COVID-19

Covid-19 is an infectious respiratory disease caused by the SARS-CoV-2 virus. The latest evidence suggests that people with chronic diseases, conditions, or a compromised immune system are at the greatest risk of experiencing severe symptoms during and post-infection.

Symptoms

Majority of people will experience mild to moderate symptoms and recover without any special medical treatment, but some in rare and severe cases will require hospitalisation and urgent medical attention.

Symptoms vary from individual to individual but the most commonly reported symptoms include (1):

• Fatigue/Tiredness
• Dyspnea (shortness of breath)
• Cognitive Impairment (brain fog and memory issues)
• Angina (chest pain)
• Persistent Cough
• Muscle Weakness
• Joint Pain
• Insomnia (poor sleep quality)
• Memory and Cognitive Issues
• Heart Palpitations
• Dizziness

The current research notes that women are more susceptible to physical decline and fatigue following covid infection but there is not yet an identifiable reason as to why this is the case?!

What is Long Covid?

Long Covid is defined as a set of persistent physical and mental symptoms that lasts for more than 12-weeks after the initial Covid diagnosis and the symptoms being experienced cannot be explained by any other alternative diagnosis.

Benefits of exercise for Long Covid

Long Covid has been shown to cause deconditioning due to the prolonged experience of symptoms and sedentary behavior such as bed rest. Fortunately, exercise can counteract both deconditioning and sedentary behavior.

Exercise benefits:

• ↓ Severity of Symptoms
• ↑ Mental Health
• ↑ Immunity
• ↓ Joint Pain and Muscle Weakness
• ↑ Cardiovascular Fitness
• ↑ Muscle and Bone Strength
• ↑ Body Composition (increased muscle mass and reduced body fat percentage)
• ↓ Risk of Developing Cardiovascular and Chronic diseases
• ↓ Inflammation Biomarkers

How can an Exercise Physiologist help with Long Covid?

Exercise Physiologists will perform an assessment and then develop an individualised and periodised exercise rehabilitation program based on the severity of a person’s Long Covid condition.

Education and strategies will be given during consultations as to how better manage the prolonged symptoms being experienced i.e., fatigue, muscle stiffness, weakness, and joint pain etc.

It is well shown in the literature that any form of physical activity helps to improve mental health by releasing chemicals such as endorphins and hormones that help improve mood. (2).

Group exercise also helps to lower feelings of loneliness and isolation, so that might be something to look at, especially in regards to individuals suffering from Long Covid. (3)

Exercise is imperative as lung functioning and cardiac health are some of the most impacted bodily systems effected by covid. The exercise programs prescribed by Exercise Physiologists will appropriately and constantly challenge the cardiovascular, respiratory, and muscular systems.

If you’re suffering from long covid and are wanting to return to work, improve your quality of life and activities of daily living, Exercise Physiologists are here to help.

Websites for further information:

• https://www.coronavirus.vic.gov.au/long-covid
• https://www.coronavirus.vic.gov.au/
• https://www.health.gov.au/health-alerts/covid-19
• https://www.australia.gov.au/

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8806149/#:~:text=Mild%20COVID%2D19%20cases%20include,of%20lower%20respiratory%20tract%20disease.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928534/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398226/

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse also referred to as POP, is when one or more of the organs in the pelvis (bladder, rectum, or uterus) becomes weak or loose and protrudes into the vagina (Continence Foundation of Australia).

The pelvic organs are supported by the interaction of ligaments, muscles, and connective tissue that make up the pelvic floor (Continence Foundation of Australia).

When the pelvic floor becomes weak it can impair its function of (Women’s Health Collective):

1. 1. Supporting the pelvic organs
   2. Resisting downward pressure from Intra-abdominal Pressure (an increased abdominal pressure caused by actions like coughing and sneezing)
   3. Closing of sphincters.

(Photo Source: Jean Hailes)

How common is POP?

