Long Covid and Yoga
Podcast Excerpt and Transcript
Listen in to an excerpt from a recent group coaching discussion with lead trainer Heather Agnew and yoga teachers-in-training on how to adapt our yoga classes to make them safer and more accessible for students returning from illness and experiencing long Covid symptoms.
or, Read the Transcript Notes with links and resources below:
How to support students living with Long Covid
Hello Folks, today we are going to start a discussion on how we can get informed about how to adapt, adjust, and provide support to students living with Long Covid (LC).
I’ve prepared a few thoughts which I’ll read now for you all, and for those who will be listening later, and then we’ll dig into a discussion together.
I’m still doing some research and hoping to put together some resources for us all – obviously because this is an evolving issue there aren’t clear guidelines for us yoga teachers to follow, but I’m doing my best to find some guidance and ideas, particularly drawing from the recommendations for folks living with post viral illnesses like Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), POTS, post-exertional fatigue/malaise (PEM) etc.
Our role as yoga teachers might include providing adaptations, modifications, and support in class, referrals back to their doctor, to a class better suited to their needs, or perhaps new classes on your schedule that can provide a more suitable practice for people living with long covid and other post viral syndromes – which absolutely we could have made more available prior to this moment in time given the number of people living with ME/CFS, POTS, and other post viral syndromes.
What started this conversation?
What started this conversation was a few grads and teachers-in-training reporting back to me that they are having students return to practice with symptoms like dizziness, fatigue, breathlessness, post exertional fatigue, brain fog, muscle pain, heart palpitations.
Before we dig in, a few important points:
Firstly, I want to start by reminding you I’m not a doctor, physio, researcher, or science communicator. I am just trying to get a handle on an evolving situation like the rest of you and hoping we can work together to try to prepare for those students returning to class with Long Covid symptoms.
Secondly – if your students come to you about new or worsening symptoms, we must refer them to their doctor. We can’t assume anything; assumptions can be dangerous. Your student might need reminding to see their doctor to rule out other serious problems, such as cardiac issues or lung disease.
If a new and serious symptom arises for a student during class – that might mean experiencing new chest pain, difficulty breathing, dizziness, bluish lips, palpitations or irregular heartbeat, cool and clammy skin, excessive fatigue, new swelling in legs, or any other sign of a life-threatening problem, stop your class, call emergency services right away.
If a student mentions having long covid or any related symptoms, what symptoms require referral to a doctor? Any of the above, and also from one source ‘Any symptom that interferes with your daily life is worth a call to your doctor’
How many people might this be?
It sounds like it depends on how many times you are infected with Covid-19, but currently I’m hearing figures like 20% of folks with one Covid infection having some Long Covid symptoms, and as many as 50% of people with multiple Covid infections. That’s a lot of people.
What are the symptoms?
There have been over 200 symptoms reported, but most commonly:
- Shortness of breath
- Brain Fog or cognitive impairment
These 3 are the most common, but other common symptoms reported include:
- Heart Palpitations with or without exertion
- Muscle aches and pains
- Loss of smell or taste
- Anxiety or depression
- Post exertion fatigue or malaise
How Long is Long Covid?
From what I’ve read, some are affected for 3-6 months, some folks who were infected early on in Covid in 2020 are still living with symptoms.
Are you just tired or unfit?
Frequently I’m seeing people saying, ‘oh well maybe I’m just tired from not doing enough exercise. Maybe I’m breathless because I didn’t practice for a few weeks? I should practice more to get my fitness back.’
Here’s what the current science says:
“Exercise induced fatigue does not seem to be linked to detraining” (the loss of fitness when you don’t exercise for a few weeks)
“For decades, physicians advised chronic fatigue syndrome patients that exercise would improve their symptoms, but for many patients, exercise actually made their symptoms worse and now is no longer recommended.
“You can’t just jump into exercise, or you’re going to be set back…but you should “slowly try to reincorporate it if you are feeling better.”
“Long Covid can manifest in different ways, so doctors and patients may need to tailor their recommendations to patients’ needs…for every patient, long Covid is different. There’s probably never going to be a one-size-fits-all recommendation for exercise.”
What is Recommended?
Rest and pacing.
“Rest and pacing, rather than graded exercise, seem the most effective treatments to prescribe widely to long Covid patients”
Unfortunately, the importance of rest and pacing for people with ME/CFS and PEM has sometimes been downplayed in favor of more aggressive measures of supposed treatment.
In 2011, a now-discredited study in the Lancet argued that a form of cognitive behavioral therapy (CBT), and what the researchers called “graded exercise therapy” (GET), were the most effective forms of treatment for ME/CFS because they forced patients to overcome a fear of exercise that the researchers argued was keeping patients ill.
These claims have since been debunked, and the Centers for Disease Control and Prevention (CDC) and other health agencies have stated that ME/CFS is an illness with biomedical origins which can be made worse by exercise, rather than an illness whose supposedly psychological roots can be conquered via GET and a bastardized form of CBT.”
On a personal note:
As someone who has lived with some chronic illness for over a decade now, it can be a real challenge to rest and pace your exertion. This is where yoga can be a support rather than a harm. Learning to listen to your body rather than the ‘shoulds’ and ‘shouldn’ts’
‘Shoulds’ might sound like – oh I should do a full practice, I should go to class even though I’m tired, I should get back to movement as quickly as possible.
