Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby. And we're gonna talk about exercising and COVID. How you doing Iyad? 

Iyad: Good Mark. Thanks for doing this. 

Mark: So I'm sure you're starting to see people who've either had COVID, are still perhaps recovering from COVID and they want to get back to exercise. So how do you start diagnosing what's going on and what they can actually do and is there guidelines. 

Iyad: Yeah, so it's a newer disease, as we all know that kind of came outta the blue a couple years back. And we initially had no idea what we're dealing with. So the initial approach was in a lot of hospitals was they were treating it like any other respiratory disease and kind of seeing what sticks.

And we found that some things were pretty helpful and some things were not helpful at all. So one of the things that we found was not helpful was to push people past their, let's say, into symptoms into their threshold a little bit more. We found that they actually didn't cope so well early on. And then there's other things, for example, that we found work pretty well.

So for example, if somebody has a disrupted breathing pattern and we can kind of go over how to kind of breathe a bit more regularly for them and practice that, that seems to regulate a few things. And then the other thing also, like I said, in my last video is that there's so many symptoms that COVID has that impair your ability to exercise.

So what we're talking about today, maybe we'll focus a little more on the respiratory stuff. You know, the feelings of shortness of breath. We have a multitude of people who come in, some who come in and say, look, I got a chest x-ray and it's clear. And doesn't say that there's anything with my lungs. I just can't tolerate any exercise. I walk for a few seconds and a few minutes, and I feel like I'm just winded and feel tired. Some of them even will tell you, I feel a little bit nauseous, just because they're kind of struggling to regulate their own body when they're exercising.

And for that kind of person, we would tend to look at a few things. We'd start with just seeing how do they breathe when they're lying down, when they're sitting up, and then we get them to walk and we monitor a few things like heart rate. We can look at their oxygen saturation, which we can measure with a small pulse exhibitor.

And usually most people have tried to do their own research on that. And they'll try to buy one in the pharmacy, which is great. And then they say, yeah, it stays at 98%, which is awesome. It means you're not, you know, your blood oxygen levels and dropping, but yeah, we tend to look at that. And then what we'll try to do is also figure out what's the number that they can exercise in safely. What's the speed. What's maybe the pace. And for some people who don't like tracking that stuff, we can just kind of go over an exertion level. We'll give them like, okay, you can actually do pretty well at maybe for example, 2 out of 10 level of exertion. So we're gonna just try to build them a program around that.

Breathing exercises seems to help a lot in this population. And one of the dysfunctions you could see is some people will tell you, they feel like the upper part of their neck and chest gets really tight from their breathing. And it's because they're trying to focus the breathing in the top part, maybe a bit more.

So if you imagine using only part of your ability to breathe and not the full capacity of your lungs to kind of expand, I could see why you would get tiring, just to breathe. Because you'd be breathing a lot harder to just try to get that same kind of volume in. So yeah, we'd want to assess that for sure.

And we would kind of then give them a program of different types of breathing and sometimes, it's still a sense of panic when you feel like you're losing air. I'm sure like a lot of us have had this kind of feeling of being winded and it's not really a comfortable one psychologically.

So some of the exercises are to also improve their ability to just kind of tolerate that kind of slow down their breath a bit more instead of hyperventilating and doing these shallow, rapid breaths. So yeah, we, we kind of work a lot more on that. And then also try to build a safe aerobic program that they can kind of start at because it's tough when you're just guessing every time.

Sometimes you walk two blocks and sometimes you walk 10 and then you're kind of tired afterwards and you're feeling a little nauseous or maybe some other symptoms. So it's a bit easier when we take the guesswork out. 

Mark: So what's happening is that people are feeling that when they have COVID, when they're in the actual disease and they learn to try and deal with it in a way where they restrict their breathing. They don't expand their lungs as much as normal. And so then they get into a habit where now they're kind of not breathing properly anymore after they're better. And they need to retrain theirselves. Kind of like we have to retrain after an injury, if we've had an ankle injury or whatever, is this something similar?

Iyad: That's potentially one of the things that happens, we actually don't know. This is the interesting part. Now there are cases where you actually have findings on a chest x-ray, like if you do a chest x-ray and you see that the lung has actually been affected. And then that could actually impair the lung's ability to behave like its elastic kind of self. Where it can actually inflate and recoil. And you might lose a bit of the recoil sometimes. Or in some conditions you can't inflate as much.

So it's so variable person to person. Luckily, we're not seeing as much of that these days, which is good, but we still are seeing some of them just because it's spreading at such a fast rate. That even if the percentage is small, we're still seeing that. But you can imagine for that person who, for example, literally could not expand their lung the normal way because of potentially some the disease process going on. You will have to find another way to do it. You have no option, but to get some oxygen in to kind of go day to day. 

