June, 1, 2021


We are one full year into the COVID-19 pandemic and with the end seemingly in sight, many people in recovery from the disease still struggle to return to normal life. Colloquially called ‘COVID long haulers’, these are people who continue to experience breathing issues, fatigue, and myriad other symptoms for three weeks or longer after the initial infection.

Those who experience Chronic COVID syndrome report symptoms such as:

• Fatigue
• Shortness of breath
• Persistent cough
• Intermittent fever
• Brain fog
• Chest pain
• Joint pain
• Muscle pain
• Headache
• Heart palpitations

For COVID long haulers, these symptoms can severely reduce one’s quality of life, and cause anxiety and depression. While the medical community searches for a solution, Pilates instructors and physical therapists are in a unique position to help.

In March 2021, the Pilates Method Alliance posted a webinar led by Research Committee Chair, Sherri Betz, PT, DPT, CEEAA, NCPT, and her colleague, Kathleen McDonough, PT, MA, NCPT, a commission member of the National Pilates Certification Program.

Sherri and Kathleen were inspired to share the material they had learned in a session on COVID Long-Haulers by Dr. Mary Massery. This article contains some of the key takeaways from their presentation for Pilates instructors: “The Benefits of Pilates for COVID Long Haulers.”

Pilates principles have innumerable applications across all aspects of life, but none more than health and wellness. For COVID long haulers and those experiencing long-term breathing problems after contracting COVID-19, this idea is even more pertinent. Because the virus greatly impacts the lungs, learning to breathe properly and strengthening the respiratory system is vital for recovery. Beginning with this core symptom of Chronic COVID Syndrome can help improve stamina and reduce fatigue, provide mental clarity, and alleviate stress, anxiety, and fear.

Diaphragmatic breathing taught through Pilates is like strength training for the diaphragm and intercostal muscles. Not only does the diaphragm assist with the physical act of breathing, it is also necessary for correct posture and torso stability. Diaphragmatic breathing also helps to soothe the parasympathetic system, promoting a sense of calm and harmony between the mind and body.

Pilates Teachers’ Unique Opportunity to Help
Pilates teachers have the unique opportunity to assess a client’s current abilities and limits and track their improvement over time. Because you work so closely with your clients, you can help them get relief from persistent COVID symptoms. 

Assess
Begin with this simple assessment:

• Breathing observation: How deeply are they breathing and where from? How much effort is going into each breath?
• Respiratory rate: How quickly are they breathing? Are the breaths slow and deep or rapid and shallow?
• Observing speech rate: How many syllables are they able to speak in one breath? Is speaking elevating their respiratory rate?
• Quality of life assessments: Where in day-to-day life are they most impacted by lingering symptoms? Online assessments can assist with this.
• TUG test: A Timed Up and Go test is a simple way to assess stamina. Simply have your client sit in a chair or bench and place a marker such as a water bottle 10 feet away from them. Have the client stand (preferably without using their hands to assist), walk to and around the marker, then come back to their original starting place and sit. 10 to 15 seconds is a healthy range for the time this task should take; if it takes more time, this may be an indicator your client needs help building endurance or improving their gait.
• VAS: Using a Visual Analog Scale, have your client rate their pain levels. The most commonly used VAS is a simple smiley face system.
• Rate of perceived exertion: As your client completes tasks or reps of any specific exercise, have them rate their exertion from one to 10. Seven and higher typically denotes that this exercise is building strength while four to six may indicate a lower intensity endurance exercise. You can use their rating to adjust their regimen by either increasing or decreasing reps or movement complexity.

 
From here, you can develop a Pilates workout regimen specifically tailored to help your client regain strength, increase lung capacity, and return to a greater quality of life.

Teaching Components
For COVID long haulers, the primary benefit of Pilates training is in strengthening the respiratory system for more effective breathing. Developing a training regimen for your client with a focus on proper breathing techniques and respiratory strengthening is key to helping relieve lasting symptoms. Some ideas may include:

• Focus on core breathing technique: Ask your clients to inhale and exhale through the nose to encourage diaphragmatic breathing and engage the core muscles. If they need to exhale through the mouth or inhale partially through the mouth allow them to do so as they build up their respiratory strength.
• Integrate physiology and posture: Incorporate spinal extension, shoulder flexion and external rotation to facilitate proper inhalation and exhalation. Lifting the arms with each inhale and lowering them with each exhale decreases the pressure in the thoracic cavity. This is why patients who are having difficulty breathing may sometimes be placed in a prone position with the arms above their head in hospital or clinical settings. Conversely, extending the spine and lifting the arms on the exhale and lowering them on the inhale offers a challenge for clients that will engage the abdominal muscles, relieve lower back pain, and grant better trunk control depending on their needs.
• Cue the diaphragm: Engaging the diaphragm either through physical touch or with the assistance of therabands wrapped around the rib cage strengthens the diaphragm and decreases the work of breathing. These tactile cues increase awareness of breath for your clients and can greatly improve their quality of breath.
• Utilize breath restriction devices to strengthen expiratory muscles: Creating resistance during exhalation adds a small amount of additional challenge that helps to strengthen the core muscles necessary for breathing. The Breather training tool offers the ability to choose the level of difficulty and switch between either inhalation or exhalation, allowing for greater personalization in breath training.
• Increase Glottal and Pelvic Control using the ‘Ha’ Sound: The glottis acts as part of the trunk control and pressure management system. Improving glottal control in COVID long hauler clients increases core engagement and teaches them to take fuller, deeper breaths.
• Re-assessment: Continually assessing client improvements and challenges allows for precise targeting and effective teaching.

Further Reading and Educational Resources:

Dr. Mary Massery, Massery Physical Therapy

The PACER Project by APTA Academy of Cardiovascular and Pulmonary Physical Therapy

Breath: The New Science of a Lost Art by James Nestor

The Wim Hof Method: Activate Your Potential, Transcend Your Limits by Wim Hof

Just Breathe: Mastering Breathwork by Dan Brule

The Oxygen Advantage: Simple, Scientifically-Proven Breathing Techniques to Help You by Patrick McKeown

What Doesn’t Kill Us: How Freezing Water, Extreme Altitude, and Environmental Conditioning Will Renew Our Lost Evolutionary Strength by Scott Carney

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