Exercise after Covid, Short of Breath
Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby. And we're gonna talk about exercising and COVID. How you doing Iyad?
Iyad: Good Mark. Thanks for doing this.
Mark: So I'm sure you're starting to see people who've either had COVID, are still perhaps recovering from COVID and they want to get back to exercise. So how do you start diagnosing what's going on and what they can actually do and is there guidelines.
Iyad: Yeah, so it's a newer disease, as we all know that kind of came outta the blue a couple years back. And we initially had no idea what we're dealing with. So the initial approach was in a lot of hospitals was they were treating it like any other respiratory disease and kind of seeing what sticks.
And we found that some things were pretty helpful and some things were not helpful at all. So one of the things that we found was not helpful was to push people past their, let's say, into symptoms into their threshold a little bit more. We found that they actually didn't cope so well early on. And then there's other things, for example, that we found work pretty well.
So for example, if somebody has a disrupted breathing pattern and we can kind of go over how to kind of breathe a bit more regularly for them and practice that, that seems to regulate a few things. And then the other thing also, like I said, in my last video is that there's so many symptoms that COVID has that impair your ability to exercise.
So what we're talking about today, maybe we'll focus a little more on the respiratory stuff. You know, the feelings of shortness of breath. We have a multitude of people who come in, some who come in and say, look, I got a chest x-ray and it's clear. And doesn't say that there's anything with my lungs. I just can't tolerate any exercise. I walk for a few seconds and a few minutes, and I feel like I'm just winded and feel tired. Some of them even will tell you, I feel a little bit nauseous, just because they're kind of struggling to regulate their own body when they're exercising.
And for that kind of person, we would tend to look at a few things. We'd start with just seeing how do they breathe when they're lying down, when they're sitting up, and then we get them to walk and we monitor a few things like heart rate. We can look at their oxygen saturation, which we can measure with a small pulse exhibitor.
And usually most people have tried to do their own research on that. And they'll try to buy one in the pharmacy, which is great. And then they say, yeah, it stays at 98%, which is awesome. It means you're not, you know, your blood oxygen levels and dropping, but yeah, we tend to look at that. And then what we'll try to do is also figure out what's the number that they can exercise in safely. What's the speed. What's maybe the pace. And for some people who don't like tracking that stuff, we can just kind of go over an exertion level. We'll give them like, okay, you can actually do pretty well at maybe for example, 2 out of 10 level of exertion. So we're gonna just try to build them a program around that.
Breathing exercises seems to help a lot in this population. And one of the dysfunctions you could see is some people will tell you, they feel like the upper part of their neck and chest gets really tight from their breathing. And it's because they're trying to focus the breathing in the top part, maybe a bit more.
So if you imagine using only part of your ability to breathe and not the full capacity of your lungs to kind of expand, I could see why you would get tiring, just to breathe. Because you'd be breathing a lot harder to just try to get that same kind of volume in. So yeah, we'd want to assess that for sure.
And we would kind of then give them a program of different types of breathing and sometimes, it's still a sense of panic when you feel like you're losing air. I'm sure like a lot of us have had this kind of feeling of being winded and it's not really a comfortable one psychologically.
So some of the exercises are to also improve their ability to just kind of tolerate that kind of slow down their breath a bit more instead of hyperventilating and doing these shallow, rapid breaths. So yeah, we, we kind of work a lot more on that. And then also try to build a safe aerobic program that they can kind of start at because it's tough when you're just guessing every time.
Sometimes you walk two blocks and sometimes you walk 10 and then you're kind of tired afterwards and you're feeling a little nauseous or maybe some other symptoms. So it's a bit easier when we take the guesswork out.
Mark: So what's happening is that people are feeling that when they have COVID, when they're in the actual disease and they learn to try and deal with it in a way where they restrict their breathing. They don't expand their lungs as much as normal. And so then they get into a habit where now they're kind of not breathing properly anymore after they're better. And they need to retrain theirselves. Kind of like we have to retrain after an injury, if we've had an ankle injury or whatever, is this something similar?
Iyad: That's potentially one of the things that happens, we actually don't know. This is the interesting part. Now there are cases where you actually have findings on a chest x-ray, like if you do a chest x-ray and you see that the lung has actually been affected. And then that could actually impair the lung's ability to behave like its elastic kind of self. Where it can actually inflate and recoil. And you might lose a bit of the recoil sometimes. Or in some conditions you can't inflate as much.