So it could be that. It could be a learned behaviour. It could be also a sign of the disease or probably a mix of the two. We actually don't know why this happens still. I can't tell you the, the cause. So we can't really like pinpoint that, but I mean, they seem to do pretty well with breathing exercises.

Even the World Health Organizations rehabilitation guidelines include breathing exercises. And they also include certain. Things that we will teach our patients. And this is something we teach everybody on the first session is what they call the rescue position. So if you're feeling really short of breath and you're feeling like you know, there's a bit of respiratory distress going on, there's certain positions that can actually help control about a bit more. And this is something that's really powerful to teach someone. 

They're freely available on the World Health Organization's website in their rehabilitation guideline. But most people won't think of looking at, and we will definitely be like one of the first things that we go over with them. And just teach them about, well, this is actually, it's gonna happen and especially in the first few days, as they try to do this and try to kind of expose themselves a bit more of that. And we will teach them how to control that, because it's really, really powerful for them to have at least a bit of symptom management, let's say. Because that's a really awful symptom to feel like you're gasping for air.

Mark: Yeah. So what should someone not do? 

Iyad: One of the things that we don't think helps so much is pushing really, really hard, really, really fast. And this is when it comes back to guesswork and we find it really valuable in these cases, especially when people don't recover the way they think it's gonna be, two weeks and it's gone.

Actually how much they're doing and to monitor their symptoms and according to how much exercise they did and to see how long it takes for them to recover. That's a really useful thing to do. What you shouldn't do is just to try to go arbitrarily and just say, I'm gonna go to kind of end of my fatigue limit and things like that right away.

We don't think that seems to help so much. Some people and the jury's still out, if it actually can affect you negatively. Some people say it does. There are reports of that happening where people actually don't do well after really, really heavy exertion. And then, there's always the person who likes to wait and see, and that's perfectly fine.

But the population we will see and that's from a younger 20 year old, all the way up to a senior who likes to just get moving and get walking and do their social interactions with their friends. We want to get them back as soon as possible, safe as possible. So that's really the kind of person that we tend to help. Instead of somebody who's just for example, would say, oh, it's gonna be fine. I'm gonna just wait it out. Which could help a lot of people too, because you know, our body has a great ability to heal. 

Natural history can be a factor here, but yeah, it all depends on how you're responding and what you're, I guess motivation is, if you just want to get out and exercise earlier, then you would want to get some exercise guidelines from one of us. 

Mark: So softly, softly on your recovery, in a way. Breathing exercises of some kind, I would assume belly breathing. 

Iyad: That's one of them. Yeah. But that's not the only thing that they could do. Some people belly breathe well and they don't breathe well, for example, from other areas. So like there's different versions of breathing that we would just, again, we just see what's happening there and what's not happening there. And the funny thing is you could breathe really well on the bed and then you go for a walk and all of a sudden it changes. So then it would be actually breathing exercise with movement a bit more. 

Mark: Perfect. And basically get some expert help so, you know what's going on while you're tracking your progress rather than just experimenting because you can cause yourself some injury and that might be permanent. Is that fair?

Iyad: I don't think we could say that confidently. I don't want to scare people in that sense, but I think you could definitely just make it longer. You can just prolong the process by guessing so much. So we would be able to even identify certain things that often, if there's something that's not quite right, we would flag it up and pass it on to our medical colleagues for further assessment. And this is, again, some things that people just aren't aware of, because it's hard for you to kind of figure out what's going on with your body sometimes.

So. Yeah, that's what we tend to look at more. We want to see is this safe for you? That's our first priority. Always, obviously. Can I get you safely doing something? And can we progressively do this in a way that doesn't necessarily have a yo-yo effect where you're a good one day and down the other day and good one day and down the other day.

Again, we can't say anything about long term damage and any of that stuff, because we just don't know if that's actually how it happens. I think that'd be a bit too simple of an answer. 

Mark: Perfect. So if you've had COVID and you want to start getting back to exercise, but you want to do it safely. The guys to see are Insync Physio in North Burnaby, you can book online or you can give them a call. Thanks, Iyad. 

Iyad: Thank you.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby. We're gonna talk about a really relevant, timely thing, exercise after COVID. How you doing Iyad? 

Iyad: Good Mark. How are you today? 

Mark: I'm good. So my wife had COVID when she should go back to exercising.

Iyad: That's a great question. It's something that we kind of we’re learning on the go because of how new this disease is. And, you know, we thought we could maybe extrapolate from previous diseases like that. We used to do, for example, like with the flu and with the common cold and other respiratory viruses.

