Post-COVID 10 Rehabilitation: **BREATHING EXERCISES**

Post-COVID syndrome have left many with residual pulmonary and systemic manifestations. These lingering symptoms can often cause difficulty in breathing, fatigue, joint pain, weakness, brain fog, and loss of taste/smell. The good news is that many of these issues CAN be reduced and even eliminated with a program that focuses on deep breathing, strength, and endurance.

Red Flags:

When we evaluate a patient with Post-COVID Syndrome, we first address any red flags or symptoms that require extra caution, including:

1. SpO2 < 90%. (oxygen level)
2. Tachycardia (fast heart rate >100 bpm)
3. Arrhythmias (irregular heart rate)
4. Tachypnoea (elevated breathing rate or rapid shallow breathing. Normal = 20 – 20 breaths per minute at rest)
5. Confusion
6. Thromboembolism (blood clots)

Education and empowerment are the foundation of our Post-COVID program. Each individual is coached on how to assess their breathing rate, heart rate, and even how to recognize an arrhythmia. 

Breathing is our way to get oxygen:

Oxygen is not needed to breathe, instead breathing is our way to get oxygen. Oxygen’s role is to produce water and energy we need to use the raw materials in our body in order to keep our bodies alive.

The reason we breathe harder during exercise is because when we workout we expend more energy. This causes our oxygen levels to drop, forcing us to breathe harder in order to get more oxygen. As you exercise, an increase in oxygen is essential so that you can restore what you are depleting. Oxygen deficiency on the other hand causes you to feel lethargic and leads to many problems. Without enough oxygen, your cells cannot be cleansed from toxins and it lowers your immune system. Another way to get a sufficient amount of oxygen is to exercise regularly. The more oxygen you have, the healthier you will be.

Exercising enables your body to be more efficient in oxygenating your body and brain. 

Exercise strengthens your heart, increases your blood flow, strengthens your muscles/joints, elevates your mood, enhances your immune system, improves your cognition/concentration, stabilizes your weight, reduces your risk of many ailments including, diabetes, cancer, cardiovascular, and helps you breathe more efficiently.

Hypoxemia is a common Post-COVID symptom

Low oxygen saturation can slow you down and keep you from performing at your peak because oxygen plays a vital role in muscle metabolism especially during exercise. Low oxygen saturation, a condition known as hypoxemia, occurs when oxygen saturation levels drop below 95 percent. Normal oxygen levels should be close to 98% (healthy adult range: 94-98%). If your oxygen level drops below 90%, you need to stop and take a break from exercising/activity to allow proper oxygenation to your muscles again. Continued exercise with low oxygen levels below 90% causes damage

Breathing Exercises: Video link https://www.dhirubhai.net/posts/aideen-virtphys_covid19-longhaulers-postcovidsyndrome-activity-6772933426484957186-8PpA

Deep breathing exercises have many positive effects including:

1. Improves Oxygen supply - Makes each breath more effective
2. Controls shortness of breath – helps slow tachypnea
3. Improves gas exchange
4. Decreases anxiety
5. Slows the heartbeat
6. Stabilizes Blood Pressure

The following are some of the breathing exercises in our Post-COVID Rehabilitation program: (Link to video demonstration: )

I. Pursed Lips: Smell the roses and blow the candles

• Inhale through your nose as long as possible
• Exhale through pursed lips as long as possible 

II. Segmental breathing

Focus on each lung region by placing your hands over the different lung section noted below. Take a deep breath and feel the air enter the specific area of your lungs causing it to expand upon inhalation and the retract as you exhale.

1. Upper lungs: hands-on upper traps
2. Lateral lungs: hands just below armpits
3. Diaphragm: one hand on chest other on abdomen. Focus on the abdomen. Hand on chest should not move. Breath deeply. (Your diaphragm is your primary muscle for breathing and it is important to properly train this muscle for proper deep breathing.)
4. Lower lungs: Hands just below the rib cage 

 III. Deep breath and hold 

Inhale 3 sec. Hold 4 sec. Exhale 5 sec

IV. Straw Exercise

Water and straw

1. Inhale through nose. 2. Blow out to form bubbles

V. Breath with arm movements

1. Flexion: move you arms up in front of you all the way up over your head as you inhale. Bring your arms back down as you exhale. 
2. Abduction: move your arms out to your side and up to ears as you inhale. Bring your arms back down as you exhale.
3. Trunk rotation: Twist your trunk to the right as you inhale. Hold 3 seconds at end range. Exhale as you return to neutral. Repeat to the left side.

Schedule an appointment now with one of our specialists for an evaluation and an individualized exercise program: www.virtualphysicaltherapists.com

Our next topic will be on improving strength and endurance Post-COVID 19! 

https://www.scientificamerican.com/article/how-do-we-breathe/

https://www.webmd.com/asthma/guide/hypoxia-hypoxemia

https://www.exercise.com/learn/why-is-exercise-important/