Long COVID And Beginning Phase Of Rehab

Last week we talked about whether or not you should return to exercise while experiencing long COVID symptoms. Just to recap, a gradual introduction of an exercise program is the best means of returning to an active lifestyle (Novak et al., 2022). We are talking so gradually that you almost have to think of the reintroduction as small goals or phases until you can return back to your potential. 

That is why this week we wanted to focus on the first phase of rehabilitation, or better known as the beginning phase of rehab. 

The first phase (early/beginning phase) is the introduction of The Active Cycle of Breathing Techniques (ACBT).

For a lot of patients who have experienced COVID there is a lingering cough that persists for weeks after the initial infection.  As a result, more phlegm (sputum) is produced, which can irritate our body even more. That is why we introduce The Active Cycle of Breathing Techniques (ACBT) as an initial phase to clear up the phlegm from the chest in order to prevent the ongoing cycle of coughing. 

As the cycle illustrates, there are 5 phases in The Active Cycle of Breathing Techniques (ACBT)

Breathing Control is the process of breathing with as little effort as possible.  Ideally, breathing slowly and gently through your nose.  If it’s difficult, use your mouth instead.  If you are having difficulty relaxing, try closing your eyes while breathing slowly.

Deep Breathing Exercises involve taking long, slow, deep breaths, in through the nose.  As you do so, you want to relax your body as much as possible.  When exhaling, do so in a relaxed manner as if you were to sigh.  Perform 3 to 5 deep breaths.

Huffing is exhaling without coughing.  To ‘huff’ is to squeeze air quickly from the lungs through an open throat and mouth as if you were misting up a mirror.  You want to do so without wheezing or tightening your chest.

There are two types of huff:

Small-Long Huff will assist in moving sputum from down low in the lungs.  This is done by taking a small to medium size breath in and then you huff.

Big-Short Huff will assist in moving sputum from higher up in the lungs.  Take a deep breath in and then you huff quickly.

Now you’re probably wondering how often you should do these exercises? 

The ACBT should be completed when you feel you have phlegm that has gathered in your lungs. How do you know if you have phlegm gathering in your lungs? Well, the first sign is persistent coughing or feeling breathless.

Ideally you should complete the ACBT once or twice a day between exercises or as your condition improves. 

Just remember before beginning a program such as ACBT it is important to consult a physiotherapist or a chiropractor to get your fitness level evaluated and get assistance in your program of care. Also make sure you check out our next weeks post about the second phase of rehab and Long COVID.

Multisystem Involvement in Post-Acute Sequelae of Coronavirus Disease 19; Novak, P. et al. Ann Neurol. 2022 Mar; 91(3):367-379.