In the third year of this global pandemic, we know more about the long-term effects of COVID than ever before. The Boston Medical Center puts it starkly, writing that “we don’t know exactly how many people get long COVID, but studies suggest it’s about one of every five people who gets COVID-19.”1 These statistics reveal that millions of people are suffering from Long COVID as I write this, and that holistic treatments, including yoga therapy, can help manage symptoms.
For obvious reasons, Long COVID is a concern for all of us. I’ve combed through studies, research, and first-hand accounts from physicians to start to understand the symptoms and effects of Long COVID on the human body. Many studies, and even current Long COVID recovery clinics, outline treatment plans that center on breathwork, which is a large focus of my yoga therapy sessions. This gives me hope that yoga therapy can help mitigate Long COVID symptoms and support healing.
What is Long COVID?
Long COVID is diagnosed when a person experiences a “variety of new, returning or ongoing symptoms…more than four weeks after getting COVID-19”.2 According to The Atlantic, it is estimated that “10 to 30 percent of those infected have long-term symptoms” of COVID-19.3 Long COVID is also known as post-COVID-19 syndrome, long-haul COVID-19, and post acute sequelae of SARS COV-2 infection (PASC). Symptoms of Long COVID range from fatigue to joint pain.
One of the most fascinating aspects of Long COVID for me is that it shares symptoms with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). I have worked with multiple clients to use yoga therapy to mitigate their symptoms of chronic fatigue, so I’m especially interested in the similarities between Long COVID, CFS/ME, and chronic fatigue.
In an interview, Kirsten Bibbins-Domingo, MD, PhD, editor-in-chief of the Journal of the American Medical Association (JAMA) sums up the resemblance when she says, “there are so many interesting things emerging about the patterns of symptoms that make up long COVID…Why do we get this symptom cluster? How do common symptoms like fatigue vary across conditions like chronic fatigue syndrome versus long COVID?”4 Her honest evaluation of Long COVID connection to chronic fatigue makes me hopeful that yoga therapy might be useful in mitigating symptoms of Long COVID.
Luckily, there are studies to back up that hope. One June 2022 study found that Long COVID patients report similar cognitive and physical symptoms to CFS, “but with less severe pain and fatigue overall.”5 It seems that the shared symptoms will help researchers recognize complementary therapies, such as yoga therapy, that aid recovery from Long COVID.
What are the symptoms of Long COVID?
Symptoms of Long COVID include:6, 7, 8
- Brain fog (cognitive impairment or disfunction)
- Changes in smell and taste
- Shortness of breath
- Chest pain
- Muscle or joint pain
- Gastrointestinal symptoms
One important thing to note is that COVID disproportionately impacts “historically marginalized racial and ethnic groups” as well as older adults, people with disabilities, and those who have been economically or socially marginalized.9 This makes yoga therapy even more crucial. Yoga therapy aims to educate clients on how to continue healing independently, long after the last yoga therapy session. Yoga therapy, therefore, gives agency to those who might otherwise not have access to good healthcare or doctors.
Are you or a student of yours experiencing any of these uncomfortable symptoms? Let’s dive into specifics about how yoga therapy can help.
How can yoga therapy help mitigate Long COVID symptoms?
One of the five Long COVID treatment options laid out by the Boston Medical Center is “breathing therapy and retraining.”10 That’s where yoga therapy comes in. Working with clients on breathing techniques to regulate the autonomic nervous system is a large part of my work as a yoga therapist. In this way, yoga therapy can help make symptoms of Long COVID more bearable, and may even help alleviate symptoms.
In fact, at Mount Sinai, researchers found that after a week of breathwork exercises, patients with Long COVID “in the pilot program reported improvement in symptoms like shortness of breath and fatigue.” These breathwork exercises were “very similar to the most basic coherent breathing technique,”11 which is one technique that I use with my clients in yoga therapy.
