BRINGING SCIENCE TO TREATMENT

Supporting the health of the healthcare worker

In the second article of a three-part series focusing on the widespread coronavirus, Trevor Langford covers the topic of caring for the healthcare worker. The strategies clinicians recommend for athletes to optimize health and wellbeing, are often forgotten when it comes to their own health. In this article, he explains how to maximize exercise and sleep to support immune function and overall health during times of stress.

With the world in lockdown amid the COVID-19 pandemic, people are trying to live as normally as possible. However, the current situation is anything but normal, and the change in routine is disturbing physically, emotionally, financially, and, of course, occupationally. With many healthcare workers serving on the frontline within hospital systems and other clinicians operating by video appointments, today’s daily stresses are far from typical. The term healthcare worker covers all roles from doctors, physiotherapists, conditioning coaches, ancillary healthcare providers, and support staff. To ensure athletes and patients are well cared for when recovering from injury or maintaining their physical condition, practitioners must be at the top of their game. Yet, changes in daily routines, time spent in different postures due to video conferencing, and irregular eating habits developed while at home all day can have a profound effect on their health status.

Exercise                  

Exercise has a great capacity to improve health and prevent illness. An appropriately graded physical activity program can manage pre-existing medical conditions, reduce the risk of disease, and maintain mental wellbeing. The UK Government currently recommends that adults should aim to do something physically active every day with 150 minutes of moderate activity per week or 75 minutes of vigorous exercise per week(1). While many will do more than this, some will miss the mark, perhaps due to time constraints, mental or physical fatigue for work, or simply a lack of desire to exercise.

Exercise can take on many forms, such as a circuit-based session (see the previous article on the creative use of home equipment), a run, cycle, or walk based on the current social restrictions. Adults should aim to minimize periods of inactivity by doing something active around the home, such as gardening, as light exercise. Other indoor activities include jump roping, timed stair climbing, and video exercise classes. Include resistance training activities such as yard work, cleaning out the garage or attic, as well as traditional weighted exercises using bands, dumbbells, jugs, or buckets filled with water or sand.

If you have the freedom to exercise outdoors, you should take advantage of the many benefits of outdoor exercise. Exercising in green spaces, such as parks and forest trails, is beneficial to all age groups and can reduce stress, symptoms of depression, and blood pressure while increasing self-esteem, mood, and overall wellbeing(2). Green spaces not only allow for physical activity but also offer social engagement.  They are more salutogenic, by promoting wellness and decreasing stress, than exercising in confined indoor spaces(3). Current guidelines require social distancing of two meters (six feet) at all times with limited social engagement. This distancing is easier to maintain in open outdoor areas, while still allowing social interaction through greetings and brief conversation. Sometimes just getting a smile and a wave from a neighbor can lift one’s spirits. Green open spaces also provide exposure to micro-organisms and bacteria, which are important for developing the immune system and regulating inflammatory responses(3).

Exercise can have both positive and negative effects on immunity depending on the type, duration, and intensity(4). Long duration events, such as marathons, can depress the immune system’s response and lead to an increased risk of upper respiratory tract infection (URTI)(4). Moderate activity results in a low risk of URTI compared to sedentary or strenuous exercise, which both increase the risk (see figure 1)(4). Post-exercise immune function is impaired when training is continuous, greater than 90 minutes in duration, of moderate to high intensity, 70%-77% of VO2 max, and carried out without nutrient supplementation(4). Following intense exercise, there is a period, referred to as an open window, during which the immune response is blunted and viruses and bacteria can take a foothold(4). This open window is between three and seventy-two hours(4). Therefore, regular moderate exercise is the best way to gain the benefits of exercise without impairing the immune system.

Figure 1:  J shaped curve showing the increased risk of upper respiratory tract infection following high-intensity exercise(4).


 Sleep

Health concerns, financial strains, or worries about loved ones during this time of global lockdown have the potential to disrupt sleep patterns. In addition, the changes in home life and work routines can alter circadian rhythms. Impaired sleep patterns correlate with hypertension, obesity, type 2 diabetes, impaired immune function, cardiovascular disease, and mood disorders(5). Sleep is critical for clear thinking, alertness, and the regulation of emotional states(5). Sleep deficits that occur over some time can affect our psychological wellbeing and alter our perception of events, leading to increased stress levels(5). It is common during periods of high stress to experience insomnia, vivid and disturbing dreams, or tiredness despite sleeping more than usual.

