An article from Chris Sapienza, Ph.D, Senior VP for Academic Affairs, Jacksonville University.
A unique virus that is transmitted person to person, COVID-19 has spurred a rapid global response in search of methods for preventing, testing, and treating the acute symptoms as well as managing the long-term effects of post-COVID care. Symptoms may appear 2-14 days after exposure and include shortness of breath, cough, sore throat, muscle pain and fever. Respiratory complications include pneumonia and, in severe cases, acute respiratory distress syndrome. Even after the virus leaves the body, patients can be left with lung damage, difficulty breathing, and reduced oxygenation to support circulation.
Mechanical ventilators have become the cornerstone in the standard of care for those with the most acute and severe symptoms; however, the ventilator itself, as a support system to breathing, causes significant complications. Risks include further lung damage and substantial respiratory muscle weakness due to muscles not actively creating a force during mechanical ventilations. Diaphragmatic weakness is likely to occur the longer the patient is on the ventilator and the diaphragm is the main muscle that allows patients to easily draw air into the body for ventilation. Recovering patients report breathlessness even after mild exertion, and laryngeal examination reveals intubation and/or extubation trauma which results in loss or disordered voice, increased resistance to breathing and/or swallowing problems.
Due to the high susceptibility of contracting the virus among such populations as the elderly and those with heart and lung disease, a rehabilitation protocol that manages the symptoms of respiratory muscle weakness and post intu/extubation trauma to the larynx is needed immediately.
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A key component of a rehabilitation program for patients post COVID is respiratory muscle training (RMT), a technique used for almost 70 years to treat patients suffering from voice disorders, chronic obstructive lung disease, Parkinson’s disease, spinal cord injury, multiple sclerosis, etc. Further, RMT has also been used to improve ventilatory capacity and endurance in both healthy adults and the elderly.
RMT Usage & Effectiveness
RMT is a form of exercise and is accomplished with hand-held devices that create an overload to the respiratory muscles and can be used to assist in improving the muscle force generation of either inspiratory or expiratory muscles. Exercises developed to build capacity in respiratory muscles also invoke activity in upper airway muscles and therefore also improve function of the upper aerodigestive tract in speech, cough, and swallowing.
When the muscular system is activated frequently with the use of RMT devices and with sufficient intensity, the system will adapt and ultimately be capable of expressing more force. Different aspects of the muscular system adapt at different times, whether it be in the initial weeks following structured exercise versus several weeks to months later. Early adaptations that are responsible for enhancing force are primarily from the nervous system, whereas continued enhancements in force production predominantly result from an increase in the cross-sectional area of the muscle, known as hypertrophy. The result is functional changes to improved ventilation and voluntary cough ability, to improved voice and swallowing function.
The application of inspiratory and expiratory muscle strength training for Post COVID care is highly applicable and worth serious exploration to improve outcomes for these patients.
Chris Sapienza, Ph.D
Senior VP for Academic Affairs
2800 University Blvd North
Jacksonville, FL 32211