Coherent breathing is diaphragmatic breathing at a rate of 5-6 breaths per minute. This breath rate has been proven to show improvements in heart rate variability,12 which is an indicator of regularity of autonomic nervous system function.13 Breathwork not only helps clients control their heart rate; it also helps modulate the nervous system’s fight-or-flight response, and potentially contributes to a regulated immune system as a result. Proper breathing is “crucial to circulation in the lymphatic system, often described as the body’s highway for immune cells,”14 so the quality of our breathing has a direct effect on our immune function. Not only that, but coherent breathing also helps to mitigate exhaustion and fatigue, as the nervous system is able to relax and expend less energy.
Breathwork isn’t the only way yoga therapy can help mitigate effects of Long COVID on the body, however. Here are a few other ways yoga therapy can help:
- Gentle physical movement that can be easily modified and adapted to fatigue levels.15
- Maintain mobility and strength.
- Offering practices that provide constructive rest, such as yoga nidra.
- Improve mind-body awareness, thus improving observation of energy levels and body signals, and increasing the opportunity to adjust physical activity and stress accordingly.
- Meditation techniques for coping with symptoms.
From my experience working with clients as a yoga therapist, I have found yoga to be a powerful tool when dealing with chronic illness, whether it is Long COVID or ME/CFS. For some of my clients in our yoga therapy sessions, I teach diaphragmatic breathing with a ratio (inhale to a count of 5, exhale to a count of 6). I also guide clients in training the body to relax while breathing. Yoga therapy not only provides a framework to maintain mobility and strength, but I’ve found it’s also a powerful management tool for pain, exhaustion, autoimmune disease, and an overwhelmed nervous system.
What does the research say about yoga therapy benefits?
The Long COVID Breathing Group at Boston Medical Center is putting breathwork into practice as a way to mitigate Long COVID symptoms. Claiming that dysfunctional breathing might contribute to Long COVID symptoms, this clinic “utilizes a range of evidence based breathing therapies,” including the Buteyko breathing method, Resonance frequency breathing, resistance training breathing, and mindfulness training.16 In yoga therapy, I often work with clients on similar breathwork techniques.
Another example of a clinic using a process similar to yoga therapy frameworks comes up at Mount Sinai. David Putrino, director of rehabilitation innovation for the Mount Sinai Health System, actually lays out the yoga therapy process, without naming it as such. Putrino states, “there is no algorithm. There is listening to your patient, identifying symptoms, finding a way to measure the severity of the symptoms, applying interventions to them, and then seeing if those symptoms resolve. That is the way that medicine should be.” I’m thrilled to see a holistic approach being utilized in a clinical setting to help treat Long COVID.
How do I start yoga therapy?
I am passionate about guiding my clients in yoga therapy sessions that work for their individual needs. My years of experience working with yoga practitioners who have therapeutic goals have taught me that every body is different, with unique limitations and growth points. Never using a one-size-fits-all approach, I always honor each individual body and symptoms in my one-on-one yoga therapy sessions.
How can I support you in your therapeutic journey? I take the time to get to know you and your needs, so that yoga therapy is not just effective, but is also enjoyable and satisfying. If yoga therapy resonates with you, I’d love to meet you. You can book a free 15-minute consultation with me to get a sense of how yoga therapy might work for you.
