Club Insider

An Industry Opportunity

Programming to Help COVID Survivors Recover

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Bonnie Patrick-MattalianBonnie Patrick-Mattalian

I don't need to remind you of the sobering statistics. Yet, as of this writing, April 15, 2021, here they are regarding COVID-19 per Johns Hopkins University of Medicine:

  • 31.4 million cases and 565,000 deaths in the United States;
  • 138 million cases globally with almost 3 million deaths.

A tragedy by any means. Doing the math, however, if there is any shred of positive news, it is that more than 135 million people around the world have recovered.

Those recovering may have suffered damage to the heart, lungs, brain, kidneys and other organs. Scarring of the lungs, an enlarged heart, tachycardia and fluid around the lungs and heart continue to be problematic for many.

According to the Harvard Medical School Harvard Health Letter, one in ten COVID survivors are "COVID Long-Haulers," meaning three months after the initial infection, they have not fully recovered even after the virus has been abated. They are struggling with lingering effects, and these symptoms and effects may continue for a year or more.

There are 98 known symptoms for persons still struggling with the after-effects of the virus. Based on a recent survey, the most prevalent of these are:

  • 100% - Fatigue;
  • 66.8% - Muscle or body aches;
  • 65.1% - Shortness of breath or difficulty breathing;
  • 59% - Difficulty concentrating or focusing;
  • 58.5% - Inability to exercise or be active;
  • 57.6% - Headache;
  • 49.9% - Difficulty sleeping;
  • 47.6% - Anxiety;
  • 45.6% - Memory problems;
  • 41.9% - Dizziness.

Of note is the fact that exertion of any kind, whether physical or emotional, may cause a relapse and/or extreme fatigue.

Science and medicine are still catching up on how to address these ongoing issues. I know because, in December, my husband and I became gravely ill and hospitalized with COVID. I landed in a COVID ward with the disease and associated illnesses. That week and the month that followed was terrifying for our families and us. We were among the lucky ones; we survived.

It has been an interesting journey since then. As I started to feel better in February, I told my doctors I wanted to start moving again. I asked what the parameters were for exercise. Their response was very arbitrary, including, "Go ahead, but it will be hard. Just don't do much; take it really easy." The exercise physiologist in me was not satisfied with that response.

So, I joined multiple national COVID survivor support groups to see what I could learn. I knew that getting moving again would help with many of the symptoms, and I would recover more quickly. And, there were hundreds of thousands of people like me craving information on holistic therapies for our symptoms.

Clinics with a focus on providing medical care for COVID long-haul syndrome sufferers are available in most states. There are long waits in many cases for appointments, and they require insurance coverage or direct payments.

Just recently, Johns Hopkins Medicine came out with guidelines for COVID survivors looking to begin moving again: bit.ly/clubinsider127.

The good news for me is I have now resumed my previous activity levels. I know my limitations and watch my heart rate and pulse oximeter.

The Opportunity For Our Industry

The virus has impacted a portion of every community. Depending upon where your site is located, .5 - 12% or more of your community's population may have contracted COVID. And, there may be another 1 - 5%+ who had the virus but either didn't know it or didn't get tested.

We've re-opened our sites. As you continue to re-open yours, any of the following may be true for your members and community:

  1. GROUP A: A percentage of your members may have contracted the virus, and they are coming back in to begin moving again. They may have underlying conditions that are new and undetected since acquiring COVID.
  2. GROUP B: A percentage of your members may have contracted the virus and canceled or frozen their accounts as they struggle with symptoms.
  3. GROUP C: A percentage of the population in your community may have contracted the virus. Although they may never have exercised before, they are looking for relief from their symptoms.
  4. GROUP D: A percentage of your population has not exercised before. In the past, typically, this has been 80% of the population. Now, this group looks at wellness and a healthy lifestyle to be more critical than in years past. They are looking for a wellness authority in their community to support a healthy lifestyle.

For GROUPS A, B and C, it makes sense to relook at our intake processes to ensure it is safe to begin exercising or resume movement. This helps to mitigate risk for the member and your facility.

For GROUPS A and B, while they are already members, this is an opportunity to relook at their health status via a questionnaire and a conversation with a fitness professional.

