Physical Activity and Exercise with Blood Flow Restriction as Medicine During the COVID-19 Pandemic and Beyond

Abstract

During the COVID-19 pandemic, physical activity levels have decreased and sitting time has increased. This is a major concern as physical inactivity increases the risk for severe COVID-19 outcomes. Evidence also indicates that COVID-19 survivors can experience reduced physical function (i.e., ability to complete daily living activities) long after acute illness. Currently, there are no evidence-based guidelines for recovering physical function following COVID-19 infection. Exercise with blood flow restriction (BFR) presents a promising rehabilitation strategy as the benefits of traditional exercise can be achieved using lower intensities. However, several barriers such as cost, access to equipment, and lack of standardized methods limit its use. The goal of this research was to promote and facilitate the use of physical activity as a critical form of medicine during the COVID-19 pandemic and beyond. With study 1, I implemented a community-based program to provide free physical activity resources to the rural Upper Peninsula during the pandemic. Physical activity was promoted through a widespread media campaign and over 260 virtual home-based workouts were delivered to community members using several platforms (i.e., Zoom, Facebook Live, YouTube, TV, DVD). With study 2, I developed a working hypothesis and theoretical framework for using BFR to help restore physical function in those individuals infected with COVID-19. Specifically, I hypothesized that passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to traditional higher intensity exercise for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. With study 3, I collected laboratory-based measures using Doppler ultrasound and anthropometric techniques in healthy adults (n=143) and applied linear regression methods to develop and validate a prediction equation for performing BFR without the need for specialized equipment. Finally, with study 4, I developed and usability tested a web-based application designed to serve as user support tool that aids physical therapists in implementing BFR. Collectively, my research addressed two major public health problems (COVID-19 and physical inactivity) and sought to enhance accessibility of physical activity and exercise with BFR during the pandemic and beyond.