Whilst research is limited on COVID -19 we can have a look at similar diseases such as SARS and ARDS (acute respiratory distress syndrome) and see what effects they can have on our bodies. Previous studies have show that these conditions can cause residual abnormalities in lung function, exercise capacity and impairment in health-related quality of life. Effects of similar respiratory diseases have show to have lasting continual effects of over 12 months.
How does COVID -19 affect your lungs?
Inside a healthy lung there are clusters of tiny air sacs called Alveoli. Oxygen is contained in these alveoli which travels through to small blood vessels (capillaries). These vessels, in turn, deliver the oxygen to your red blood cells which then travel around your body to produce energy which intern allows us to survive.
To make this an easy process the walls if the alveoli are very thin.
The coronavirus (similar to SARS) damages both the walls of the alveolus as well as the capillaries. The debris that accumulates because of all of that damage lines the wall of the alveolus and makes them thicker. The thicker this wall gets, the harder it is to transfer oxygen. This will lead to shortness of breath and in serious cases ventilatory support may have to be used.
Symptoms that may occur after the initial recovery of COVID-19 are wide spread but physiotherapy can help with:
Mild to moderate depressive symptoms
Respiratory muscle weakness
A key component in the rehabilitation program to restore SARS patients’ physical fitness and independence was exercise.
Here at the Claydon Clinic we can create a specific rehabilitation program for you consisting of exercise training, simplified strength training, and breathing exercises. It is important to follow a specific plan that has been tailored to you because Covid -19 has been shown to affect people in different ways. Mild to severe symptoms have been recorded with some lasting days to others lasting months. Examples of exercises are shown below.
We can deliver these exercises and demonstrate techniques remotely via our online service.
Benefits of exercises
Increased muscle strength and joint movement
Improved stability and balance
Improved exercise tolerance and fitness
Improved well-being and immunity
Increased functional ability.
Reduces stress, anxiety, tension and depression
Improves self-esteem and confidence
Getting back to exercises after COVID -19
Getting breathless when you exercise is normal, whether your lungs have been effected or not. It is actually recommended on a regular basis to improve general health. If you get breathless during everyday activities, exercise will help to reduce how breathless you on a day to day basis. It is important however to check with your physiotherapist or doctor whether you are well enough to start exercising.
There are several breathing techniques that you can use when you exercise to help you control your breathing.
Here are some examples:
Blow as you go: breathe out when you are making a big effort, such as standing up, lifting, climbing a step
Pursed-lips breathing: breathe out with your lips pursed as if you were whistling.
Trying to relax as much as possible. This will help to keep the small muscles in your airways relaxed, keeping them as open as possible.
Supporting your shoulders and arms in a relaxed way without gripping on to things, helps to allow the muscles in your shoulders and neck to work more efficiently as extra ‘breathing’ muscles. Tensing these muscles will use more oxygen and may increase your breathlessness.
If you get so short of breath and feel you need a need a breather, there are certain positions that you might find helpful to reduce breathlessness
Standing leaning forward: Lean forwards resting your elbows onto a wall, a windowsill, a railing or the back of a chair.
Sitting leaning forward: Sit leaning forward with your elbows resting on your knees. Make your wrists and hands go limp. You can rest your head and arms on pillow on a table when you are really short of breath.
Standing leaning back or sideways: Lean back or sideways against a wall, with your feet slightly apart and about one foot (30cm) away from the wall. Let your hands hang loosely by your sides or rest them in your pockets. You may prefer to rest your hands or thumbs on your belt loops or waistband, or across the shoulder strap of your handbag.
We can advice on outcome measure to help you know how breathless is acceptable when carrying out exercises.
Borg rating of perceived exertion (RPE) is an outcome measure scale used in exercise intensity prescription. It is use in monitoring progress and mode of exercise
It is important to pace your self when you first start back to exercise. Your muscles will fatigue more quickly than before and you will find you have lost your pre COVID-19 fitness levels. If you rush back then you are at a high risk of causing injury to muscles and could even result in tearing them. If your muscles are weaker then they are not supporting your joints as much, this means higher impact activity will put more pressure through your joints than before. Normally physios use the motto “ No pain, no gain ”, however pain can be a signal that your body has had enough, listening to pain in this case is important. it would be sensible to stop and give your body time to rest and recover and try again 24hrs later. Try doing a variety of exercises to prevent tiring out one set of muscles too quickly or getting unpleasantly breathless. Work at a pace that allows you to exercise for longer. For example, you could do some exercise in the morning and some later in the day.
If you had mild symptoms of the coronavirus and feel that you do not suffer from shortness of breath and would like to start back to your normal exercise routine, wether it would be strength or cardio work out , it would be sensible to begin at approximately 50 percent of your original intensity and duration. You can use this as a bench mark. If it is too difficult then reduce it further, if you feel it is too easy then increase it slightly. It would be sensible to complete the work out 3 times and week with 24 hours in-between session before increasing the intensity and duration by 10% the following week.
Walking is one of the best ways to start exercising again. It is the most natural movement pattern for the body. Try walking for 6 minutes, then slowly increase as able.
Exercises to improve your balance like standing on one leg for 30 seconds will also help to improve your core and posture. Make sure you have a stable support to hold on to if necessary at the beginning.
Exercises like sit to stand out of a chair are great because the require little equipment and are also functional. You can start with using cushions to make the chair higher therefore easier. Aim to complete 5 sit to stand then repeat this set 3 times.
People with a lung problems often cough and produce more phlegm (sputum) than is usual. It is important to remove sputum from your lungs to help you breathe more easily, prevent chest infections and reduce bouts of coughing. Leaving sputum in your chest can make your condition worse.
The Active Cycle of Breathing Techniques (ACBT) is one way to help you to clear sputum from your chest. ACBT is a set of breathing exercises that loosens and moves the sputum from your airways. It is best to be taught ACBT by a physiotherapist.
The ACBT exercises are breathing control, deep breathing and huffing which are performed in a cycle until your chest feels clear.
Nutrition plays an important part in recovery. Simply, eating five portions of fruits and vegetables of different colours a day, along with increased intake of high quality protein will be enough to support the body and provide resources for the repair of muscles which will have been taxed considerably during the course of the COVID-19.
We have links to expert nutritionists. If you need further help/advice then please email us.
As on of the main focuses in rehabilitation is improving respiratory function, cessation of smoking is very important along with the avoidance of ibuprofen where possible.
The NHS Smoking Helpline can give you support and advice. Phone 0800 022 4332
Unfortunately COVID-19 affects us negatively physically and mentally. It is also extremely common to suffer negative mental affects of being in an acute hospital setting such as intensive care.
Conditions such as anxiety, depression and post-traumatic stress disorder – PTSD are only but a few that will have an impact on the lives of survivors.
Here at The Claydon Clinic we have an experienced cognitive behaviour therapist. James Shepherd can be contact on 07588630235