Just after ICU discharge the load capability of a recovering COVID-19 patient is extremely low. The ability to transfer from a bed to a chair is of course the primary goal. But do not underestimate how heavy a burden it is for the COVID-19 patients to simply sit in a chair. Do check how long it takes for these patients to recover!

It is common practice that post ICU-patiens are put in a chair and stay there for 30 minutes until someone helps them back to bed. This can be far too long in the initial rehab phase for COVID-19 patients. It can be counterproductive as it is to intense and the body will not recover for the next activity. Pay attention to overexertion!

Once this very early rehabilitation phase is passed, the load capability can increase. At this point in time (in most cases still in the hospital environment), one can start exercising with extremely limited load settings. Also psychological counceling (it is a severe trauma experience) and ergo therapy might be indicated. For the physical rehabilitation in this phase it is ideal to start with Pulley systems. Pulley systems allow for functional movements, are extremely well accessible and can be used even from seated positioning. Note however that the minimal resistance setting of your pulley system and the increments are low enough.

After this phase the patient can progress to a guided active rehabilitation phase.
By means of testing (and re-testing) the individual load capability can be measured and used as input for the exercise program.

Cardiorespiratory evaluation

With COVID-19, being an infectious disease with a high impact on the cardiorespiratory system, it is recommended to do evaluations at a regular interval. Several methods are available.

		Steep Ramp Test The Steep Ramp Test (click here) is the ideal test for early rehabilitation of COVID-19 patients. This cardiorespiratory test is very short and with an extremely low burden for the patient. Still however it gives a valid and accurate estimation of the maximum load capability of the patient. It can be used as reference value for the rehabilitation program. The EN-Cardio Bike Reha is capable of completely automatically perform this test.
		Åstrand test A traditional test with a submax load that also gives a good estimation of the maximum load capability. The Åstrand test is a little bit more strenuous for the patient, and there for the second choice for extremely weak individuals. However, if it is possible this test gives a very reliable result. Again that result can be used as input for your training program. Also this test is standard available on the EN-Cardio Bike Reha.
		6 Minutes Walking Test (6MWT) Although exercise testing is mostly done on ta bike (since the power is standardized on a bike), the 6MWT has been validated and tested for reliability in COPD patients and patients with heart failure (Sadaria and Bohannon, 2001; Solway e.a., 2001). It therefor might also be very suitable for COVID-19 patients. And above all, it is a very modest burden for the patient. The unique EN-Motion treadmill is the only treadmill with the auto-speed function. This treadmill therefor allows patients to move at their own speed, the treadmill adapts accordingly. Based on the 6MWT an exercise program can be prepared.

Musculoskeletal evaluation

In the early rehabilitation phase strength training is used for two goals

• functional rehabilitation: the ability to use the locomotor system in ADL
• cardiorespiratory training: using large muscle groups in order to train lungs and circulation

The most widely used testing for strength training is the 1RM test.
It is easy, very sub-maximal (though the amount of repetitions should not exceed 25) and a good indication of the max strength.
All EN-Dynamic units have the possibility to do a 1RM test.

Bringing it all together, testing and training

Training protocols - either for cardiorespiratory training or for strength training - are always based on an estimated max value.

With the EN-Train concept it all comes together.

In EN-Train you define what exercises are applicable for that specific patient.
With the EN-Cardio Bike, the EN-Motion treadmill or the EN-Dynamic exercise units you perform the test
The test results are stored in EN-Train.
Base on the training goals and on these test result, the optimal individual protocol is created by the EN-Train concept.

The client is guided through the rehabilitation facility.
All units are automatically set.
Feedback is given to the therapist about the exercise progression so he can re-test or adjust the protocol.

Specifically for COVID-19 patients EN-Train offers the ideal solution.
Simple and accurate measurement, guided training, clear goals and proper feedback.

For COVID-19 patients the Enraf-Nonius Medical Training equipment is optimal since:

• the starting load is extremely low
• the increments in load adjustment are extremely small
• the accessibility is very good

With Enraf-Nonius Rehabilitation and Medical Fitness products you are assured of the best training and evaluation methods for any stage in COVID-19 rehabilitation.

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