POP affects up to 50% of adult women, and commonly occurs after having menopause, if you are overweight or after giving birth (Continence Foundation of Australia).

Types of POP

There are three common types of POP, including (Office on Women’s Health):

• Dropped bladder (Cystocyele): This is when the bladder bulges into the vaginal space and is the most common form of POP.
• Dropped uterus (Uterine): This is when the uterus bulges into or out of the vagina.
• Dropped rectum (Rectocele): This is when the rectum bulges into or out of the vagina.

What are the Signs and Symptoms of POP?

Common signs and symptoms of POP, but are not limited to include (Continence Foundation of Australia):

• An observable bulging lump out of your vagina
• A dragging sensation in the vagina
• Difficulty emptying bladder or bowel
• Recurring urinary tract infections
• Pain in the lower back, pelvis, or abdominals
• Lack of sexual sensation
• Struggles to keep a tampon in.

Please see your General Practitioner if you are experiencing these above symptoms and have not been diagnosed with POP, for further investigation.

Stages of POP

There are 4 stages of POP that will help guide the most appropriate treatment pathway for you. These include (Women’s Health Collective):

• Stage 1: The organ is greater than 1cm away from the vaginal opening and is in the upper half of the vagina.
• Stage 2:  The organ has descended to nearly the vaginal opening.

Stages 1 and 2 are common stages in women postpartum and can be reversed.

• Stage 3:  The organ has everted 1cm and protrudes out of the vagina. Conservative interventions like exercise can manage symptoms.
• Stage 4: The organ has completely everted and outside of the vagina. Typically require a combination of approaches both surgically and conservative.

How does exercise help POP?

Whether you do or do not require surgery, exercise plays a pivotal role in strengthening your pelvic floor muscles and the muscles surrounding them. Particular exercises can greatly manage and improve symptoms from POP, however, certain exercises can make symptoms worse (Exercise Right).

An Accredited Exercise Physiologist is appropriately trained in prescribing exercises that are safe and effective for managing POP.

Exercises to Avoid if you have POP

The following exercises are advised against if you have POP as it can make your symptoms worse:

• Valsalva moves (holding your breath)
• Plyometric exercises (impact exercises like jumping and hopping)
• Wide legged exercises (side steps and wide legged squats)
• Weighted exercises that place a large amount of downward pressure (lat pull down, back squats, overhead press)
• Core exercises that result in poor recruitment of your core (sit-ups and crunches)
• Exercise involving prolonged static standing.

Safe Exercises if you have POP

The following exercises are supported if you have POP as they will not make your symptoms worse (Women’s Health Collective):

• Low impact cardiovascular exercise like walking
• Swimming
• High rep low to medium weights
• Speed walking.

Exercise Treatment for POP

In regards, to exercise treatment for managing POP an Accredited Exercise Physiologist can guide you through a tailored program that includes (Women’s Health Collective):

1. Teaching you how to correctly recruit the muscles that make up your true core (Transverse Abdominis and Pelvic Floor) to ensure correct support to your pelvic organs.
2. Ensure you have good posture as a forward posture can increase downward pressure on the pelvic floor and can impact bladder and bowel control.
3. Strengthen the muscles that surround your pelvis like your glutes, hamstrings, adductors, lower back, and abdominals as these muscles support your pelvic floor.

Top Tips to Consider when Strength Training with POP

Below are listed some important things to consider when performing strength training with POP to reduce downward pressure on the pelvic floor (Women’s Health Collective):

• Exhale on the hardest part of the movement and inhale on the easiest part of the movement (e.g., inhale as you squat down and exhale as you stand up)
• Vary the positions you are in during your training session, for instance, perform a range of sitting, standing, and lying exercises
• Start initially with feet in a narrow stance
• Progressively increase repetition of an exercise before increasing weight.

Further Resource

https://www.continence.org.au/who-it-affects/women/prolapse#signsandsymptomswilldependonthetypeandlevelofprolapse