EN 
ES Doctor Francisco De la Rosa - Specialist in physical medicine and rehabilitation of the Department of Physical Medicine and Rehabilitation of the Hospital de la Plaza de la Salud
Source: Newspaper Today
As a specialist in physical medicine and rehabilitation, it is necessary to manage the effects of physical deconditioning and detraining in all our patients. We see it daily in patients who have medical conditions that alter the level of physical activity they can perform (for example, prolonged hospitalization, postoperative periods, chronic non-communicable diseases or chronic rheumatic diseases, among others). Then the services of the multidisciplinary rehabilitation team are required for the evaluation, prevention and treatment of the harmful effects of said limitation.
In the specific case of confinement due to the COVID-19 pandemic, the general population has had an abrupt decrease in the level of physical activity and that exercise specifically aimed at physical conditioning.
One of the most specific recommendations of the World Health Organization and international sports organizations, through their medical commissions, has been to keep doing some kind of physical activity at home to combat the effects of deconditioning; The beneficial effect that regular exercise can have on the immune response is also validated. What is difficult to comply with the measure has been the particularity of each individual in terms of the availability of equipment at home, the advice of certified personnel and adherence to the exercise program. Likewise, in the de-escalation process in different countries, the regulations of each country on outdoor activity have also played an important role.
Physical fitness refers to the ability of an individual to perform physical activity. In a broad way, it is necessary to mention the different elements that make it up, such as muscular strength and endurance, cardiorespiratory capacity, flexibility and speed, among other aspects that allow a detailed assessment of how fit a person is at any given time. given for physical activity. The bad news is that these elements, particularly strength and endurance, are gained with time and effort, slowly, and are lost relatively quickly.
An example has been evidenced in a study published by Pedersen and Cols. in the Journal of the American Medical Association, where a patient with a similar body mass index was taken as a reference, and a decrease in daily step count from 6200 to 1300 daily steps for three weeks. They saw how insulin resistance and abdominal fat increased and muscle mass decreased at the level of the legs in the different sub-groups of their research.
Similar results have been seen even in young adult patients (mean age: 24 years), which could also be accentuated by the sarcopenia process that begins to be seen from the age of 30-35 years according to most authors.
If we additionally take into account the variations in diet and sleep hours that have also been evidenced during this period, we should note that habituation to the training program must respect those physiological and structural changes that can be verified in the literature.
Competition planning
Athletes participating in competitive events may have an additional feeling related to the desire to compete at this time. At present, international and local federations are preparing to prepare the logistics related to sporting events, although there are no confirmed events yet. The postponement of the Tokyo 2020 Olympic Games marked the world sports community, and although for many it will serve as a second wind to prepare, for others it could represent the end of the race. At the recreational level, many mass events, such as iconic marathons, triathlons and “masters” events, still remain without a definitive date, but with protocols under development to be carried out safely. This will allow all these athletes to take the time to prepare, without rushing the process. In addition, it is important to note that once the competitions are published, there should be at least 8-12 weeks of preparation for less demanding events and with previous experience, and longer periods for those events in which there is no experience or that are More demanding