Researchers from the University of Monash, Australia, produced a helpful guide for people to regulate their sleep patterns during the COVID-19 crisis(6). They focus on two categories: supporting the body clock with the maintenance of daily rhythms and preventing and managing signs of insomnia (see figure 2). Environmental, biological, and social factors regulate sleep(6). Natural daylight helps differentiate between night and day and regulates meal times, working schedules, exercise, and social calendars. Those who stay indoors for extended periods lose the ability to differentiate between these cues. Therefore, attention to sleep hygiene is just as important as oral and physical hygiene.

Figure 2: Guidelines adapted from the Sleep Research Society on how to manage your sleep during home isolation(6).

Supporting your circadian rhythms (your internal body clock)

  • Get out of bed at the same time each day – This time is referred to as an anchor of the day and helps to set routine for the whole day.
  • Get daylight into your eyes as early as possible – Circadian rhythms (the internal body clock) are regulated by sunlight.
  • Interact with others early in the day – Aim to do this as soon as possible by phone or video.
  • Eat at regular meal times (especially breakfast) – This helps to maintain a steady internal body clock.
  • Exercise frequently and at usual times of the day. If your job has you chained to the computer, set an alarm to remind yourself to get up and walk around the house for a few minutes every hour.
  • Stop all blue light activity (smartphones and tablets) one to two hours before bed – A dark environment allows your body to produce melatonin and prepares your body for sleep. 

Preventing and managing insomnia

 How to respond to a bad night’s sleep:

  • After a poor night’s sleep still get up at the same time – sleeping longer after a bad night can affect the body’s natural clock and the ability to settle later that night.
  • Go to bed the following evening at your normal time, although you may feel the need to go to bed earlier – If you go to bed too early, you may find yourself waking during the night and then struggling to sleep again.
  • Keep moving throughout the day and avoid sleeping during the day – If you are too tired, try to limit it to a power nap of 10-20 minutes if possible.
  • Try not to worry about sleeping – try to avoid letting sleep thoughts enter your head, as anxious thoughts of, “How am I going to get to sleep?” will make it harder to get to sleep.
  • Your body’s got this – Don’t get anxious and worry you’ll never sleep again. Give your body a break – it’s doing the best it can under less than ideal conditions. When you relax about sleeping, chances are, your body will too. 

What to do when you can’t sleep:

  • If you can’t sleep, then stop trying to sleep – Doing something quiet such as reading a book (not a tablet) or listening to an audiobook is a productive way of allowing your body to rest until you feel tired again. Sometimes just getting out of bed for a cup of warm milk and honey will reset your body enough to allow you to fall asleep a bit later.
  • Focus on getting yourself into a relaxed state of mind – Shift your focus from sleep to rest. Even if you’re not sleeping, allow your body to rest and relax. Practice some meditation during this time and you will feel rejuvenated.

Healthy habits to improve sleep quality

  • Go to bed at your usual bedtime – as your alertness reduces.
  • If you are wide awake or distressed, get yourself into a more relaxed mental state before attempting to sleep.
  • Keep the bed for sleeping and not for home working on a laptop or eating – It’s important to allow your brain to differentiate between its time to sleep and when it isn’t.
  • Avoid caffeine six hours before sleep.
  • Avoid cigarettes as they are stimulant and will promote alertness.
  • Alcohol, while appearing to help you get to sleep, actually disrupts sleep later in the night.

 Conclusion

Ensuring the health of healthcare workers is as optimal as possible during home isolation is essential. Exercise is vital to maintaining both physical and mental wellbeing. However, high-intensity exercise (70-77% VO2 max) for longer than 90 minutes duration can suppress immune function and leave athletes and healthcare workers more vulnerable to viruses. Sleep is also essential to wellbeing. Maintaining good sleep hygiene and respecting circadian rhythms help healthcare workers to think clearly and have the energy to care for those who need them. Taking care of the caregiver, especially during this stressful time, is crucial for returning everyone to good health. Therefore, if you are a healthcare worker or support staff member, don’t forget to keep your own health a top priority. We care about you so make time to sleep, exercise, and eat well!

References

  1. UK GOV, Sept, 2019 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf
  2. J. Environ. Res. Public Health 2020, 17, 1526.
  3. Environmental Res, 2018, 166, 628-637.
  4. ASPETAR Sports Medicine J, Aug, 2015, 2, 306-312.
  5. PT, Dec, 2018, 43, 12, 758763.
  6. Sleep Research Soc, Mar, 2020. https://www.sleepresearchsociety.org/sleeping-tips-when-staying-indoors-during-isolation-period/
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