Prehabilitation and rehabilitation: taking care of your respiratory system during COVID-19

15 May 2020

We know that a large number of our population will be infected with coronavirus in an effort to develop herd immunity, and whilst not all of us will develop the COVID-19 disease as a result of the virus, preparing our bodies and minds to experience it is essential.

There has been a very positive outcome from ‘prehabilitation’ before an operation: a preventative strength-training style programme designed to prevent injuries before they can occur. In a recent webinar, Professor Gavin Giovannoni, Professor of Neurology at Barts and The London School of Medicine and Dentistry, and Academic Director of MS Academy, advocated prehabilitation for COVID-19, both strengthening our health and mitigating our risks of experiencing a more severe version of COVID-19.

The likelihood of developing symptoms of COVID-19 after exposure to coronavirus is between 50% and 75% and the level of severity we experience, from mild symptoms, to severe symptoms requiring hospitalisation, is affected by a number of factors we now know about. Many of these factors are modifiable (fig 1), meaning we can act on them to reduce our risk and change our outcomes.

Figure 1: risk factors for experiencing severe COVID-19 and for mortality from it

Watch our webinar for further details on this: How to prepare in the event of you getting COVID-19

One of the key modifiable risks is the strength of our respiratory system. By strengthening our lungs and our overall respiratory system, and by learning to calm and deepen our breathing, we can help reduce the risk of damage in the event that we develop COVID-19, and improve our healing afterwards.

Prehabilitation: monitoring your lung capacity

One way that you can monitor your respiratory health is to measure your oxygen saturation at home. Jody Barber, a Highly Specialist Neurological Physiotherapist from Hertfordshire who specialises in respiratory health and MS, suggests monitoring your baseline lung capacity with a Peak Cough Flow Meter, a reasonably cheap device costing £5-£15. You can get these from your pharmacist, or from most mainstream online retailers. Instructional videos can be found online, like this one from a UK physiotherapist.

Jody gives a short demonstration in the following video, including explaining the different parts of the device, and outlining posture and technique for wheelchair users and for those who need a carer to assist their hold of the device.

Prehabilitation: taking care of your lungs

Jody has recorded a ten minute video talking through breathing exercises that can help to strengthen the lungs:

Jody describes in detail some specific exercises that can be done to stretch the alveoli at the end of lungs and improve the health of the lungs, explaining why this is important.

The first exercise she calls ‘stacking your breathing’.

The second ‘exercise’ she recommends is singing. Supported through speech and language therapy, singing loudly and strongly requires large intakes of breath and controlled release of air, which gives the respiratory system varied, healthful movement. Singing is also recommended within mental health spheres as a simple way of reducing stress, exercising mindfulness, and swapping the production of cortisol for endorphins, the ‘feel good’ hormone (minutes 0-1.24 of the next video).

Finally, Jody shares the benefits of using a kazoo, a simple childrens’ wind instrument which moves and stretches the diaphragm, building strength (1.25-3.51 of the next video).

One way we can strengthen our overall respiratory system is through learning to calm our sympathetic nervous system (when we are under stress and take short, shallow breaths), and activate our parasympathetic nervous system, (where we are calm and take deep, full inhalations). Becoming more aware of our breath, and taking time to sit calmly and breathe fully for a few minutes can be very beneficial.

Jody shares a short, eight minute breath awareness video to help activate our parasympathetic nervous systems, and give our bodies the chance to breathe calmly and deeply for a while.

Rehabilitation: healing your lungs after illness

Building back capacity into your lungs after an illness that affects your respiratory system, like pneumonia or COVID-19, is an essential part of your recovery. To start with, things you managed perfectly well before your illness may leave you very breathless. It is expected that healthy people will take up to six weeks to recover from COVID-19 and those with other health difficulties may take longer.

Gradually building strength and healing in your body, whilst being kind to yourself and accepting your body as it is after illness is very important.

Jody has some simple, deep breathing exercises that you can do to slowly increase your lung capacity.

Once you can comfortably do the deep breathing exercises, you might want to try ‘stacking your breath’ (see video number 3), increasing the amount of air you take into your lungs further so that the alveoli at the end of lungs are stretched and able to function better.

When you are able, you may wish to begin some gentle movement to accompany your breathing as part of your rehabilitation. We know that COVID-19 causes feelings of fatigue and exhaustion which may be exacerbated if your MS also affects you in this way.

The practice of deep, aware breathing can be found in yoga, tai chi, qi gong and other forms of exercise combining movement and breathing, as well as in the more stationary practices of meditation and mindfulness. The benefits of coordinated breath and movement have been understood for years in different cultures, and lately have been researched academically, scientifically validating some of these benefits. Evidence linking these practices and improved respiratory function is particularly strong. Specific studies into the benefits of yoga for those with neurological conditions (Mishra: 2012) and of pilates adapted to wheelchair practice for those with MS (der Linden: 2013) might be of interest here.

Managing breathlessness

Whilst recovering from COVID-19, it is possible that simple everyday tasks such as climbing the stairs or transitioning from one place to another may leave you breathless. Sometimes this breathlessness might come be strong, and frightening. Jody has recorded a short video to give some ideas for how to get control of the breath in these times, and how to stay calm and focused in regaining breath in those moments.

Additional information

The British Lung Foundation with the Chartered Physiotherapists have produced a video of other breathing exercises that can help in the case of breathlessness that some people may be experiencing as a symptom of recovering from COVID-19.

Other videos that can help in recovering breath at times of breathlessness, or can assist in strengthening the lungs after a respiratory illness include:

This video is specifically for respiratory recovery, recommended by a practicing nurse in a COVID-19 hospital setting. The video is demonstrated by another healthcare practitioner directly from their hospital where they are treating patients with COVID-19.

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MS Academy was established five years ago and in that time has accomplished a huge amount. The six different levels of specialist MS training are dedicated to case-based learning and practical application of cutting edge research. Home to national programme Raising the Bar and the fantastic workstream content it is producing, this is an exciting Academy to belong to.