Maintaining the health of people with and without COVID-19 during isolation

All participants will be provided with a Health Package either via paper or email, depending on the participant's access to technology, place of isolation and participant preference. The Health Package will include: • A physical activity/exercise program (via an exercise app [PhysiApp] or paper-based) which will be varied according to the participants’ reported exercise history, symptoms, clinical signs and fatigue levels • Anxiety management techniques • A guide to healthy eating, using food commonly found in the pantry and/or easily accessible for those at home or healthy food choice options (via UberEats or requests to SLHD services) for those isolated in hotels The study coordinator will meet virtually with the participant via phone or videoconference to discuss the elements of the Health Package and how it will be used. Participants will be asked to engage with the program for two weeks or until discharge (whichever comes first). For non-COVID-19 participants, discharge will be based on a negative swab on day 10 and day 13 of quarantine. For COVID-19 participants discharge will depend on two consecutive negative swabs after 14 days of isolation. The actual days of enrolment in the program will be documented. Program Details Exercise program The exercise program will be prescribed by a physiotherapist or accredited exercise physiologist who are highly experienced in exercise prescription for people with chronic conditions,especially lung disease. The exercise program will be a ‘light’ exercise program, designed to help participants keep active. It is NOT a fitness training program. Participants will be screened by the exercise physiologist or physiotherapist using a short questionnaire (Adult Pre-Exercise Screening System [APSS] (APSS 2019) to determine suitability for exercise, and the presence of any cardiovascular or musculoskeletal precautions or contraindications to exercise. The screening will be done by telephone or videoconference. A script for the screening call will be followed. In addition, the participant’s medical record will be reviewed for any past or current clinical problems that may affect the exercise prescription. The exercises will focus on activities of daily living and will be exercises that can be easily performed at home or in a hotel room, such as walking around the room, sit-to-stand from a chair, squats, heel raises, wall push-ups, arm exercises with light hand weights using cans of food or bags of rice or bottles filled with water, or resistance bands (provided by SLHD), and flexibility exercises. Exercise programs will be individually tailored based on a person’s reported usual physical activity level, measured using the APSS. All exercise programs are intended to be completed at a ‘light intensity’ which is indicated by self-report of ‘very, very slight/light’ to ‘slight/light’ breathlessness or perceived exertion during exercise i.e. 0.5 to 2 out of 10 on the Modified Borg Scale (Borg 1985). A decision tree for determining exercise level and adjusting exercise level will be used. The duration and frequency of exercise will depend on the participant's health status and previous exercise history. A minimum of 20 minutes exercise per day will be prescribed, up to a maximum of 45 minutes per day. Exercise will be able to be completed in in short bouts of at least 10 minutes duration, if necessary. The exercises will be provided via exercise software (PhysiTrack)(https://www.physitrack.com/) with end-to- end encryption, which allows for real time exercise prescription, modification, and monitoring. An email or text message will be sent directly to the participant, which will prompt him/her to access their exercise program by either downloading a free PhysiApp or via a link to their web browser. The software includes videos, pictures and written instructions of how to perform the exercise program safely. A downloadable PDF or printed version of the exercise program will also be provided, if required. Anxiety management Participants will be provided with information on how to practice anxiety management techniques such as: • Breathing control • Visualisation of a calm place • Relaxing muscles • Counting • Staying present – e.g mindfulness • Distraction techniques • Grounding techniques This information will be provided in the Health Package booklet at baseline. Links to appropriate websites for anxiety reduction will also be provided. Escalation procedure: If a participant is distressed due to anxiety, stress, panic or depression they will be asked to contact the staff managing their care and will be referred to a psychologist. Nutrition advice Advice on healthy eating will be provided in the Health Package booklet (prepared specifically for this study) at baseline. For those participants isolated at home the information will include how to use pantry staples to prepare simple and economical healthy meals with a focus on foods supporting immune function. For those participants isolated in a health hotel the information will include advice on healthy meal choices from SLHD services and healthy ‘buy-in’ options from UberEats. The exercise physiologist or physiotherapist will contact the participants via telephone or videoconference every 2-3 days. At these contact calls a checklist will be completed of the participant's reported exercise sessions over the previous 2-3 days and whether they have used any of the anxiety management techniques or the advice regarding healthy eating. Any barriers to exercise, anxiety management or healthy diet will be discussed and strategies to overcome such barriers will be implemented where possible.