1 Center, B. M. (2022). Long COVID. Boston Medical Center. Retrieved December 12, 2022, from https://www.bmc.org/patient-care/conditions-we-treat/db/long-covid
2 Staff, M. C. (2022, June 28). Covid-19: Long-term effects. Mayo Clinic. Retrieved December 12, 2022, from https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351
3 O’Rourke, M. (2021, March 8). Unlocking the Mysteries of Long COVID. The Atlantic. Retrieved December 12, 2022, from https://www.theatlantic.com/magazine/archive/2021/04/unlocking-the-mysteries-of-long-covid/618076/
4 Unger, T., & Bibbins-Domingo, K. (2022, November 8). ‘Tripledemic,’ long COVID, burnout & more with Kirsten Bibbins-Domingo, MD, Phd . American Medical Association. Retrieved December 12, 2022, from https://www.ama-assn.org/delivering-care/public-health/tripledemic-long-covid-burnout-more-kirsten-bibbins-domingo-md-phd-0
5 Haider, S., Janowski, A. J., Lesnak, J. B., Hayashi, K., Dailey, D. L., Chimenti, R., Frey-Law, L. A., Sluka, K. A., & Berardi, G. (2022). A comparison of pain, fatigue, and function between post–covid-19 condition, fibromyalgia, and chronic fatigue syndrome: A survey study. Pain, Publish Ahead of Print. https://doi.org/10.1097/j.pain.0000000000002711
6 Office, U. S. G. A. (2022, March 2). Science & Tech Spotlight: Long COVID. Science & Tech Spotlight: Long COVID | U.S. GAO. Retrieved December 12, 2022, from https://www.gao.gov/products/gao-22-105666
7 Association, A. M. (2022, May 15). What is long COVID? American Medical Association. Retrieved December 12, 2022, from https://www.ama-assn.org/delivering-care/public-health/what-long-covid
8 Herrera, J. E., Niehaus, W. N., Whiteson, J., Azola, A., Baratta, J. M., Fleming, T. K., Kim, S. Y., Naqvi, H., Sampsel, S., Silver, J. K., Verduzco‐Gutierrez, M., Maley, J., Herman, E., & Abramoff, B. (2021). Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM&R, 13(9), 1027–1043. https://doi.org/10.1002/pmrj.12684
9 Lubell, J. (2022, September 23). HHS reports detail plans to boost care, research on Long COVID. American Medical Association. Retrieved December 12, 2022, from https://www.ama-assn.org/delivering-care/public-health/hhs-reports-detail-plans-boost-care-research-long-covid
10 Center, B. M. (2022). ReCOVer Long COVID Clinic. Boston Medical Center. Retrieved December 12, 2022, from https://www.bmc.org/infectious-diseases/recover-long-covid-clinic
11 Institute, T. M. (2021, April 2). Breathwork Key To Long Covid Treatment? [web log]. Retrieved December 12, 2022, from https://themindedinstitute.com/breathwork-key-to-long-covid-treatment/.
12 Lin, I. M., Tai, L. Y., & Fan, S. Y. (2013). Breathing at a rate of 5.5breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. International Journal of Psychophysiology, 91(3), 206–211. https://doi.org/10.1016/j.ijpsycho.2013.12.006
13 Staff, H. H. P. (2021, December 1). Heart rate variability: How it might indicate well-being. Harvard Health. Retrieved December 12, 2022, from https://www.health.harvard.edu/blog/heart-rate-variability-new-way-track-well-2017112212789
14 O’Rourke, M. (2021, March 8). Unlocking the Mysteries of Long COVID. The Atlantic. Retrieved December 12, 2022, from https://www.theatlantic.com/magazine/archive/2021/04/unlocking-the-mysteries-of-long-covid/618076/
15 Herrera, J. E., Niehaus, W. N., Whiteson, J., Azola, A., Baratta, J. M., Fleming, T. K., Kim, S. Y., Naqvi, H., Sampsel, S., Silver, J. K., Verduzco‐Gutierrez, M., Maley, J., Herman, E., & Abramoff, B. (2021). Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM&R, 13(9), 1027–1043. https://doi.org/10.1002/pmrj.12684
16 Center, B. M. (2022). Long COVID Breathing Group. Boston Medical Center. Retrieved December 12, 2022, from https://www.bmc.org/long-covid-breathing-group
17 O’Rourke, M. (2021, March 8). Unlocking the Mysteries of Long COVID. The Atlantic. Retrieved December 12, 2022, from https://www.theatlantic.com/magazine/archive/2021/04/unlocking-the-mysteries-of-long-covid/618076/