19, but not before many had contracted it. While more than we ever thought possible have succumbed to it, it is estimated that millions of people worldwide live with the aftermath, experiencing a wide range of persistent mild to debilitating symptoms, even after just a light case of the virus. Long haulers have turned to exercise to combat physical deconditioning and fatigue, with inconsistent responses. An editorial in the May 2021 Journal of Orthopaedic & Sports Physical Therapy was co-authored by researchers and by both those who have experienced long COVID and those with prolonged post-viral symptoms from another multi-system virus, myalgic encephalomyelitis/chronic fatigue syndrome. The article brings home the message of “lagom” to avoid relapses, which may take hours or even days to emerge. Their message is simple:

STOP trying to push your limits. Overexertion may be detrimental to your recovery.
REST is your most important management strategy. Do not wait until you feel symptoms to rest.
PACE your daily physical and cognitive activities. This is a safe approach to navigate triggers of symptoms.

How do you find that balance of “not too much, not too little?” The Borg Scale of Perceived Exertion is a good tool to find your personal pace (see March 15, 2017 Ai Chi Plus blog post, “Stretch your limits”). Start off by working or doing daily activities at a “fairly light” level (green range), even if it seems too easy. As your endurance improves you will find that what was “fairly light” initially is now very light and you will be able to do a bit more without ill effect. The Borg scale can be applied to everything from length of time out of bed, to walking distance, to exercise regimes~ even to doing Ai Chi steps that challenge core strength, balance, breath, mobility and reduce stress. Pace yourself to find that moving target of lagom.

If you are patient and pace yourself, you will get there!

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