COVID-19 rehabilitation for fatigue, breathing, and mental health

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While most people make a full recovery from COVID-19, some can develop complications. COVID-19 rehabilitation focuses on helping people regain their physical and cognitive abilities after the illness.

The virus SARS-CoV-2, which spreads easily from person to person, causes COVID-19. Symptoms range from mild to severe, though not everyone develops any.

People who experience severe or debilitating symptoms may need support as they recover. This may include:

Early evidence suggests that some complications, such as heart or lung damage, may improve with time, particularly if they receive prompt rehabilitative care.

This article explores why some people may need rehabilitation after COVID-19, the different types available, and some online and in-person resources that may help.

COVID-19 can affect the body in a variety of ways. While 81% of people experience mild to moderate illness and recover without treatment, 14% develop severe symptoms that can last several weeks or months.

Some people also go on to develop “long COVID,” which occurs when COVID-19 symptoms linger for weeks or months after acquiring the initial infection. Some people refer to this group as “long haulers.”

People who are recovering from severe illness, or who have long COVID, may require rehabilitation to manage the aftereffects of COVID-19. According to the World Health Organization (WHO), these include:

People who required ventilation while they had COVID-19 may experience further complications, such as delirium or injury to the airways. Lasting fatigue or long stays in an intensive care unit (ICU) can also weaken the muscles due to the prolonged rest.

The following sections look at the types of rehabilitation that may help people recovering from COVID-19 and its long-term effects.

Some people who recover from COVID-19 may need physical rehabilitation to help them resume normal activities after staying in the hospital, or following periods of prolonged isolation.

Physical therapy can help those with decreased strength begin to move more, gradually building up their stamina. According to a 2020 review, physical therapy for those recovering from COVID-19 aims to:

  • restore function to the muscles
  • reduce the likelihood of mental health conditions that may occur as a result of limited mobility
  • enable people to return to their normal lives

How physical therapists achieve this depends on a person’s unique circumstances and stage of recovery. If they are still in the hospital, this can involve:

  • helping people learn to change positions in bed
  • performing passive joint motion, which consists of a therapist moving someone’s body for them
  • teaching stretches a person can do in bed or at their bedside
  • helping people practice walking without aid

After someone leaves the hospital, a physical therapist may recommend:

  • aerobic exercises that people can do around the home, such as walking up and down the stairs
  • low-intensity resistance training, such as squats or carrying objects
  • balance training

Postexertional malaise

It is important to note that many people with long COVID report that exercise can temporarily worsen their symptoms. This is known as postexertional malaise (PEM).

For this reason, the National Institute for Health and Care Excellence (NICE) in the United Kingdom advise doctors not to use graded exercise therapy to treat people with long COVID.

If a person notices their symptoms worsen during or after exercise, they should stop the activity and rest. It is important for anyone recovering from COVID-19 to carefully pace their exercise so they do not experience PEM, injury, or other side effects.

COVID-19 can have long-term effects on lung function in some people. These are more likely in those with an existing chronic illness that affects the lungs, such as chronic obstructive pulmonary disease.

Pulmonary rehabilitation, or respiratory physiotherapy, has the following aims:

  • reducing shortness of breath
  • improving lung capacity
  • managing any respiratory complications
  • reducing the impact of respiratory symptoms on mental health

Like physical therapy, pulmonary rehabilitation also works to improve muscle strength and endurance. By helping someone become more active, they can also improve their breathing.

However, specific interventions can ease symptoms such as coughing, wheezing, and shortness of breath. These exercises include:

  • training to adjust someone’s breathing rhythm
  • techniques to strengthen the breathing muscles
  • expectoration training, which helps someone clear mucus from the airways

COVID-19 can also impact the nervous system, including the brain. For some people, this may result in changes in cognition. According to a September 2020 article in The Lancet, those with long COVID may experience:

  • memory problems
  • trouble concentrating
  • brain fog
  • dramatic mood changes
  • a loss of taste or smell

People with severe COVID-19 may also experience cognitive changes. Up to 80% of people who receive ventilation experience delirium, which can include hallucinations. For critically ill patients who do not need ventilation, the condition affects 20–40%.

Doctors are still learning about the best ways to reduce the likelihood of these complications. However, cognitive rehabilitation therapy (CRT) can help manage or potentially recover from them.

CRT helps someone practice specific thinking patterns and behaviors to strengthen their cognitive abilities. This may include:

  • memory training
  • speech therapy
  • mental exercises
  • psychological support for people who feel confused or disoriented

Living through a severe illness can affect a person’s mental health in several ways. Some people who survive COVID-19 may experience psychological trauma, which is a response to extreme stress.

Trauma may cause anxiety, depression, or disassociation, which refers to a feeling of disconnection from a person’s thoughts, feelings, or experiences. People who go through a traumatic event may not remember it clearly, or only remember certain parts.

Some people who experience trauma go on to develop post-traumatic stress disorder (PTSD), which causes longer-lasting symptoms, including flashbacks, nightmares, and hyperarousal. This may be particularly likely in people who needed to stay in an ICU or emergency medical care.

In addition to the impact of the initial illness, the chronic symptoms or complications people may experience can also be challenging. According to the National Institute of Mental Health (NIH), those with a chronic illness are more likely to develop depression.

However, effective treatments and therapies are available for trauma, PTSD, depression, and any other mental health condition that may arise due to acquiring COVID-19. A person may benefit from:

  • therapy, whether online or in-person
  • support groups for people with a particular condition
  • survivor groups, for people who have survived COVID-19
  • activities that ease stress and anxiety, such as yoga or mindfulness

Rehabilitation clinics

More healthcare centers in the United States now offer rehabilitation services to people recovering from severe COVID-19. A doctor could refer someone to these services, or a person can look online for nearby clinics.

Some examples of rehabilitation clinics include:

Support groups

Online support groups may help people with limited mobility stay connected and find others going through similar experiences to them. The groups that can help people with long-term symptoms include:

Other online resources and tools

Health organizations have published a range of materials to help people recover from COVID-19, including ideas for restoring strength, aiding breathing, and managing mental health. These include:

A person should call 911 or their local emergency department if they, or someone nearby, experience:

  • difficulty breathing
  • blue or white lips
  • persistent chest pain or pressure
  • new confusion or delirium
  • inability to stay awake

Notify the operator that the person may have complications as a result of COVID-19.

People recovering from COVID-19 should also seek help if their symptoms are severe or suddenly worsen. Support may be available for those whose symptoms make it difficult for them to carry out daily tasks, such as washing or dressing.

If someone is experiencing anxiety, stress, or other mental health issues, they may wish to speak to a counselor or therapist. People with the symptoms of PTSD should seek treatment early if possible, as this can help in the long-term.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Click here for more links and local resources.

The cognitive, physical, and pulmonary effects of COVID-19 are numerous, affecting each person differently. Rehabilitation from this disease may involve consulting multiple specialists, depending on the impact of the illness.

Physical therapists, respiratory physiotherapists, and psychologists could all help people regain function and improve their quality of life.

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