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How to Ease Your Clients Back Into Training Post-COVID

We recently looked at some of the ways you could safeguard yourself as a personal trainer when supporting clients with a compromised cardiovascular system from COVID. The article outlined some of the guidance from other health professionals about keeping your clients engaged with their training while you helped them recover. 

Remember, clients must get medical clearance from their doctor before they restart their training. In this article, we will look at some of the practical ways we can provide clients with support with their training post-COVID.


Principles of Getting Back Into Activity After COVID
The most important thing to keep in mind when supporting your client back into a training routine is that they aren't still unwell. The client must be free from symptoms before returning to exercise. The symptoms are fever, persistent cough, chest pain or palpitations, or being out of breath when at rest. If any of these symptoms are still present, and long COVID may last for a while, the client should not be exercising. 

Encourage your client to speak to their doctor or cardiologist and get cleared to exercise to return to training because of the risks that exercise-induced stress could place on their bodies. The Return To Exercise Guidelines encourages the individual that has had COVID to practice “extreme caution” as the virus can affect people in different ways. It's better to be overly cautious than to have your client set their progress back.


Step 1. Work on CV Fitness
Regardless of how mildly your client feels they experienced COVID symptoms, it's advisable that they make a very gradual return to working out. With their cardiovascular fitness, they might feel tempted to push hard in the beginning because they'll feel the loss of fitness more acutely. 

The guidance consistently given with effort is to start at no more than 50% of the client's standard work capacity and to increase very slowly, no faster than 10% per week, even if their symptoms were very mild. If there are any signs that the exercise has induced symptoms, such as chest pains, shortness of breath, palpitations or fever, stop the session immediately and judge whether medical intervention is required. This may seem dramatic, but following COVID, there’s an increased risk of myocardial inflammation

As a compassionate and well-informed trainer, you will have the skills to explain to your client why it's vital that you're progressing them at this steady pace, and you may choose to give them other objectives to focus on other than quantifiable fitness targets. 


Step 2. Work on Strength
Around 2 weeks after the COVID infection, your client may want to start focusing on rebuilding strength. The British Medical Journal's recommendation is to focus on "movements against gravity" of no more than 40% of your 1RM beginning with bodyweight exercises

After 3 weeks, the client can make a "graduated return to exercise", where your focus as a trainer can be on increasing muscle strength and function. A very gradual build-up to 70% of the client's 1RM, working between 8-12 reps and 2-3 sets to increase muscular strength. Progression to 70% is not a race, and the goal of the sessions shouldn't be to get them there as quickly as possible. 

If your client was working from a lower level of baseline fitness or had an additional disorder (comorbidities) before COVID, they are likely to have a significant level of deconditioning after being unwell. You might consider referring them to a rehab professional and work as part of a suite of health care professionals.

Monitoring the rate of perceived exertion throughout the session will be necessary. You could use a fingertip pulse oximeter, heart rate monitoring, or ask your client to rate how hard they're working out of 10. 


Step 3. Work on Endurance
Endurance is likely to be dramatically reduced following COVID. The aerobic capacity required for endurance workouts will be limited. Further, muscular endurance may be reduced - especially if your client has spent any length of time in bed while unwell. 

The more severe their COVID symptoms were while they were infected, the more their endurance will suffer. If aerobic capacity is limited because of the muscle weakness in their respiratory system or an ongoing lung problem as a complication of COVID, it might be advisable to collaborate with a pulmonary rehab specialist. 

As with general aerobic fitness and strength, it's vital that you are guided at every stage by your client. Communication with them about their rate of perceived exertion will be essential. Further, more emphasis than usual may need to be placed on their recovery time between sessions.


Conclusion
Know that the guidance available on supporting clients returning to exercise following COVID is overwhelmingly focused on athletic populations. There's significantly less advice available for general population clients. It's going to be of the utmost importance that as the professional "on the front lines" with your client, you are cautious about how hard you push them. Better to not push them enough than too hard and risk harming their progress.

Continuously monitoring their exertion by oximeters, heart rate monitors, and simply asking them and communicating why you're so vigilant will help you and your client get the best out of the session. It's worth mentioning that the "sing/ talk" test might not be an accurate measure of effort in a post-COVID population, given that persistent cough and fatigue are such common symptoms. 

In the closing article on the topic, we're going to look at how online personal trainers can ensure they're offering safe, meaningful and progressive training programmes to support clients who have had COVID. There are some additional considerations for remote coaches than face-to-face personal trainers that we'll explore more fully.
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