Once the physician clearance is received, the best solution is to provide 1:1 or small group programs for GROUPS A, B, and C.

I decided to look around our industry to see what changes sites were making towards these accommodations for people recovering from COVID. Many organizations chose not to comment. However, here are some highlights from centers that are monitoring these needs in their communities:

Cooper Wellness Strategies

Predictably, the world-renowned Cooper Aerobics has developed processes to improve the quality of life for COVID survivors. Cooper Wellness Strategies provides programming solutions for medically-directed fitness centers around the country. And, they have several solutions for exercisers suffering from post-COVID syndrome.

According to Cooper Wellness Strategies Program Director, Sheryl Brown, PT, MSPT, as part of their Cooper Tracks exercise and education programs, their Immunity and Reconditioning Track orientation process is individualized and provides 1:1 support. The intake process includes medical clearance/medical history review and a comprehensive health assessment before beginning the eight-week group program. "Key to following the principle of Exercise is Medicine, the participant's signs, symptoms and vital signs should be monitored while exercising in the program," explains Brown. The trainer should monitor fatigue, shortness of breath and rate of perceived exertion (RPE), before and during exercise.

Nutritional education, stress management and social support are provided. Brown comments, "Our program emphasizes breathing retraining, which helps decrease shortness of breath and improve the efficiency of respiratory musculature during exercise and activities of daily living. Mindful relaxation exercises are performed at the end of each exercise session to help the body recover from exertion, reduce muscle tension, lower blood pressure and heart rate and may even contribute to improving quality of sleep."

For additional information on Cooper Tracks, contact Sheryl Brown at sbrown@cooperwellness.com.

Valley Health

Valley Health in Virginia is a 60,000 square-foot facility certified through the Medical Fitness Association (MFA) and managed by Power Wellness.

Jeffrey Jeran, MS, CSCS, FMHA is the Corporate Director of Fitness Services Valley Health and is also the Chair-Elect for the MFA.

Jeran states, "Our Next Steps Program provides the direction and support people who are recovering from COVID need." Next Steps is typically an eight-week program open to the public, including two supervised sessions per week plus nutritional guidance. There are ten different programs available based on chronic condition prevalence and need.

The positive outcomes from this program include a very high transition rate to membership. "Our Next Steps Program graduates that became members also stay engaged with us as members on average for one year longer," Jeran explained.

For additional information on Valley Health's programs, contact Jeffrey Jeran at jjeran@valleyhealthlink.net.

DeWitt Physical Therapy and Wellness

Dr. Jeanette M. De Witt PT, DPT, LAT, ATC, NASM-CPT, NASM - FNS, Certified Precision Neuromuscular Therapist, is the Owner of DeWitt Physical Therapy and Wellness, offering in-person and telehealth physical therapy and personal training.

This center utilizes a holistic, science-based whole-body approach to healing for special conditions. As a physical therapist, Dr. DeWitt explains, "We are conservative in our approach, and we develop criteria for each individual to move through each step in programming as we monitor their vital signs closely."

Their philosophy and programming follow the route of "Recover, Restore, Revitalize." For COVID patients, the team focuses on diaphragmatic breathing and exercises to open the chest wall. Many patients also utilize essential oils and nutritional services as warranted for condition-based solutions. And, DeWitt has a vibrant Facebook community, helping families achieving optimal health together.

For more information on DeWitt Physical Therapy and Wellness, contact Jeanette M. De Witt at jeanette@dewittptwellness.com.

Piedmont Atlanta Fitness Center

Joshua J. Lee, PT, DPT, is a Doctor of Physical Therapy at Piedmont Atlanta Outpatient Rehabilitative Services. Paige N. Jones III, ACSM CEP, EIM3, is the Manager of the acclaimed Piedmont Atlanta Fitness Center.

The physical therapy department works in conjunction with the Georgia Lung Clinic to begin rehabilitation with patients who have had COVID-19 or are recovering from COVID-19.

