If you’re anything like me (or the 50 people I just lined up with outside of Target 30 mins before it opened to get some Clorox wipes), then your sympathetic nervous system is probably a little revved up. With a lot of misinformation and fear circulating right now, I thought it would be helpful to search the literature for some practical tools that might serve healthy or affected populations as we’re all trying to self-quarantine.
We’re all aware of the need for disinfecting, frequent hand washing, covering coughs and their benefits. As a physical therapist with experience in the ICU setting, I thought that exploring some of the techniques we utilize for patients suffering from oxygen desaturation or complications relating to lung capacity would be particularly useful right now. Why? In a paper produced by the World Health Organization through a Joint Mission with 25 international experts on the novel coronavirus (COVID-19), “80% of laboratory-confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases - 13.8% have severe disease and 6.1% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure).” Confirmed cases commonly affect the respiratory tract, so perhaps some active tools to facilitate improved respiratory rate, lung clearance and pulmonary function would be useful. As a disclaimer, I’m in no way arguing that the techniques discussed can prevent one from contracting COVID-19, but rather, I want to share some practical tools that are backed by research to help set a foundation for those right now staying at home.
0.1 Hz Paced Breathing:
Lets talk about stress. Whether from fear of contracting COVID-19, the recent market crash, or anticipation of two weeks home with your kids - stress is defined by an increase in sympathetic nervous activity and has a strong interaction with respiration. A study in 2005 showed that “Faster respiratory rate is associated with higher levels of sympathetic traffic”. What tools can we use to address this default patterning in a time of worldwide elevated sympathetic traffic? An anti-hyperventilation strategy known as 0.1 Hz paced breathing has been shown to promote CO2 homeostasis and relaxation. This technique involves breathing at a rate of 6 times/min, with statistically significant changes noted with a daily practice of 10 minutes over 7 days. There was also a solid study that showed that higher vagal (parasympathetic) activity was inversely related to the production of inflammatory cytokines, suggesting a link between paced breathing and improved immune responses5.
How does it work? Take 4 seconds to breathe in and 6 seconds to breathe out. It seems easy enough, but maybe the hardest part is taking 10 minutes to do it and, really emphasize on the exhale. This makes physiologic sense since fully exhaling drives our parasympathetic nervous system (rest and digest) and allows for a more productive inhale without increased residual CO2 buildup. As I’ve been trying it, I’m shocked at how hard it is to maintain and (though not assessed in the literature) trying to implement during my threenager’s tantrum or while cloroxing the kitchen.
What if you feel like you can’t do this- perhaps the technique can be improved. As physical therapists, we teach the most efficient strategy is to use a large muscle called the diaphragm. This is commonly known as belly breathing. To try it, place one hand on your stomach and one on your chest. Try to let the belly hand rise and keep the chest hand still.
