Covid-19 is becoming a chronic disease due to the large number of patients presenting cardio-respiratory, neuro-muscular or even psychological sequelae due to the Sars-Cov-2 virus.
The objective of therapeutic physical activity, after the rehabilitation sessions, is to improve the clinical condition and the long-term development by optimizing cardio-respiratory and motor capacities.

The number of patients concerned changes depending on the extent of the different waves of contamination, but it can be estimated that more than 300,000 patients will have sequelae that meet the conditions for dispensing physical activity for therapeutic purposes.

The patients concerned represent the cohort of people affected by severe forms of Covid, often with invasive mechanical ventilation (men> 60 years old, smokers, obese, diabetics and non-athletes) but also paradoxically patients who have developed a form without hospitalization.

The obvious
There is no certainty that we can offer a precise decision tree, but Covid-19 often causes fatigue which can cause real physical deconditioning and a fragile psychological state, this finding justifies the dispensation of physical activity for therapeutic purposes in the post-Covid period.

“Prescribing physical activity does not prejudge its reimbursement by health insurance, even if physical activity is now considered a therapy in its own right.”

Prescribing physical activity during a consultation by the attending physician has a demonstrated impact on compliance.

The priority is the support of the target population and the patients concerned

Motivation is one of the fundamental parameters for the success of the process and for adherence to the care.
A demotivated patient is unlikely to achieve the goal jointly set with the doctor.
Motivation is not a static trait but is a dynamic and fluctuating variable. It is generated and maintained under certain conditions and is dependent on the attitude of the doctor.
Motivational interviewing is the foundation for success.

The essential points
Covid-19 is a new disease in which lung damage causes respiratory failure, but cardiac damage associated with coagulation disorders has been found.
The sequelae of hospitalizations and in particular of mechanical ventilation under artificial comas are classic with sarcopenia, vestibular and cognitive disorders and neuromuscular sequelae.
Post-care often involves stays in a re-education and rehabilitation center and then by offering suitable physical activities for therapeutic purposes for a very variable and possibly long duration.

Technical points
The targets of the proposed physical activity are adaptive cardio-respiratory comfort, gain in VO2Max, posture, muscle strengthening, autonomous mobility … the return to a minimum of the state of form prior to the disease.
Evaluate the sequelae of severe forms and the limitation of active mobility with the 6-minute walk test in order to set credible and achievable goals and then propose the counting of steps or activity times.

FOCUS: patient infected with the Sars-Cov-2 virus and suffering from cancer
Studies show an increased risk of mortality compared to the general population with an increased risk for lung cancer. If these patients should benefit from specialized care in order to limit the increased risk of death, it is obvious that post-crisis care will initially be versatile between the oncology and functional rehabilitation teams. Then the relay will be made with health professionals before treatment by a health sport player trained for cancer (Cami sport and cancer or holder of a specific DU).