Lee explained, "Regarding standard parameters and guidelines for COVID-19, unfortunately, due to its extremely variable presentation and the lack of data on each of the presentations (anosmia to dysphagia/gastrointestinal to renal), we have been doing it on a case-by-case basis so far to ensure safety. We have found that some people do well with just walking and moderate exercise, while others may need to start with simply learning to stand and be okay with standing without fatigue. Some have balance issues; others do not." He continued, "Without careful medical clearance (ruling out major cardiovascular/pulmonary/GI/renal systems) and assessment, it could be quite dangerous to give a general exercise protocol or even guidelines without knowing the full history and new presentation post-COVID."

Many COVID survivors have complained of extreme fatigue with exercise. Lee attributes that to oxygen obstruction, GI issues or possible sympathetic nervous system overdrive. He reminds us that it is essential that each person heal at their rate and to know that this may take months or more.

Lee reminds us that there may be a need for counseling for the COVID survivor also. And, he asks, "Please be patient and kind with your providers as we are also struggling with the vast unknowns and cannot give specific answers but are working very diligently to better grasp an idea of how to move forward and help our patients/clients the best we can."

For further information on Piedmont Outpatient Services, please contact Joshua J. Lee at josh.lee@piedmont.org or Paige N. Jones III at paige.jones@piedmont.org.

Additional program and platform solutions that can be integrated into fitness center operations include:

  • Genavix HealthyCare - Enabling individuals and families to early detect, reduce or eliminate elevated or chronic risk factors through lifestyle change. Industry veteran, Mike Benton, leads this program.
  • Avidon Health - A health platform that combines human connection with data-driven technology that produces outcomes and changes lives. Avidon is an enablement product created by industry and health promotion knowledge leaders that engages populations.
  • Stasis Performance Breathwork - This is a comprehensive, medically-based program to improve lung capacity through structured deep breathing exercises. Developed by Josh Duntz, a former member of Navy Special Operations teams, the program also helps to reduce stress and improve mental health.

Through a significant amount of research on COVID impacts and solutions, I support centers to clarify the current market demand and create differentiated programs and services according to what is important to consumers now. For example, program opportunities for our sites to support both COVID survivors and the public at large include:

  • Salt Rooms - Halotherapy is an evolving field not yet scientifically proven. Anecdotally, participants have reported improvements in breathing and stress reduction. Medical professionals should manage such a program.
  • Facilitated and Assistive Stretch Sessions - When performed by a trained professional, assisted stretching will help to reduce fatigue and stress.
  • Infrared Saunas - Yes, they are back. They can help with sleep, stress and fatigue. Participants need to stay hydrated during these sessions and after.
  • Sleep and Stress-Reducing Therapeutic Programs - Aromatherapy, Blue Light Glasses, Meditation, Hydromassage and Massage focusing on the vagus nerve are increasing in popularity at many centers.
  • Nutritional Coaching, Cooking Classes - Food can be used for healing. We need direction in order to change our mindset accordingly. Partner with a local restaurant for cooking classes at their location, a community win/win.
  • Individualized Membership Options - A one-size-fits-all membership option approach may not be sustainable. Give your community the option to create their membership plan. Those who are just beginning on a new, healthy journey --that 80% of the population who never exercised previously-- will be attracted to individualized lifestyle solutions.

Someone recently asked me if it even made sense to focus on COVID survivors or the virus at all. They explained that the pandemic was almost over as far as they could see. A few thoughts on this pertinent question. The following statistics are specific to the United States:

  • As of the week this article's authorship, COVID accounts for 912 deaths and 70,000 - 80,000 cases per day. Cases and hospitalizations have increased by 7%.
  • The segment of our population that COVID has impacted needs our help and support, and the relationship we build with them now will likely extend for years to come.
  • Experts report this is not the last pandemic or the last wave of this virus or mutations that we will see.

So, while we focus on adjusting our operating models and programs, establishing our centers as the "go-to" in the community for all health-related items will be an integral part of our success moving forward. We will include virtual programs and engagement options likely for the next few years.

As industry champion Dr. Amy Bantham explained to me, this pandemic is actually the kick-in-the-pants our industry needed. We are rethinking our offerings and refocusing the experience with the customers driving decisions. That's precisely the way strong businesses thrive.

During this reset, we have the opportunity to become an essential part of the community through education, messaging, programming and creating relationships with new segments of the market.

By re-establishing ourselves as the health promotion authority for our local community's needs, we will provide solutions and build stronger relationships that will weather any storm.

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