• It is recommended to treat 2 to 5 times a week, in which strength training is applied 2 to 3 times a week. The order of increase is first of all the frequency of rehabilitation, second the duration and third the intensity. It is recommended from REACH to perform the first endurance exercise at a very low intensity 40-50% HRmax. Based on the reserve heart rate, the training intensity is normally between 40-60%, or a score of 4 or 5 on the modified Borg scale (COPD guideline), or a maximum heart rate 50-80% (cardiac rehabilitation guideline). When endurance exercising is not possible, an alternative could be to emphasise strength training (muscle endurance) or possibly interval training.


    • The rehabilitation frequency for strength training is twice a week. Initially, 50% of the 1-RM can be chosen, perhaps with a 2-week build-up of 30-40% 1 RM). Generally, build-up to 70-80% 1RM, 2-3 sets of 10-12 reps is recommended.


    • If pulmonary problems are in the foreground, Hoogstraat Rehabilitation Centre (The Netherlands) recommends rehabilitation in a specialized lung rehabilitation setting. However, physical limitations will often have a multifactorial origin in which pulmonary limitations will regularly play an important role(8)


    • It is important that the physiotherapist realises in the primary care what his resources and skills are, but also where additional research is needed, so that consultation and referral to the hospital can take place in due time. The physiotherapist must also be able to identify whether other disciplines (with knowledge of the consequences of COVID-19) such as psychologists and dieticians should be involved.


    • Exercise therapy and / or exercise coaching in non-infectious COVID-19 patients with residual lung function impairment should be performed by a healthcare professional with previous experience in treating patients with respiratory impairment (17)


    • Nothing is yet known about the total duration of physical therapy supervision. The KNGF (Dutch Association) guideline for COPD describes the following: although some studies suggest that positive effects are retained longer after longlasting training programs (> 12 weeks), shorter programs (4 to 7 weeks) also appear to result in clinically relevant progress(18). Treatment progression should be followed by repeated evaluation of symptoms, muscle strength, exercise capacity, daily physical activity and self-management (including effectiveness of mucus clearance) (18)


    • Based on the available literature, it is recommended to make follow-up appointments after the end of a rehabilitation program (18). Education of the patient to improve adherence and self-management must form an integral part of the physiotherapy treatment, is described in the KNGF guideline COPD.


    • Promoting physical activity over the course of the training program is important. In addition to offering forms of therapy that improve exercise capacity and mucus clearance, the physical therapist must also try in a problem-solving approach and in collaboration with the patient, to let the patient develop an independent active lifestyle. The objective of the intervention is for patients to achieve the recommended physical activity standard to improve and maintain health, in accordance with recommendations for the elderly from the American College of Sports Medicine and the American Heart Association (13).

 

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