But one of the things that's really interesting is, it seems that we can probably start exercise soon, within a few days after the majority of the major symptoms settled down. But the exercise parameters are not well understood. Like, so for example, we can't just say, oh, you're day five here, go do this thing. Pass a handout to the general population, because everybody seems to be very different. 

So the way we are kind of doing this now, we're realizing at first was when we tell people to push into symptoms and push into their exertion, is that they actually would have contrasting reactions. So some people would actually get a bit worse and some people responded well.

So general idea now is you should kind of do a little sub-threshold exercise in the early days. So don't go into those symptoms where your heart rate's racing, or you're hitting that shortness of breath in the first few days. And that's kind of something that we're starting to see more and more of in the clinic. And the interesting part is I haven't seen two people that present it the same way.

Mark: So it's very individual. I guess it depends on a myriad of factors depending on, you know, what your original fitness level was or who knows, I mean, it hits everyone. Even really well trained athletes sometimes get pretty severe symptoms. 

Iyad: Yeah. And that's really significant actually to note. Everybody's symptoms have been so different. So you have people who say, oh, I had a lot of headaches and kind of fogginess and maybe some kind of nausea with different movements. Some people have developed heart related symptoms. So like a popular example is Alfonso Davies, a soccer player had inflammation of the heart muscle tissue, which again, it happened. It's not luckily as common as we hear about it, which is good. So that's a cardiac symptom. And then you have the common one, which is the shortness of breath where people feel like they just can't inhale and exhale properly. 

So depending on what presents to us, we basically would do an assessment of just very basic things. Like, you know, some breathing assessments. We do an exercise tolerance test where we monitor the heart rate, we would monitor a few things. And then depending on the impairment, for example, if you have some respiratory kind of issues, we would start everybody almost on a breathing program.

And it sounds kind of funny. You almost have to relearn how to breathe again. And that's something that we've seen work really well for a lot of people. And it's not too different from other respiratory conditions where we find breathing exercises to be very helpful. And then some people will need a prescribed walking program where they stay within a certain heart rate or a certain exertion level.

And that's something that we would determine just from the, you know, we get you to do this kind of think of like a exercise test. And then we kind of adjust the parameters according to that. And then sometimes, you know, in cases where there's something a little more severe, we would want some medical intervention there.

We had one person in the clinic where we needed to work closely with the cardiologist office to make sure that they're safe to just move and walk and get their heart rate up a bit. So, and again, it's so different person to person and that's kind of what makes it, I'm sure hard for a lot of people to self-manage and you know, like even us healthcare professionals, we're trying to kind of learn about this thing every day and just trying to do the best. But yeah, that's why we can't just make these concrete statements say everybody should be doing X, Y, or Z, because it seems to vary a lot between the people.

Mark: So you mentioned something earlier as well. When we were talking prior to recording where you had COVID and in your recovery process, it was a little bit problematic for you. What was that like? 

Iyad: Yeah. So for example I had no symptoms at rest, but one of the things that we noticed is with a bit of activity, I would get different responses. So it'd be like a bit of you know, shortness of breath sometimes, or sometimes you'd feel like a little dazed, but generally that seems to have improved pretty well with just a gradual program. But that's the piece where it's so different again. So I've had lots of people who just their primary symptom is just respiratory.

And that's basically the only thing they have. Is they just have shortness of breath and then it takes them a while to kind of settle that kind of sensation that they're gasping for air afterwards. So really, really depends. And one of the things we obviously want to make sure when we are getting people to exercise, is they're staying safe, for example. Like we monitor things like blood oxygen level. 

And this is something you could just do with a pulse oximeter from the pharmacy where you just kind of see, are you actually losing oxygenation in your blood, because then it's a different story. And obviously the exercise guidelines would change significantly and we'd want to work pretty closely with our medical colleagues for some of those cases.

But, yeah it's just so different person to person. And this is, again, I want to stress that it's not the same when we're talking about with cases of long COVID, which tend to be a little different and we could probably do two hours on that thing, because it's not the same. Long COVID is we're learning more and more about it, but it's not the same as recovering from an acute infection.

Mark: Thanks Iyad. So if you are looking for some great support in recovering from your COVID experience and it's still happening folks. I was out yesterday, I was the only one wearing a mask in all the stores I went into. And there's another wave happening. I mean, we can be tired. The COVID ain't tired. It keeps doing stuff. It's still there. If you need help with your recovery, with getting back into exercise, with doing it smart and safe and in a way that increases your abilities and brings them back, the guys to see are Insync Physio. Insyncphysio.com is the place to book or you can call them at (604) 566-9716 in Vancouver. Or in North Burnaby (604) 298-4878. Again thanks Iyad. 

