What should a family physician know about nutrition and physical exercise rehabilitation’ advices to communicate to ‘long-term COVID-19’ patients?

Figures & data

Figure 1. Symptoms and signs of coronavirus disease 19 (Covid-19) and some acute/chronic complications linked with Covid-19 in the cardiorespiratory and neuro-muscular chain.

ICU: intensive care unit. SARS: severe acute respiratory syndrome.

Table 1. Recommendations for nutritional rehabilitation: eating well to regain the strength after COVID-19

N°	Item	Recommendations
1.	Eat on schedule	.Eating plan: regular meals/snacks are a part of patients routine .Eating regularly: provide the body with the needed nutrients/calories to restore strength and immune function
2.	Protein	.Daily allowance: 25–40 grams at each meal and 10–20 grams at each snack .Protein from fish, poultry, dairy, beans: stimulate muscle growth and prevent a continued muscle’ breakdown .Use ready-to-drink protein shakes, homemade shakes, protein powders
3.	Calories	.Daily allowance: at least 35–47 calories/kg of weight .Reduce body’ stress, and match rebuilding the strength .Enlarge the protein portions with vegetables, fruits, whole grains, other starches (e.g.; brown rice, potatoes, whole grain bread), which have high concentrations of carbohydrates and proteins .Use olive oil, nut butters, and other healthy fats to push calories .Monitor the weight: the aim is to return to the pre-Covid-19 weight, or to obtain a reasonable weight (in case of an overweight patient)
4.	Hydration	.Drink on somewhat of a schedule .Drink with each meal and consume about 1–2 cup of fluid in between meals .Good examples of fluids: shakes, water, juice, milk, tea
5.	Vitamin C	.Daily allowance: 500 mg .Keep the immune system healthy .Eat a food with vitamin C with each meal: an orange with breakfast, some sweet red pepper (in a salad or on sandwich) at lunch, and some tomato sauce with dinner and/or mango for dessert
6.	Vitamin D	.Daily allowance: 800–2000 IU .Get outside at least 3 times/week for 30 minutes (with exposure on hands, arms, legs and face) .Eat some foods (e.g. fatty fish such as salmon, fortified milk, eggs)
7.	Zinc	.Daily allowance: 5–10 mg if adequate intake along with food. If deficiency in Zinc, then a 20–40 mg daily supplement is indicated for 2 weeks .Mineral essential for a healthy immune system .Found in seafood, meat, yogurt, nuts and beans
8.	Calcium	.Daily allowance: 1–1.2 gr .Important nutrient for bone health .Eat a calcium-rich food at different meals and snacks throughout the day
9.	Omega-3 fatty acids (omega-s3: ALA, EPA, DHA)	.Daily allowance: 500 mg of EPA and DHA .Reduce excess inflammation .Found in fatty fish like salmon, tuna, sardines, herring, sea bass and mackerel. .Chia seeds, ground flaxseeds and edamame: healthy type of omega-3s .Eat fatty fish 2 times/week
10.	Gut health, probiotics and prebiotics	.Gut: first-line defense against infection. .Probiotics: good strains of microorganisms/bacteria that aid in a diversity of ways. They are found in fermented foods like yogurt with active culture, kefir, pickled vegetables, tempeh, kombucha tea, kimchi, miso and sauerkraut.Eat 1 portion of yogurt/day with active cultures or make a shake with kefir .Prebiotics (i.e.; the food that probiotics live on.) which keep healthy the digestive tract, are found in fruits, vegetables, beans and whole grains

ALA: α-linolenic acid. DHA: docosahexaenoic acid. EPA: eicosatetraenoic acid.

Figure 2. Three items of the physical exercise rehabilitation.