HOW TO STAY FIT DURING COVID-19 PANDEMIC

PATIENTS WITH CHRONIC KIDNEY DISEASE

The coronavirus disease 2019 (COVID-19) pandemic causes complex CKD patients to exercise in rehabilitation centers and gyms. Therefore, we need to promote physical activity programs at home and/or field to promote adequate fitness and mental wellbeing in that population. But, of course, the exercise training during dialysis continues freely with the use of health protocols.

The presence of CKD constitutes a higher risk of an adverse prognosis following COVID-19 infection.

EXERCISE THERAPY DURING OR AFTER COVID-19 INFECTION

1. During the infection phase, if the chronic kidney disease patients affected with SARS-CoV-2 are physically able to rehab (i.e., not reporting fever or dyspnea, oxygen saturation ≥ 95%, rhythmic heart rate), it should be started respecting all safety procedures to avoid the therapist’s infection. Still, home-based or telehealth sessions should be prioritized.
2. Clinical examination must be performed in all CKD patients after COVID-19 infection before starting a physical rehabilitation program. 
3. Lung damage, as fibrosis, associated with SARS-CoV-2 can lead to the impairment of alveolar air exchange and a decrease of pulmonary ventilation function. Therefore, a cardiopulmonary rehabilitation protocol for CKD patients affected by SARS-CoV-2 must be applied and customized based on the specific sequelae of each individual; in this context, respiratory muscle training has been used as an essential tool in the recovery of these patients.
4. CKD patients affected by SARS-CoV-2 may be at high risk for musculoskeletal health impairments, such as sarcopenia, protein-energy wasting, cachexia, and frailty. Exercise rehabilitation therapies may play an essential role in improving physical function health and attenuating the expected sequels in CKD patients infected by SARS-CoV-2. Physical function rehabilitation performed with resistance training, balance exercises, and neuromuscular electrical stimulation could counterbalance muscle and strength losses due to muscle disuse caused by bed rest and long hospitalization periods.

EXERCISE IN TRANSPLANT PATIENTS

1. Kidney transplant recipients with suppressed immune systems and baseline chronic kidney disease after transplantation appear to be at a higher risk of COVID- 19 related morbidity and mortality.

2. The continuation of physical activity during this pandemic crisis is essential. Regular exercise is an effective means of improving functional capacity, protecting cardiovascular and health, strengthening the immune system, and reducing stress and anxiety. Although many government policies enforce quarantines/lockdown, outdoor exercise is allowed if physical distancing is upheld. Even when outdoor activities are not possible, regular indoor exercise should be done. In addition, many virtual exercise classes are now available for high-risk individuals and should be encouraged.
3. Continue to take exercise within the guidelines: you should not use swimming pools or take part in contact sports at this time, but do make sure you stay healthy by cycling, walking, jogging, or running or doing simple exercises such as press-ups, aerobics, or Pilates. You can also play some sports outside such as basketball, tennis, golf, and fishing. Εxercise should be enjoyable, so find out what you like doing it and do it regularly within your capabilities.
4. Competitive sports are not restricted, but athletes should strictly adhere to sanitary measures against infection.
5. During or after COVID-19 infection, there are the same recommendations as in CKD patients.
6. Athletes and heavy laborers recovering from COVID-19 illness may be susceptible to a range of complications that may prevent or hinder their return to strenuous activity. Renal transplant athletes, who suffer more severe disease or have high-risk morbidities, require additional testing and specialist consultation before they can resume intense training. Clinical decisions about return to play must account for the severity of illness, age, comorbidities, degree of detraining, and activity goals. Additionally, there are specific recommendations for sports eligibility and specific return-to-sports exercise programs.

Sources of advice:

1. TS Covid advice - Transplant Sport http://transplantsport.org.uk › uploads › 2020/07
2. Aziz F. et al.: The care of kidney transplant recipients during a global pandemic: Challenges and strategies for success. Transplant Rev (Orlando). 2020 Oct; 34(4): 100567.
3. Ribeiro, H.S et al. Post-COVID-19 rehabilitation: a special look at chronic kidney disease patients. Ren Replace Ther 2021;7, 33.
4. O'Connor F, and Franzos A.  COVID-19: Return to play or strenuous activity following infection.  UpToDate,Aug 2021.
5. Clyne N and  Deligiannis A. To improve the life of patients with kidney disease: the impact of exercise. Clin Kidney J. 2021 Apr; 14(Suppl 2): ii1–ii2.
6. https://cardiacrehab.gr/