India is grappling with the dual challenge of the second wave along with repeatedly mutating strains of the Covid-19 virus. It is estimated that the incidence of hospitalisations is higher in the age group of more than 65 years and the percentage of affected individuals requiring hospitalisation in this group is 28.17 per cent versus 6.04 per cent hospitalizations in the age group of 0-64 years, mentioned Dr Akshata Rao, lead rehabilitation, Bengaluru, Nightingales Home Health Services.
Covid-19 significantly impacts lung functions. Shortness of breath and low oxygen levels are its hallmarks. These symptoms are a distress sign and a risk factor for a more severe impact of the disease and therefore warrants hospitalisation. Unfortunately, discharge from the hospital is not the end of the ordeal for most Covid-19 patients. One in 10 individuals experience “long- Covid or post-Covid health conditions” even after 12 weeks.
Therefore, rehabilitation by physiotherapists is a key strategy to ensure that the condition of these patients does not deteriorate further or require readmissions, mentioned Dr Rao. “We have seen the impact first hand with our post-Covid patients. There was an improvement in oxygen saturation after exercise sessions and lesser reliance on external oxygen requirement,” Dr Rao said.
How does it help?
*Leaning forward position: While sitting on a chair keep a pillow on the lap and rest your elbows or just rest elbows on the knees. This can be done in a standing position too by leaning forward on a wall.
*Prone position ventilation: Lying on the tummy – also called ‘prone‘ position — has been highly recommended for critical Covid patients to improve lung dynamics and improve oxygenation.
*Breathing using belly: Involves breathing using the diaphragm muscle. Sit with some support or in a lying-down position, place your hand on the belly and as you breathe in, the tummy goes up, and slowly breathe out, the tummy goes down.
Cough and lung sputum clearance
When the lungs are affected due to Covid, they produce more than normal sputum which needs clearing to make breathing easier and avoid further infections.
In situations like this, the Active Cycle of Breathing Techniques (ACBT), a set of breathing exercises, best taught by a physiotherapist, can help clear the lungs of sputum by loosening and helping to cough it out. This is how it can be performed:
Respiratory control: Perform in sitting or half-lying position. This relieves the secondary muscles involved in inspiration and relaxes them, especially in the neck. Slowly breathe in through the nose, count up to two and then very slowly exhale through your mouth – while pursing your lips as if blowing out a candle – and exhale till a count of three. Try to let go of any tension with each breath out. Also, try closing your eyes so that the focus can be on breathing.
Deep breathing exercises: Take long and slow breaths through the nose, keep the chest and shoulders relaxed and like a sigh – breathe out relaxed and gently. About three-five deep breaths can be done. A physiotherapist can advise you on whether any breath-holding is required and also the right number of breaths depending on your current lung capacity and other vital parameters.
Huffing: Huff involves exhaling with the mouth and throat open, it helps to move the sputum up the lung airways and helps clear it in a more controlled way. In order to “huff”, quickly squeeze the air out of lungs through open mouth and throat – as if cleaning your glasses. Use your belly muscles, but avoid any strain which might cause wheezing. Huffing should always be followed by breathing control.
When done correctly, the movement/rumble of sputum in the chest can be heard. Wheezing means you are huffing too hard. Your physiotherapist can help adjust the ACBT to suit your individual needs.
A therapy plan which takes into consideration your current health status, lung capacity and overall activity levels can help you recover from long Covid symptoms effectively. If you are worried about stepping out, you can opt for home-based assessment and therapy sessions to recover in the comfort of your home.