So it's so variable person to person. Luckily, we're not seeing as much of that these days, which is good, but we still are seeing some of them just because it's spreading at such a fast rate. That even if the percentage is small, we're still seeing that. But you can imagine for that person who, for example, literally could not expand their lung the normal way because of potentially some the disease process going on. You will have to find another way to do it. You have no option, but to get some oxygen in to kind of go day to day.
So it could be that. It could be a learned behaviour. It could be also a sign of the disease or probably a mix of the two. We actually don't know why this happens still. I can't tell you the, the cause. So we can't really like pinpoint that, but I mean, they seem to do pretty well with breathing exercises.
Even the World Health Organizations rehabilitation guidelines include breathing exercises. And they also include certain. Things that we will teach our patients. And this is something we teach everybody on the first session is what they call the rescue position. So if you're feeling really short of breath and you're feeling like you know, there's a bit of respiratory distress going on, there's certain positions that can actually help control about a bit more. And this is something that's really powerful to teach someone.
They're freely available on the World Health Organization's website in their rehabilitation guideline. But most people won't think of looking at, and we will definitely be like one of the first things that we go over with them. And just teach them about, well, this is actually, it's gonna happen and especially in the first few days, as they try to do this and try to kind of expose themselves a bit more of that. And we will teach them how to control that, because it's really, really powerful for them to have at least a bit of symptom management, let's say. Because that's a really awful symptom to feel like you're gasping for air.
Mark: Yeah. So what should someone not do?
Iyad: One of the things that we don't think helps so much is pushing really, really hard, really, really fast. And this is when it comes back to guesswork and we find it really valuable in these cases, especially when people don't recover the way they think it's gonna be, two weeks and it's gone.
Actually how much they're doing and to monitor their symptoms and according to how much exercise they did and to see how long it takes for them to recover. That's a really useful thing to do. What you shouldn't do is just to try to go arbitrarily and just say, I'm gonna go to kind of end of my fatigue limit and things like that right away.
We don't think that seems to help so much. Some people and the jury's still out, if it actually can affect you negatively. Some people say it does. There are reports of that happening where people actually don't do well after really, really heavy exertion. And then, there's always the person who likes to wait and see, and that's perfectly fine.
But the population we will see and that's from a younger 20 year old, all the way up to a senior who likes to just get moving and get walking and do their social interactions with their friends. We want to get them back as soon as possible, safe as possible. So that's really the kind of person that we tend to help. Instead of somebody who's just for example, would say, oh, it's gonna be fine. I'm gonna just wait it out. Which could help a lot of people too, because you know, our body has a great ability to heal.
Natural history can be a factor here, but yeah, it all depends on how you're responding and what you're, I guess motivation is, if you just want to get out and exercise earlier, then you would want to get some exercise guidelines from one of us.
Mark: So softly, softly on your recovery, in a way. Breathing exercises of some kind, I would assume belly breathing.
Iyad: That's one of them. Yeah. But that's not the only thing that they could do. Some people belly breathe well and they don't breathe well, for example, from other areas. So like there's different versions of breathing that we would just, again, we just see what's happening there and what's not happening there. And the funny thing is you could breathe really well on the bed and then you go for a walk and all of a sudden it changes. So then it would be actually breathing exercise with movement a bit more.
Mark: Perfect. And basically get some expert help so, you know what's going on while you're tracking your progress rather than just experimenting because you can cause yourself some injury and that might be permanent. Is that fair?
Iyad: I don't think we could say that confidently. I don't want to scare people in that sense, but I think you could definitely just make it longer. You can just prolong the process by guessing so much. So we would be able to even identify certain things that often, if there's something that's not quite right, we would flag it up and pass it on to our medical colleagues for further assessment. And this is, again, some things that people just aren't aware of, because it's hard for you to kind of figure out what's going on with your body sometimes.
So. Yeah, that's what we tend to look at more. We want to see is this safe for you? That's our first priority. Always, obviously. Can I get you safely doing something? And can we progressively do this in a way that doesn't necessarily have a yo-yo effect where you're a good one day and down the other day and good one day and down the other day.
Again, we can't say anything about long term damage and any of that stuff, because we just don't know if that's actually how it happens. I think that'd be a bit too simple of an answer.
Mark: Perfect. So if you've had COVID and you want to start getting back to exercise, but you want to do it safely. The guys to see are Insync Physio in North Burnaby, you can book online or you can give them a call. Thanks, Iyad.
Iyad: Thank you.