What Improvements Can Autonomic Conditioning Bring in Long Covid? | With Dr Jenna Tosto-Mancuso

hi in this second of our two-part series on autonomic conditioning Dr Assad Khan and I talked to Jenna tosto Mancuso physical therapist and Clinical Director at the abilities Research Center at Mount Sinai we ask her about whether movement-based autonomic conditioning can help other forms of dysautonomia like GI issues and temperature regulation how important it is to understand the issues around exertion for long haulers and what kind of improvements might be expected from well-executed autonomic conditioning the autonomic system dysfunction can manifest in lots of different ways and there's lots of different triggers for that um you know so for me personally if I'm performing an activity around the house that sound hoovering or cleaning up there's a certain amount of time where my heart rate stays normal and then suddenly it goes up that would seem to be and I'll start to feel weird dizzy palpitations right so that's a certain degree of movement has exceeded my ability to control the autonomic system and it's gone mad equally for people with pots standing up uh you know doesn't take long at all for the autonomic system to um malfunction but there are other things too that cause autonomic uh system malfunction whether it's temperature or stress or many other things the autonomic system has to regulate to what degree do you see a role in reconditioning in those fields aside from just movement which is what you worked on what do you have a take on that and and where do you see movements in terms of how much can movement help in terms of those other factors of autonomic control and and is it possible to recondition those other sort of stimuli as well I think that's a really terrific point and a really important Point um because I think that when we think of autonomic dysfunction oftentimes immediately we jump to this you know the typical presentation of pots or the presentation of orthostatic hypotension or orthostatic intolerance when in reality the symptom presentation and also the triggers can be a variety you know I'm here in New York City and it is very very hot and very very humid this time of year and so that can often be you know a really tremendous trigger for folks with autonomic dysfunction and to my point earlier the clinical presentation of autonomic dysfunction does not always have to be that classical presentation of pots or orthostatic intolerance right it can be in significant GI disruption or GI symptoms it can be in inappropriate thermoregulatory balance so excessive sweating or feeling chills and cold so incredibly incredibly important Point what we've seen both in the literature and in my practice is that if we start first with the idea of autonomic reconditioning through means of movement titration and movement-based intervention we do see a carryover into those other areas in Arena so while we can address those primary symptoms again things like fatigue and orthostatic tolerance Etc and you know logistically and logically that that makes sense um kind of off on the surface level we do see a bit of a carryover into those other systems because if we remember at its power autonomic reconditioning is meant to upregulate and up titrate the tone of the autonomic nervous system so the balance and the um the ability to work in Synergy of that sympathetic and parasympic parasympic branches of the nervous system so again we do see carryover into those other areas um other things that we can add in again from non-pharmacological conservative management based approaches um there and I've seen again both in the literature but in my practice tremendous help with things like breath work um you know I think breathing and breath work exercises is a window to the autonomic nervous system we've known this for quite some time we've implemented it not only from an autonomic reconditioning perspective but also you know across the Continuum of movement science Even in our Elite athletes things like that so uh that can be an additional measure again from conservative management standpoint but within the scope of the autonomic reconditioning that that I perform quite regularly and and my patients have have seen great carryover again in not just pure symptoms but also the secondary um when deaths put out um on Twitter that we were going to be doing this video there was a lot of interest but there was also some negative feedback about the whole concept of autonomic reconditioning and I understandably many in the chronic illness Community are very wary of any mention of any sort of exertion and um for good reason I guess because of the history um and then also uh even within that there is this tension between the concept of radical rest which is basically doing nothing uh which I guess you know does have its value perhaps right at the beginning or you know in certain phases when you really really quite sick but then there's You could argue that remaining active within your anaerobic threshold and not triggering uh pesc is still resting in a way so how would you reassure people in the community that this is actually uh safe I think this is such an incredible topic and I know a thought I feel like you and I have chatted on this topic quite a bit over the past few years um and it's something I'm rather passionate about um because I I want to start by saying I think it's incredibly important to acknowledge um the lived experience of patients and lived experience of those with long covet and the reality is it can be you know I I think it can be and it has been shown to be uh potentially triggering the idea of physical activity um and so I think the key points I like to make on this that are meant to be reassuring but also to really underscore the backbone of the concept of autonomic reconditioning in that this is a symptom titrated approach which means it is a ones that it is not a one-size-fits-all it is incredible it is Paramount and Incredibly important for folks who