Providing medical care for patients at the frontline can be physically demanding. Exercise is an important part of a routine that can help mitigate the physiologic stressors that come with providing care at the frontline, but in the setting of decreased time and space, providers may have difficulty developing new routines. We worked with a physiotherapist to create an exercise regimen for frontline providers that requires little space, little time, and can still help keep us healthy in the face of an ever more challenging work environment.

During the COVID-19 pandemic, frontline providers have faced an increase in the number of critical patients and procedures, increasing work hours, and tighter call rotations due to sick or quarantined colleagues. Providers may find themselves more prone to injury at a time when their presence is needed more than ever.

Regular exercise may help limit the effects of the stressors inherent to providing care at the frontline. It can help reduce stress and treat and prevent depression [1,2]. Physicians, residents, and medical students who participate in regular exercise are sick less frequently and are better equipped to handle the stress of their schedules [3]. Irregular schedule changes and can affect sleep, but exercise is one of the few interventions shown to improve rejuvenative sleep [4].

The odd hours and tight schedules now becoming normal for many frontline providers can limit the ability to get the recommended 150 minutes per week of moderate-intensity aerobic exercise ideal for overall health. However, just 75 minutes per week of high-intensity training has been shown to have similar benefits [5]. What is more, as some frontline providers have found themselves living in isolation to protect their friends and family, sleeping in garages or basements, finding space to exercise can be more difficult than ever.

With that in mind, Ron Mikos worked with us to adapt a successful HIIT workout focusing on the muscle groups frontline providers may expect to use the most. This workout is designed to be completed without weights in an area the size of a yoga mat.

9-Minute Workout:

  1. Perform “Set A” exercises from left to right
  2. Rest 1 minute
  3. Perform “Set B” exercises from left to right
  4. Total of 9 minutes

 

Muscle GroupClinical CorrelateSet A Set B
ChestCPRSpiderman push up
30 seconds		Close grip (diamond) push up
30 seconds
CoreStandingV-Up
30 seconds		Saw plank (on elbow)
30 seconds
ShoulderIntubatingDive-bomb push-up
30 seconds		Archer push-up
30 seconds
LegsLifting and runningSeesaw lunge
30 seconds per leg, 1 minute total 		Squat (hold) and Squat (pulse)
30 seconds each, 1 minute total
BackProceduresStar plank (on hands)
30 seconds		Alternate Supermans
30 seconds
ArmReductionsDoorway bicep curl
30 seconds per arm, 1 minute total 		Tricep extension (start on elbow plank position)
30 seconds

Click on the images above for videos of specific exercises. If you prefer to watch a continuous video:

Modifications: If this workout seems too hard, all push-ups can be performed on the knees. If it seems too easy, add 15 seconds to each exercise. If that’s not enough, add 15 more.

Pearl: If you find yourself needing a little inspiration, uptempo songs can help improve your HIIT workout [6]. But since frontline providers ALSO need to keep rhythm during, say CPR, here’s the “Songs to do CPR to” playlist from NY Presbyterian Hospital.

For more exercises like this, visit the New York Times Well section. If you want more wellness tips and tricks, check out our Healthy in EM series.

References:

  1. Salmon, P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin. Psychol. Rev. 2001;21:33–61. PMID: 11148895
  2. Mead, G. E. et al. Exercise for depression. Cochrane Database Syst. Rev. 2013 Sep 12;(9):CD004366. PMID: 19588354
  3. Williams, A. S. et al. Understanding the Exercise Habits of Residents and Attending Physicians. Fam. Med. 2015;47:118–123. PMID: 25646983
  4. Brand, S. et al. High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls. J. Adolesc. Health 2010;46:133–141. PMID: 20113919
  5. Løppenthin, K. et al. Effect of intermittent aerobic exercise on sleep quality and sleep disturbances in patients with rheumatoid arthritis – design of a randomized controlled trial. BMC Musculoskelet. Disord. 2014;15:49. PMID: 24559487
  6. Stork, M. J., Karageorghis, C. I. & Martin Ginis, K. A. Let’s Go: Psychological, psychophysical, and physiological effects of music during sprint interval exercise. Psychol. Sport Exerc. 2019;45:101547. https://doi.org/10.1016/j.psychsport.2019.101547
Christian Rose, MD

Christian Rose, MD

Clinical Informatics Fellow
Stanford University;
Emergency Physician, Kaiser Permanente
Ronald A Mikos Jr, CSCS NC

Ronald A Mikos Jr, CSCS NC

Strength & Conditioning Coach
Active Care Sports Performance & Orthopedic Rehabilitation
Nutrition Consultant, Bauman College, Berkeley, CA
Farm Educator, Giltract farm (U.C Berkeley), Berkeley, CA
Ronald A Mikos Jr, CSCS NC

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Contessa Gayles

Contessa Gayles

Filmmaker
Cocomotion Pictures
Contessa Gayles

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Tomás Díaz, MD

Tomás Díaz, MD

Education Fellow
Department of Emergency Medicine, UCSF
Tomás Díaz, MD

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