Post-Covid exercises ask for a visit to the cardiologist, doctors recommend

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Before resuming the gym, running or even exercises with less impact, experts suggest that practitioners of physical and sports activities who have had Covid-19 undergo a cardiological evaluation called APP (pre-participation evaluation). The rule is independent of performance or activity level.

According to Agnaldo Piscopo, director of the Cardiovascular Emergency Training Center at Socesp (São Paulo State Cardiology Society), the disease may have generated cardiovascular sequelae (symptomatic or not). Even those who had mild or moderate disease are recommended to undergo evaluation.

This is the case of myocarditis, an inflammation of the heart. The disease, which can be silent, leads to acute heart failure. The main symptoms are shortness of breath and easy tiredness.

“We have found a large number of patients who had Covid and presented an inexplicable tiredness. When they go to the office, they are facing heart failure due to myocarditis. Affected by Covid-19 are also more likely to develop arrhythmias, heart failure , in addition to an increased risk of coronary artery disease,” explains Piscopo.

According to cardiologist and intensivist Gustavo Eder Sales, chief coordinator of the ICU (intensive care unit) at Hospital Albert Sabin, in addition to myocarditis, many patients had arrhythmia after infection with the coronavirus. The disorder can also be asymptomatic.

“During the effort in physical activity, the person may need the heart more and have a complication. Not every arrhythmia causes sudden death, but it can bring complications. As the muscle beats out of step, it loses function and becomes more dilated. arrhythmia. It’s like a vicious circle”, explains Sales.

Another possibility is the occurrence of a stroke (Cerebral Vascular Accident). “As the heart doesn’t beat properly, it forms clots that can go to another part of the body”, completes Sales.

According to Piscopo, the first step is to undergo an anamnesis, which can be done by a general practitioner or cardiologist. Afterwards, the patient must undergo a clinical cardiological examination.

During the investigation, it is important to check for signs of heart failure, such as swelling of the lower limbs, tiredness and shortness of breath when making small or medium efforts or progressive efforts.

The list of recommended tests includes cardiac auscultation, electrocardiogram, echocardiogram —if there is any suspicion of heart disease— and stress test. People with suspected myocarditis should also have an MRI of the heart.

Even with heart health up to date, the return to activities should be progressive and with lighter loads.

“Before returning to the gym, running or walking, ask yourself: am I okay to get back to the physical activity I’ve always done?” says Piscopo.

For businesswoman Andréa Bulbarelli, 52, who lives in Ipiranga (South of the capital), the answer is yes. Physical activity had been part of her life since before the pandemic.

“I’ve never stood still for long periods, but I’ve never been a card-carrying athlete either. I like to vary my workouts. I’ve done dancing and loved it, I like yoga and walking around the neighborhood,” she says.

Before the pandemic, she practiced yoga, weight training and aerobics. With the arrival of Covid, she stopped exercising. At the time, the rapid transmission of the coronavirus forced the state government to adopt restrictive measures. The gyms were closed for months.

In May 2021, Andrea’s blood pressure decompensated. Worried, she went to the cardiologist, had the requested tests and was diagnosed with anxiety. Two months later, she started to practice street running.

In January 2022, Andrea caught Covid-19. The fact that she had three doses of the vaccine in her arm made for a quick recovery. In 14 days she was cured and back to running. Currently, she divides the five days a week between running and muscle-strengthening training. “My idea is to participate in the [Corrida de] São Silvestre at the end of the year”, he says.

In the post Covid, Andréa did not return to the cardiologist. She considered the diagnosis from months ago. “I don’t have any heart problems. The doctor made some recommendations and said that sport should be part of my life”, she says.

For Páblius Staduto Braga, a specialist in sports medicine at the SBMEE (Brazilian Society of Exercise and Sport Medicine) and the Brazilian Medical Association, walking and cycling without reaching high levels of fatigue and exhaustion are activities indicated for the resumption of physical activity. .

He draws attention to the care that one must have with the race, if it has never been practiced. For beginners, the ideal is to alternate walking and small trots. Opt for short distances. “Running is slimming, but if you’ve never done it, don’t just run away.”

“Even if you don’t have a heart problem, going over the limit can cause illness and injury,” says Braga.

Another important alert is for possible diseases that the person may have acquired without knowing it during the time they were sedentary, such as hypertension. It makes all the difference for the body to exercise frequently and then stop suddenly.

“People want well-being, to do activities that provide pleasure and good experiences, but without limits. Be careful. Pay attention to your body, to accentuated tiredness, and to symptoms that you didn’t have before. Appreciate the pain. If you feel it, look for an expert immediately. Sometimes, it’s better to take a step back and go back little by little than to go over the limit and have problems later on”, guides Braga.

“It’s worth the alert: respect your body, what you treat and the symptoms you didn’t know.”

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