are participating in autonomic reconditioning to understand that principles of energy conservation principles of pacing and again the Cornerstone of symptom titration in that we're really following symptomatology and symptom uh tolerance but following those key factors in order to inform intervention is really really the Cornerstone of autonomic reconditioning and so for those who are wary of movement I think the idea that the movement is introduced in a way that is respectful of symptoms and is at no point meant to push past symptom tolerance and and push past points of exertion um I think that that really needs to be underscored I think additionally to that um understanding that uh the way that autonomic reconditioning is structured it is meant to still be within scope of Tolerance and so if we can we can really drive that point home um I I think that really is is the the most key feature to to hone in on and what kind of improvements do you see across sort of your patient group I mean I don't think anyone's necessarily going to think wow if I just do some movements I'm gonna you know immediately in two weeks time I'll be completely better and I'll be running a marathon again right so what kind of improvements do you see in which sorts of symptoms do those you know what can people expect if they do this in the right way or what is the range of outcomes that you see yeah so the way I explain it to patients I don't find the road to recovery the recovery trajectory in this case to be linear right so it's it's not that that line graph go you know going straight up with that progression that if you do or the example I often use was the molecular skeletal injury right so it's not that someone will come and it's if you do XYZ for three to six weeks we can expect definitively this outcome um what I often find is that the recovery trajectory is a bit more sinusoidal um so we're seeing these Ebbs and flows and symptom exacerbations and and what we find with autonomic reconditioning over the course of intervention is that you know if we think about the Peaks and valleys uh the Peaks being flare-ups of symptoms The Valleys being stability of symptoms um ideally we find that we're getting less frequent flare-ups and the severity of those flare-ups is less than less over time until we hit a point where the symptoms have gained stability and so that's not to say and I always like to be clear right autonomic reconditioning is not thoroughly Curative I think that it can be something that as we're managing symptoms it can get folks to a point where we've gained symptoms stability and we're seeing less frequent flare-ups and if we are seeing a flare-up the severity of those symptom flare-ups is less and less really with the ultimate goal of of maximizing folks day-to-day and allowing them to get back to day-to-day activities and things that are meaningful to them um and so again I think that when we're trying to imagine what's in this recovery trajectory look like that's the best visual that I can give um and admittedly that's precise what I see in my practice I see that over time with continued progression of the autonomic reconditioning program folks are having more and more stability in their symptoms and and we're getting really getting those symptoms under control well not everybody's going to be fortunate enough to access agenda or a therapist or skilled in autonomic reconditioning I mean I know notable patients are the same but are there any practices that you might be able to recommend that could be done safely at home and how would you Ensure again and just really hone in at this point about staying within the anaerobic threshold to folks who do have access to a physical therapist or an occupational therapist or any type of healthcare provider or coach that is well informed in autonomic rehab or autonomic reconditioning I highly advise connecting with those folks in your in your community um just because I do think that degree of of oversight can be held helpful but that's not to say that that these principles can't be implemented in day-to-day life and so I think that for an individual who is is attempting to engage in some degree of autonomic reconditioning perhaps on their own um really really important facets to understand is number one the trend of your symptoms and the trajectory of your symptoms so what are your symptoms what are things that you know to exacerbate them and just maybe over the course of say five to seven days what does that General symptom presentation look like right how frequently are your symptoms squared going back to that visual analog scale of the symptoms can we rate them in severity at their best at their worst really getting a good understanding of that rpe or rate of perceived exertion scale and trying to implement that for starters on your day-to-day life so if you are ambulatory and you're walking in your home or you're walking in your community at its lowest threshold can you keep that activity uh still at that light light area of exertion and tolerate it well without flaring your symptoms up so again just starting to integrate some of those Concepts start with day-to-day life um if one is trying to implement more of a movement-based approach they might try to implement some of those supine or laying down based interventions and again this idea of starting with time-based intervals very gentle range of motion based movements can be really a helpful thing so I I think that with good education on things like pacing and energy conservation strategies and symptom titration um it can be a really a really nice thing for folks to start to do hope you found that discussion enlightening next up on the channel Dr Assad Khan and I is speaking to American pulmonologist Dr Wes Ely and Superstar virologist Professor ikike so stay tuned for those catch you next time

Channel: Gez Medinger

Views: 8,685

Keywords: pasc, psac, post covid, long haul, dysautonomia

Id: mdvbu1H_pew

Length: 12min 10sec (730 seconds)

Published: Thu Aug 10 2023