Dr Dane Vishnubala

Making a Safe Return To Exercise After COVID-19 

As leisure facilities start to reopen, operators are welcoming back staff and members. Welcome though this is, it won’t be plain sailing for everyone as colleagues and members return to an altered landscape marred by the impact of Covid-19. We asked Dr Dane Vishnubala, Consultant in Sport and Exercise Medicine and Chief Medical Advisor at Active IQ, for his advice on making a safe return to exercise and the physical activity workplace after Covid-19. His insight includes:

  • Overcoming apprehension among staff and members as they return
  • Managing mental health in light of the impact of the pandemic on physical and social wellbeing
  • Mastering the recommend phased return to exercise
  • Identifying – and avoiding – the common mistakes being made post-pandemic

Many people may be apprehensive to return to their local gym after a long absence. What can operators or fitness professionals do to reassure members and get them to take their first steps back to the gym?

First and foremost, make every effort to ensure members feel safe in covid-terms. Show social distancing measures are in place, have hand sanitiser at the entrance and near any touch points, ensure plenty of sanitiser and paper towels are available throughout the gym. Also ensure staff are seen to be checking that people are respecting the distance and sanitisation requirements. This can be a challenge and needs to be done sensitively.

Many people have felt physically and socially isolated so being personally attentive will reinforce that you care about members as they return. A reassuring conversation on the gym floor and offering on-the-spot guidance will help reassure people as they return to their fitness routines. Engaging in conversation will also help highlight any physical or mental health issues they may have so take time to talk meaningfully: don’t just say ‘hi’ and move on.

When talking to members, put the emphasis on health and wellness rather than aesthetics. Firstly, this stance helps fitness professionals prioritise the primary and secondary prevention of a range of diseases. Secondly, it will encourage members to work on improving their wellbeing more than their body image which is more attainable and healthier for all. However, while saying this, we must also recognise the wide variety of goals that lead people to the gym.

What about staff? Many will have been out of work for a year or more. Is there anything operators can do to help prepare them mentally for a return to work?

If feasible, plan a phased return for staff to help them get back into the swing of things and encounter colleagues and members in smaller, more manageable stages.  If you can give staff a longer time slot for their activities this will alleviate time pressures and help them ease back into the routine. Consider running some refresher training on skills, use of tech and updated post-Covid protocols.

The mental wellbeing of staff is absolutely critical at this time. This is especially the case for those who have been adversely affected by Covid-19 whether they have been unwell themselves, seen a loved one suffer or even lost friends or relatives to the disease. It’s a good idea to set up an online Staff Support Forum group for the first few months after staff return to give colleagues a welcome outlet to discuss their concerns and ask questions. Make it easily accessible – a Private Facebook group can work well.  To ensure this doesn’t fizzle out, form a small team of Mental Health Champions to manage the forum and post regular, thought-provoking content that engages people and makes them reflect. When posting comments, invite people’s views and thoughts to encourage active participation in the forum.

Is there anything operators can do to help support members who may have had COVID, especially those suffering from long COVID symptoms?

Firstly, I’d recommend they take a very conservative approach to working with people returning to the gym post-COVID-19. I was part of the research team behind the article ‘Returning to physical activity after Covid-19’ that was published by the British Medical Journal in January. Its insight on helping people return safely to physical activity following COVID-19 is based on current evidence and consensus statements alongside our multidisciplinary experience in sports and exercise medicine, rehabilitation and primary care.

The main takeout recommendation is to use a phased approach to exercise while noting each person’s experience. This is clearly explained here Returning to physical activity after covid-19 (bmj.com).

People who had more severe COVID-19 illness, such as those who were hospitalised, are thought to be at higher risk of cardiac, respiratory or circulatory complications as they recover and their rehabilitation should be managed in conjunction with post-COVID-19 medical services.  Anyone who didn’t require hospital treatment but had symptoms during their illness suggestive of myocardial injury – such as chest pain, severe breathlessness or palpitations – should be cleared by their GP to exercise first. Finally, anyone whose symptoms are prolonged and not settling could be suffering from Long Covid, a long-term health condition that can be worsened by taking exercise.

Health will now be a big priority for people who may have never considered joining a gym before, especially those with underlying health conditions. What can operators do to help these new members start their fitness journey?

The pandemic has certainly heightened awareness around the fact that being fit and well can help people fight disease better. We also know that rehabilitation from COVID-19 through exercise can enhance people’s physical and psychological recovery while preventing deconditioning whereby strength, fitness and functional capacity are lost.

New members are likely to find the gym intimidating initially and will need plenty of reassurance.  This is best offered initially by understanding front-of-house staff and then by speaking to a PT who has been trained in exercise referral and has appropriate skills to work with people who have long term conditions.

As well as having this advanced knowledge, staff working with new members must be trained in communication and consulting skills alongside behaviour change methodology as all are key when working with new members and people with underlying health conditions.  Before the pandemic, the physical activity sector was increasingly being called upon to upskill PTs to meet the growing demand for ‘exercise on prescription’. The recent NICE guidelines advocating exercise before painkillers to help manage chronic pain is the latest move to shine a light on the true value of physical activity when it comes to our nation’s health.  It will lead to further demand for physical activity solutions to medical problems, but the leisure industry must ensure only suitably qualified staff pick up the gauntlet.

What are some common mistakes people are making?

A common mistake is people returning to the gym expecting to pick up their fitness routine where they left off before lockdown.  Unless they’ve been able to train with the same weights and to the same intensity as they did in the gym, this is simply unrealistic.  Quite apart from being demoralised by not being able to get straight back to their routine, they could easily injure themselves – which will only set them back further.

A potential mistake is people returning to exercise too soon after having Covid-19.  Even those who only had mild symptoms must be cautious and only return after being completely symptom free for seven days.  They must then take it steady and build their load and intensity gradually, all the while staying alert to how they’re feeling.

People who have Long Covid symptoms must not think they can just return to the gym and start exercising and should be cautious. They have a long term health condition and need to recognise that professional guidance from a highly-qualified exercise professional will be their quickest and safest route back to wellness.

The recommended phased return approach should see phases lasting at least seven days and clients should expect at least five phases. Using the Borg Rating or Rate of Perceived Exertion (RPE) Scale (where 6 is ‘no exertion’ and 20 is ‘maximal exertion’) Phase 1 would aim for an RPE of 6-8; Phase 2 – RPE 9-11; Phases 3 & 4 – RPE 12-14 and Phase 5 – RPE of 15.

The best instructors will know when to regress a programme and staying alert to each individual’s needs has never been more important.

Posted in Gyms & Clubs, The Fitness Network.