‘Shouldn’ts’ might sound like– I shouldn’t still be feeling tired, I shouldn’t be taking this long to feel better, I shouldn’t need to take a nap everyday.
This is where yoga and the self-study and the body awareness and the energy awareness can be helpful, so we don’t have that battle with those ‘shoulds’ and ‘shouldn’ts’ and we can respond to what is happening right now
So, for me yoga has played a key role in overcoming those urges and being able to live with myself as I am rather than what I think I should be. So, that’s just my own personal not from me on that.
I do understand for those of you who are listening who are dealing with LC that there are other yoga practices that you can be using right now. One of them is to be listening to your body.
As yoga teachers, what should we be prepared to do?
- Offer chairs, bolsters, and props for practice (use them yourself, make them a key part of the practice so students are more inclined to use them)
- Invite students to work at their own pace, and offer multiple options for each pose – that might include a standing version, a seated version, a reclined version of each pose
- Speak to how fatigue is a sign to rest, not to push
- Offer alternatives, especially to things like sun salutations if the up and down is causing dizziness, e.g., seated Sun Salutations (floor, chair), wall salutations, adapting salutations so you aren’t going into forward fold, coming up and down off the ground, keeping the head above the heart etc.
- Sequence more time for breathwork, meditation, and rest
- Sequence space between poses – perhaps moving away from super dynamic flows in every class – having some classes where there is time to pause. That might be pausing in Mountain, Child, or Savasana depending on the pose. Maybe offering some classes that are a little steadier.
- Get creative about flows if you are teaching flow classes that instead of being big dynamic asana flows that can be a little more gentle, that combine gentle movement, breathwork and mudra – like an Anjali Mudra flow which combines gentle multiplanar movement, breath and mudra.
- Reducing those overly deep breath cues (take in a really big breath), that might be really challenging for people living with LC. We might make more recommendations to breathe as much as you need to for this moment, if your breathing is difficult, aim to take gentle breaths.
- Consider offering shorter classes – online or in-person. 15 min online classes, 30-min classes
- Be aware of bio-medical-miracle claims that are already present in the yoga and wellness communities that suggest certain poses, breathwork or meditations for ‘healing’ from long covid. There is no evidence for that at this point.
- Do be aware of general benefits of gentle exercise, breathwork, meditation, philosophy, mudra, mantra, rest, self-study, body-awareness, community, and togetherness, there are lots of general benefits that people living with LC can draw from.
- Consider offering accessible yoga classes that can be suitable for folks with LC, as well as CFS, POTS, chronic pain, etc. check out the accessible yoga folks for their workshop options (link below).
On Pacing in Practice
(this is really useful!) Adapted from https://world.physio/sites/default/files/2021-06/WPTD2021-InfoSheet4-Pacing-Final-A4-v1a.pdf
Learn about your energy reserve
- this is how much energy you have each day, or if you follow spoon theory, how many spoons you have each day. This varies from day to day, so you might keep a journal to get a sense of your baseline energy reserve. Your baseline is what you can do easily on a good day, and your maximum effort on a bad day.
- Don’t exercise or practice to exertion. Leave some energy at the end of your practice, don’t keep going until you are tired, whether than be yoga practice or cycling or swimming or dance, whatever movement you do.
- Learn how much energy you have. This is where your energy journal is useful – you should start to see some patterns in your energy, and also start to learn to see the early signs of a crash. Like, I have my energy in the morning not the afternoon, or, after I get the kids ready for school I have a crash. So, you can learn about how you need to pace, rest, reduce, modify your activities to avoid those energy crashes.
Learn how to use the 4 Ps to help you plan your activities
- Prioritise what you really need to do in a day or week. What activities are really necessary? Can you farm this activity out to someone else? Can you adjust or modify the activity for what you need this week?
- Plan your main prioritised tasks for the day and plan your rest time.
- Pacing – break up your activity into smaller, more manageable tasks with rest breaks. That might include your practice – yoga snacks rather than a full practice – so taking 10 min here to do some yoga, and 10 min there, rather than thinking my yoga practice must look like this…your yoga practice doesn’t like
- Pleasure – spend some energy on things you enjoy that can help improve your quality of life – this is something that, for people living with chronic illness, life can become very small and lack pleasure. If all you spend your energy on are the necessary work things, the necessary household things you love, which might include energy intensive things like practicing yoga, but it might also include listening to music, art, being in nature, just being outside rather than inside. Find things that you can do that work with your energy baseline now that give you pleasure, that can ensure that you have quality of life, that’s important for your physical health, mental health, emotional health, spiritual health.
Learn how to save energy
- Learn to say no.
- Avoid the temptation to say yes, or “do just a little more”.
- Modify your activities to use less energy.
- Ask for help, use accessible options, take short cuts.
Learn to rest
- Rest means minimal activity and little or no mental stimulation.
- Learn what activities aren’t really restful for you, like TV and social media.
- Rest is a practice, give yourself space and grace to develop this practice
Learn from folks who’ve been doing this for a long while, like those living with chronic pain or illness, and those who study or live with ME/CFS
Infographics from the physio community that are quite helpful:
A few other things I found somewhat useful (I’ll keep adding to this – and appreciate your additions too):
- “Twelve percent of patients still have painful, swollen joints (premature arthritis) a year after infection” https://www.painscience.com/microblog/long-covid-hurts.html
Finally, check out what’s happening the communities like Adapted Yoga, Adaptive Yoga, Accessible Yoga.