Long-term management of people with COVID — that is, symptoms that persist beyond four weeks after COVID infection — can be extremely complex due to the wide variety of problems associated with the condition.

While there is no ‘one size fits all’ treatment, it is increasingly recognized that allied health professionals, such as physiotherapists and occupational therapists, are important in treating people in different stages of COVID.

We’re still learning about long COVID, but these experts can adapt exercise training, breathing techniques, and ways to safely manage fatigue to help people get back to their normal roles and routines.

Long COVID and the body

While the exact mechanism why people develop long-term COVID remains unclear, current evidence suggests that the persistent COVID virus may trigger a cascade of sustained inflammatory and immune responses in the body.

This results in signs and symptoms in multiple body systems, including the respiratory and autonomic systems, which control functions such as heart rate, breathing, and digestion. This could explain common symptoms of long-term COVID, such as brain fog, fatigue, headaches, difficulty breathing, and changes in taste and smell.

Estimates suggest that anywhere from 5 to 50 percent of those infected with COVID develop long-term COVID.

Allied health professionals — who are not doctors, dentists, nurses or midwives but provide specialized care — such as physical therapists and occupational therapists can be particularly effective in managing the signs and symptoms of long-term COVID.

This may be in part because they are used to working with patients to develop strategies and work towards functional goals.

Practice training

Exercise training is the most common treatment prescribed by physiotherapists to help people with long-term COVID. Studies have shown that exercise programs can help people with long-term COVID reverse the effects of fatigue, muscle weakness, shortness of breath and exercise intolerance.

Pulmonary rehabilitation is an exercise and education program often led by a physical therapist and designed to help people with persistent lung disease. Such programs have been shown to be effective for people with long-term COVID.

However, not all exercise programs are suitable for everyone with a long COVID. For some people with ongoing fatigue issues, starting a graded exercise program that progresses through a variety of poses can also be effective in improving exercise fitness and reducing fatigue levels.

Repetitive range-of-motion exercises such as range-of-motion exercises may be prescribed for joint and/or muscle pain and stiffness. Other therapies such as fall prevention, muscle strengthening and balance training are also suitable for people with reduced mobility, deconditioning and muscle wasting due to long-term COVID.

It is important to seek advice from a physiotherapist before starting any exercise, as overexertion can hinder your recovery. Thorough assessment of your heart function and fatigue symptoms before returning to exercise — and close monitoring during exercise — are essential because symptoms can fluctuate over time.

Breathing techniques and inspiratory muscle training

In addition to prescribing an exercise program, physical therapists can provide strategies for managing shortness of breath, a common symptom of long-term COVID. For example, physical therapists often teach people how to practice relaxed controlled breathing to recover from episodes of shortness of breath.

People with long COVID may also feel the persistent need to cough or empty their chest. Secretion clearance techniques such as the active cycle breathing technique may be helpful.

Inspiratory muscle training includes specific exercises prescribed to strengthen the respiratory (respiratory) muscles. This often involves taking a deep breath through a device that provides resistance.

This form of training has proven helpful for some people with long-term COVID, but is not beneficial for all patients.

It is important to consult a physiotherapist about the best breathing technique for your symptoms, as therapies for people with long-term COVID work best when they are tailored to the person.

Breathing exercises should be closely monitored as they are not helpful for everyone with a long COVID. Photo: Getty

Fatigue management and other treatments

In addition to rehabilitation exercises, both physiotherapists and occupational therapists can provide personalized strategies to manage symptoms and improve participation in work and daily life for people with long-term COVID.

For example, they can develop strategies to improve or compensate for poor attention and memory, or help plan a daily routine to cope with fatigue so that people can resume their usual roles and routines.

Other health professionals can also provide individualized treatment to help with recovery. Psychologists can offer non-drug treatments to improve anxiety and depression. Speech pathologists can help someone who has a persistent hoarse voice.

Functional goals and strategies can help people with long-term COVID return to their usual routines. Photo: Getty

How do you get help for long COVID?

If you have long-term COVID, ask your doctor to refer you to a multidisciplinary long-COVID program where different types of health professionals work together, or specific health professionals depending on your symptoms.

Multidisciplinary programs have been shown to be most effective in treating people with long-term COVID. In Australia, there are some long COVID clinics that provide monitoring and treatment. However, there is an urgent need to establish more of them across the country.

While long-term COVID symptoms can be debilitating, many symptoms appear to improve with time. That said, you may be able to recover more quickly with the help of a physical therapist or occupational therapist.


Clarice Tang, Senior Lecturer in Physiotherapy, Western Sydney University, Karen Liu, professor of occupational therapy, Western Sydney University, Curry SalibaUniversity of Western Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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