Iyad: Thank you.

Kayaking can be an excellent form of exercise that’s also fun to do during the summer. As a seemingly low impact activity, it can actually improve your aerobic fitness, strength, flexibility, as well as balance. Along with this, studies have shown that kayaking also leads to stress reduction, as well as an improvement in mental health.

But like any other activity, there are precautions and it is always smart to warm up before exercising.

Take a look at a few of our paddling warm up stretching videos below!

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

As summer approaches, one of the best places to exercise is the beach. Not only do you get a beautiful view, but working out on the sand also allows for a challenge due to sand plyometrics. Sand plyometrics has been proven to increase performance in regards to strength.

A study by Arazi, Mohammadi and Asadi (2014) was conducted on 14 men comparing the effects of plyometric training on sand versus land surfaces. Both groups showed significant improvements in the vertical jump and standing long jump test.

Another study by Binnie et al., (2014) comparing the effects of sand versus grass training on ten elite athletes demonstrated that there were significantly higher heart rates present and rating of perceived exertion in the sand training sessions. There were also no differences in their post exercise performance, no indication of further muscle damage, and rates of inflammation were similar between each surface. The results suggest that performing conditioning sessions on sand rather than grass can result in a greater physiological response without adding any additional damage to the performance during the next day.

To conclude, both studies demonstrate that sand training can offer a higher energy cost and lower impact-training stimulus when compared to a firmer training venue such as grass. If you’re hoping to get more out of your workouts or training sessions, try it out at your next session!

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Resistance bands are cheap, portable, and versatile. With a simple resistance band, you can easily do a full body workout. Here are some exercises for the lower body. 

Supinated Clamshell
Loop a band around your legs just above your knees. Lie on your back with hips and knees flexed to 90 degrees. Pull the knees apart while contracting your glutes and hold the position for a few seconds. Slowly return to starting position and repeat.

Knee Raises
Loop a band between the middle of your foot, and hold the band with one foot while lifting the other. Keeping your foot flexed, raise your knee up to hip level, making sure the band is still looped across the top of the raised foot. Pause at the top, and lower your leg back down to starting position. Repeat on the other side. 

Lateral Band Walk
Place feet shoulder-width apart to create tension on the band. From a half-squat position, take small steps from side to side, while keeping the band taught. 

Glute Bridge
Tie a band around your legs right above your knees. Lie on your back with your feet on the floor, bending your knees to 90 degrees. Lift your hips until your shoulders, hips and knees align, contracting your glutes through the entire movement. Increase the difficulty of this movement by repeating the movement on one leg, while sticking the other one straight out.

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Extended durations on cramped, uncomfortable seats for hours can cause your body to become stiff and sore. These discrete simple stretches and exercises can help travellers reach their destination pain-free, while encouraging blood circulation throughout the body. 

Seated
Seated Spinal Twists – Sitting tall, grab onto the arm rests of your seat and twist your torso from one side to the other.

Neck Rolls – slowly twist your neck from side to side, and up and down. Then bring your left ear to your left shoulder, and repeat on the other side. Finally, tuck your chin down to your chest and repeat the steps until you feel the tension release from your neck. 

Shoulder Rolls – sit in a relaxed position with your arms by your sides. Roll your shoulders both forward and backwards.

Ankle Circles – lift your feet off the ground and roll your ankles in a circle.

Standing
Calf Raises – stand with your feet a couple inches apart and raise your heels so you’re on your toes. Hold this position for a few seconds before lowering back down. You should focus on stretching out your calves. 

Quad Stretches – In a standing position, bend your knee, grab your ankle and pull it behind your back. 

Pec Stretch – place your hand on a wall with your elbow at chest height. Rotate your body away to stretch out your shoulder. Repeat on the other side. 

In addition to these stretches, don’t forget to take the opportunity to walk around every few hours to get your blood circulating throughout your body. 

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

This exercise is deceptively simple. It is called the one legged squat and the key of the exercise is, you want to keep the knee in alignment, don’t let it wobble back and forth. And as you keep the knee in alignment, you also want to make sure you engage the core as you squat down you want to bring the buttocks backwards so the centre of gravity is back, and as you squat down, you want to keep the knee over ankle - not over your toes. And you’re going to repeat three sets of ten. As you master that then you’re going to add a more difficult component - the hop. Now all this as you can see is using a red resistance band and as you do the hop you want to make sure you keep the alignment the same as you were doing before with just the squat. You’re also going to do three sets of ten.