#MSCOVID19: round 2


Barts-MS rose-tinted-odometer: ★

Every now again it is worth covering a topic that is important for people living with MS (pwMS) a second time. Today’s topic is COVID-19 prehabilitation.

Today when I got on the  London Underground to come to work the carriages were ~75% full, i.e. very few empty seats and not much standing room. In other words, adequate social distancing was not possible. This was at 7.05 am, which means it will only be getting worse as we head to peak time. In an attempt to get the economy back on its feet and society working the government is encouraging people back to work, which is why we are seeing a second surge in COVID-19. The difference this time is the demographic is different. The average age of those with COVID-19 is younger and hence fewer people are needing hospitalisation and intensive care admission. However, this is likely to change as more and more people come down with COVID-19 in the next wave of infections. 

I sincerely hope that you are doing everything you can do to prepare for when you get COVID-19?

In the event of you getting severe COVID-19, there are a lot of things you can do to maximise your chances of surviving the infection and its immune complications. Prehabilitation is the term I have used to describe this programme. 

The following is a list of things I recommend you do:

  1. Smoker? If you are a smoker stop smoking. 
  2. If you have comorbidities make sure their management is optimised.
  3. Hypertension? Check your blood pressure yourself. If it is high see your GP. If you have established hypertension make sure your medications have been adjusted to render you normotensive.
  4. Diabetic? Make sure you adhere to your diabetic medication and be extra-vigilant with your glucose monitoring. You may need to check in with your diabetic nurse or diabetologist for advice if your blood glucose levels are all over the place. 
  5. Obese? Maybe it is time to get back on that diet and lose some weight? I would recommend looking into intermittent fasting and avoiding processed and ultra-processed foods. There are no magic diets. You need to find one that is suitable for your lifestyle, culture and metabolism. 
  6. Alcohol misuse? If you drink more than the national guidelines try and cut back on your excessive drinking? If you have a drinking problem and need help please speak to your GP. 
  7. Asthmatic? How is your asthma control? If you have bronchospasm you may need to get your meds/inhalers changed. You don’t want to have poorly controlled asthma when you get COVID-19. 
  8. Sleep-deprived or sleep disorders? It is important you optimise the amount of sleep you are getting. Sleep deprivation is associated with multiple poor health outcomes. PwMS are more likely than the general population to have a sleep disorder. If you use sedatives to sleep you may want to try and wean these as they can affect respiratory function if and when you get COVID-19.
  9. Exercise? There is no doubt that being deconditioned or unfit is a risk factor for a poor outcome from many serious diseases. If you are unfit this would be an opportune time to start exercising with the aim of increasing your fitness. For those of you who are mobile, I have suggested the couch-to-5 programme in the past. If you are not mobile there are upper body exercises that you can do. Ideally, an exercise programme should be personalised with a physiotherapist, but if this is not possible there are pragmatic ways of getting going on your own.
  10. Breathing exercises: A lot of clinicians are instructing the general population to start doing deep breathing exercises to increase the ventilation of the little-used parts of the lung. This can be done before or more importantly after you develop COVID-19. 
  11. Mental health: Anxiety and depression are stressors in themselves and will affect how your body responds to infection. It is important that if you are anxious and/or depressed you get this treated. Exercise, mindfulness (meditation) and cognitive behavioural therapy have all been shown to reduce anxiety and improve depression. These are things you can do yourself. I am aware that it may be hard to address depression and anxiety during the lockdown, but there are things you can do to help yourself; but, if you think you need help can please reach out to your general practitioner and/or MS team.
  12. Pulse oximeter: if you live alone and get COVID-19 I would recommend having access to a pulse oximeter to monitor the oxygen levels in your blood in the case you get COVID-19 pneumonia and are asked to stay at home. It is clear that many people with COVID-19 drop their blood oxygen levels without being aware of it.
  13. Advanced directives / Living wills: It is important to prepare for things in advance. If you did get severe COVID-19 and needed to go to ITU, possibly be ventilated and receive advanced life support. Is that what you would want? If it is not, make sure this is documented formally with your general practitioner and is included in your medical records. Also, let your family know what your wishes are. It may be a good time to update your will and instructions for your family in the event of you getting severe COVID-19 and passing away. You may want to prepare a folder summarising your medical condition, including your advanced directive, with all the necessary contact details of your next of kin. If you do get COVID-19 and are admitted to the hospital. Also, make a list of things you will need to take to hospital in the event of you getting COVID-19; please don’t forget your mobile charger. Please remember visitors are not allowed for COVID-19 patients so having a functioning mobile phone is an important way of keeping in contact with your family and friends.

CoI: multiple

Twitter: @gavinGiovannoni 

Medium: @gavin_24211

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Hi Prof G, thank you for the above post and breathing video. It is very useful to be reminded for sure. We are all trying to get on with our lives & live with caution, post COVID-19, possible second-wave 2020! Having young adults in my household & trying to remember to remind them to wash their hands when they come home from being out & about, has its challenges! The difference between health services & to try & receive the optimisation with your other health issues are also, very challenging too! So well done if you succeed and don’t give up if you don’t – even if you do become & feel a bit of a thorn in your local practice’s side 🙁 We patients don’t know what it is like in your very busy, overwhelmed, understaffed & in most cases under-funded & oh, not forgetting the ‘working from home’ environment that seems to add to all the frustrations & problems. Although, these problems were there pre-COVID – it has now added layers of organisational issues & staffing setup too!

    Do not laugh – but I had my Neuro appointment at 11am in my local hospital – travelling along to the hospital quite happily on time, with my mask, gloves and anti-bac wipes, only to receive a phone call, that (having pulled over) when answered, heard the cheery voice of my Neurologist! He asked if it was okay to talk – I said that “I’m on my way to see you for our appointment at 11am!” – He apologized, not knowing what had happened & that he’d call me back, allowing me time to get home! I did receive the call back & the call went well (still forgot to ask him about progression, grrrrrrrr!) & having checked my letter from the hospital – I re-read it and further down the page I found that it did in fact say, wait for it…’Telephone Consultation!’ After having a few appointments recently face-to-face & I couldn’t think for the life of me – why this appointment would have been any different! Apart from COVID-19 – dictating different rules & regs – now why does that sound familiar! 🙂 🙂

  • Timely post. Thanks.
    How about adding Vitamin D repletion? Although we are having a mini heatwave, I suspect levels might be declining early due to the miserable August. Also as small study in Spain seems to show a significant advantage for hospital admissions treated with calcifediol in terms of ITU admissions. https://doi.org/10.1016/j.jsbmb.2020.105751
    Its role in the RAS also suggests benefit:
    With the pandemic continuing, perhaps its reasonable to recommend Vit D supplementation while waiting for the defining RCT that never seems to arrive..

  • Thanks for the reminder.

    Not the point of the post, but as you mentioned the London Underground, why not cycle to work?

By Prof G



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