Gym Class: COVID Lessons That Infection Preventionists Can Apply to Physical Therapy

Small clusters of environmental transmission in gyms and other workout settings can tell us about potential risky environments in healthcare. Outpatient physical therapy for one.

The topic of fitness and gyms has come up more lately as people return to their pre-COVID-19 lifestyle. Insight into a cluster of COVID-19 cases related to a fitness environment and classes in South Korea is particularly interesting. Over the course of 24 days in mid-February and early March, cases began to spring up related to sports facilities in Cheonan. By early-March there were 112 cases with 73% being symptomatic. Digging into these findings, researchers established a few critical datapoints-the classes were 50 minutes of high-intensity workouts twice a week. Students tended to develop symptoms 3.5 days after the class and 50.9% of the transmission was from instructors to fitness class participants. Also, 33.9% of cases were a result of in-family transmission and 15.2% were from meetings with coworkers or friends. 

Some of the pieces to SARS-CoV-2 transmission that we heavily focus on in epidemiology is the environment, activity, length of time for exposure, and volume of people. Delving into the environmental aspects, the research team found that the moist, warm temperature within this setting was amplified by turbulent air flow due to high-intensity exercise and heavy breathing. The authors added that “of note, instructor C taught Pilates and yoga for classes of 7–8 students in the same facility at the same time as instructor B, but none of her students tested positive for the virus. We hypothesize that the lower intensity of Pilates and yoga did not cause the same transmission effects as those of the more intense fitness dance classes.”

What does this have to do with infection prevention? These small clusters of environmental transmission in the community can tell us about potential risky environments in healthcare. Outpatient physical therapy for one. As we work to reopen elective surgeries and outpatient services, physical therapy and rehab will be one. These gyms are critical areas to incorporate infection prevention but are often overlooked. What classes are being offered? What is the process to reduce risk? These are pieces we need to consider and are often forgotten in the efforts to establish in-patient processes as hospitals get busier with surgeries.

The cluster related to fitness classes in South Korea can teach us a few things-the importance of reducing exposures in large groups with little social distancing, and how high-intensity exercises in certain environments can increase risk. Adequate ventilation, reducing the volume of people and close quarters, and consideration for activities is necessary for making exercises, like outpatient physical therapy, safe. Special consideration must also be given to those patients with increased risk for severe disease. Space visits out to ensure social distancing, adequate cleaning and disinfection. Physical therapists should wear masks as should patients, depending on the activity. These small considerations are important for our efforts to normalize some of our outpatient services while still protecting patients and staff from COVID-19.