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Build Strength During the Coronavirus Outbreak With 'Prehabilitation'

Two physicians discuss a proactive approach to fight infections, improve health

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As the new coronavirus spreads throughout the U.S., federal officials are urging Americans to stay home as much as possible to reduce their chances of getting sick from COVID-19, the respiratory illness caused by the virus. This has led many to abandon routines that provide regular physical activity — walking with friends, group exercise classes, etc. — putting older adults, especially, at risk for loss in physical strength.

But a practice commonly prescribed to patients ahead of surgery, called prehabilitation, can help slow or stop this decline and minimize the long-term damage it can cause.

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Erwin Tan, M.D., a geriatrician and director at AARP Thought Leadership, asked Julie Silver, M.D., an associate professor and associate chair in the Department of Physical Medicine and Rehabilitation at Harvard Medical School and a medical staff member at Massachusetts General, Brigham and Women's, and Spaulding Rehabilitation hospitals, to explain how this proactive approach can help build resiliency, even during times of increased isolation.

What is prehabilitation?

Most people have heard of rehabilitation — a practice generally aimed at restoring strength after an illness or injury. Prehabilitation prepares people for an upcoming physically stressful situation. The concept dates back to World War II, when the military successfully implemented an early prototype of boot camp to prepare soldiers for the hardship ahead.

In medicine, prehabilitation is often used to get patients ready for surgery to increase their chances of a healthy and successful recovery.

Why is prehabilitation especially important right now?

With the current coronavirus outbreak, everyone's goal is to avoid an infection. And one of the best ways to protect yourself is to limit exposure to others, which is why health experts and government officials have issued physical distancing (commonly called social distancing) guidelines for the country.

But staying home and avoiding groups for an extended period of time can have its downsides, including decreased physical activity. And this can lead to a cascade of events in the body that make people more susceptible to infections and less able to fully recover from them — especially older adults and people with underlying health conditions, who experts say are most at risk for severe illness from a coronavirus infection.

What happens when we become more sedentary?

Many people know that aerobic exercise is good for the heart and lungs, and resistance exercise (weight training) makes skeletal muscles stronger. But what a lot of people do not realize is how quickly we lose strength when we decrease our daily physical activity.

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Even short-term bed rest can result in a loss of muscle mass, research shows. And older individuals are more likely to lose muscle mass at a faster rate than younger people. Not surprisingly, a loss in muscle mass results in a loss in strength, followed by a long list of other events that cause the heart and lungs to weaken. The good news? Studies show that doing some exercise ahead of a period of rest or illness has a protective effect.

How can we make sure we are as strong as possible while distancing?

Prehabilitation can help ensure that you are as healthy as possible in the event that you do become infected with COVID-19 or another illness. Here's how to do it:

  • Evaluate how active you are now compared to before you started physical distancing. If you are less active, then set a goal to get back to your previous activity level (your baseline). Need ideas? Check out these exercises you can do at home. If you live in a community that has issued a stay-at-home order, check your local government's rules on outdoor exercise. Keep in mind, however, that federal guidelines encourage older adults and people with underlying health conditions to stay home as much as possible.
  • If you plan to increase your activity or exercise level above your usual baseline, talk to your doctor about how to do this safely.
  • Focus on eating a nutritious diet as much as possible and be sure you get enough protein (adding in a little extra is a good idea, research shows).
  • If you have diabetes, work with your doctor to make sure that you are managing your blood sugar levels to reduce your risk for infection.
  • If you smoke, now would be a great time to quit. Be careful to drink alcohol in small amounts, if at all.
  • Almost everyone is experiencing more stress than usual, which is why it's important to implement a daily stress-reduction strategy. Try meditation, yoga or guided imagery, for example.
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What else do you want people to know?

This pandemic is very worrisome, but there are every day actions you can do to help minimize your risk for illness. Wash your hands often with soap and water, and be sure to keep a safe distance — at least six feet — between yourself and others. And remember: If you are not sick, then you likely have a window of time in which you can better prepare your body just in case you do get sick in the future.

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