Although we are learning about this new disease daily, interesting new research by Severin et al finds that,

“in patients identified as having respiratory muscle impairments, respiratory muscle training may prove valuable in mitigating the health impact of future pandemics.”

Severin et al

Respiratory Muscle Training

The purpose of respiratory muscle training (RMT) is to improve the strength and stamina of all your respiratory muscles. RMT targets the muscles you use to breathe in and out in the most efficient way, mainly using your diaphragm, intercostal muscles, transverse abdominus and abdominals. Not only will this improve your breathing muscle strength, but also exercise capacity and difficult or laboured breathing.

You can easily train your most important breathing muscles with a POWERbreathe Inspiratory Muscle Training device. Inspiratory muscle training (IMT) uses resistance to exercise your breathing muscles. The POWERbreathe IMT training protocol of 30 breaths twice a day is scientifically proven. Furthermore, using a forceful in-breath is also scientifically proven to produce the most benefit.

Respiratory Muscle Training and Viral Infection

Because of the newness of this pandemic, there is only a small amount of research investigating the role of breathing exercises in reducing respiratory failure. However, there is existing research that supports the use of pre-operative Inspiratory Muscle Training for reducing the risk of post-operative complications.

POWERbreathe IMT in Pre-op, Post-op and ICU

Medical professionals are enrolling patients to use POWERbreathe IMT pre-operatively in order to improve post-operative outcomes. The intention is to increase their respiratory fitness prior to surgery, using the most advanced, electronic POWERbreathe K-Series. This will stand patients in good stead after surgery. So, the fitter you are before surgery the more quickly you’re likely to recover.

The current consensus of opinion is that POWERbreathe IMT can be very important before and after any period of hospitalisation. The time in the middle, weaning from a ventilator, is more difficult with COVID-19 patients. This is due to the potential spread of the virus through respiratory droplets. However, in normal circumstances, use of the POWERbreathe KH2 for ventilator weaning is proving popular and effective.

Pre-op IMT Improves Post-op Outcomes The POWERbreathe K-Series is in use in a large multi-centre, preoperative study in the NHS called the Inspire Study.

Improve your Respiratory Fitness

Improving your respiratory fitness following full recovery from COVID-19 (SARS-CoV-2) is possible with exercises to help breathing. The POWERbreathe Medic Plus breathing training device provides deep breathing exercises for COVID patients who are in full recovery, where safe and practicable, taking care not to exacerbate the condition; trying too hard too soon. We suggest you only begin using IMT after consultation with your GP after full recovery, because this coronavirus transmits between people through respiratory droplets and contact routes.

How COVID-19 Affects Your Lungs – NHLBI

Below, an NHS Paramedic shares his experience of COVID-19 and how the POWERbreathe Medic Plus is helping with his recovery.

Breathing Exercises for COVID using POWERbreathe Medic Plus

COVID-19 and Respiratory Burden

Patients who suffer severe breathing difficulties from COVID-19 require mechanical ventilation. This removes the effort of breathing that patients experience, and provides a ‘rest’ for the breathing muscles, lungs, heart and brain. However, this results in loss of muscle strength all round, including the breathing muscles. So, the sooner weaning takes place the less likely patients are to suffer worse clinical outcomes.

“A major risk factor for weaning patients from mechanical ventilation is weak inspiratory muscles (i.e., diaphragm). Unfortunately, an unintended consequence of mechanical ventilation is the rapid development of inspiratory muscle weakness that promotes weaning difficulties.”

Scott Powers, Professor-Department of Applied Physiology/Kinesiology-University of Florida.

Evidence from studies show a connection between poor respiratory muscle performance, mechanical ventilation and respiratory complications. In fact, there are studies that show IMT improves ventilator weaning outcomes and reduces the length of stay in hospital:

Physiotherapy Management for COVID-19 in the Acute Hospital Setting recommends the use of IMT as part of the weaning process in their Recommendations to guide clinical practice.

Respiratory Muscle Training in the time of COVID-10 – Across the World

This video from the American Physical Therapy Association (APTA ) discusses the basics of Respiratory Muscle Training. It includes numerous references to POWERbreathe IMT, as well as, how to utilise IMT in several patient populations, including those patients with COVID-19.

Furthermore, a clinical trial will be looking into rehabilitation for people with COVID-19 in ICU. It is, ‘Pulmonary and Motor Rehabilitation for People With COVID-19 in Intensive Care Units to Reduce Length of Stay in Hospital‘. It will investigate how early pulmonary and motor rehabilitation impacts on length of hospital admission (ICU and acute ward) and early and late outcomes in patients that develop ARDS due to COVID-19.

Participants will start rehabilitation at admission in ICU. They will start a hierarchical, standardised protocol that includes functional, respiratory and strength training, including ‘cautious inspiratory muscle training’.

“Once patients are no longer infectious, additional techniques can be used to help clear their lungs. These include blowing bubbles to create positive pressure in the lungs, tapping the back to help the lungs release the mucus, or focused patterns of huffing and coughing. We can also use spring-loaded resistance devices to strengthen diaphragm muscles.”

Dr Bernie Bissett, Intensive Care Unit Physiotherapist

Dr Bernie Bissett is very familiar with using IMT, including POWERbreathe with patients in ICU settings and is using respiratory muscle training to help “set ICU patients free”.

Post-COVID Hub

Asthma UK and British Lung Foundation are working together to bring this dedicated Post-COVID Hub of up-to-date information. It is for COVID-19 patients who, during recovery, are experiencing breathing difficulties. It also for their families. Furthermore, it is a hub for carers, healthcare professionals, researchers, policy-makers and commissioners.

Supporting Recovery from COVID-19

This BMJ article, ‘Management of post-acute covid-19 in primary care’, is intended for primary care clinicians. It explains how post-acute COVID-19, or “long COVID”, appears to be a multi-system disease, which may occur after only mild acute illness. It suggests that a holistic and paced approach may assist with recovery, along with interprofessional, community-facing rehabilitation services which embrace patient self management and peer support.

Respiratory Symptoms and Support

The article explains how breathing techniques are helpful. This is because after illness there may be reduced diaphragmatic movement, and around 80% of the work of breathing is done by the diaphragm. As a result, a patient will experience shallow breathing, an increase in fatigue and breathlessness, as well as, higher energy expenditure. Breathlessness is common after acute COVID-19 but will improve with breathing techniques.

Breathing Techniques

The aim of the ‘breathing control’ technique is to normalise breathing patterns and increase the efficiency of the respiratory muscles, such as the diaphragm. Respiratory muscle training exercises the diaphragm and intercostal muscles (the muscles between the ribs). It improves breathing muscle strength and stamina, and reduces breathing fatigue. It is suggested that specialist advice be sought to help identify which breathing technique best suits a patient.