Elderly people who are discharged from hospitals often spend a few days or weeks in an acute rehabilitation center or receive physical and occupational therapy at home to regain strength. When the COVID-19 pandemic upended typical transfers to centers or in-home therapy regimens, Albert Einstein College of Medicine and Montefiore Health System researchers grew concerned about older patients’ unmet rehabilitation needs while recovering from COVID-19.

Anne F. Ambrose, M.B.B.S., M.S.Faculty ProfileResearch Profile

The researchers, accustomed to working on studies involving cognition and mobility, quickly created an exercise guide for older adults aimed at boosting breathing capacity and overall muscle tone. The Journal of the International Society of Physical and Rehabilitation Medicine published the guide in mid-April during the pandemic’s surge, and the Association of Academic Physiatrists and the American Academy of Physical Medicine and Rehabilitation also posted it on their websites.

Late last month, Montefiore began distributing English and Spanish versions of the guide in patients’ discharge kits, which also include instructions, surgical masks, and a COVID-19 recovery pin. The guide is also available online in Chinese, Hindi, and Japanese.

“Many older patients who had COVID-19 are not getting proper rehab or physical therapy at home after their hospital stays, like they would have had prior to the pandemic,” said Anne Felicia Ambrose, M.B.B.S., M.S., associate professor and director of research in the Arthur S. Abramson Department of Physical Medicine and Rehabilitation at Einstein and Montefiore. “COVID-19 affects the lungs and makes people very weak, so our guide provides detailed instructions on breathing exercises along with other techniques to regain muscle strength and mobility.”

Joe Verghese, M.B.B.S.Faculty ProfileResearch ProfileExpert Profile

Dr. Ambrose noted that physicians also can benefit from understanding the importance of the exercises. “The physicians on the forefront of this battle are from every specialty, but most have not had rehabilitation training,” she said. “This manual can help them provide guidance to the patients they discharge in managing themselves at home. We’ve had amazing feedback from other rehabilitation specialists so we want to share this widely.”

Pivoting to a New Project While Quarantined

The roots of the project grew from work Dr. Ambrose and her husband, Joe Verghese, M.B.B.S., chief of geriatrics and of cognitive & motor aging at Einstein and Montefiore, had conducted in his lab, which focuses on neuroplasticity and cognitive ability.

“We were testing feasibility of home-based exercise programs before this pandemic, which proved useful in developing this manual,” said Dr. Verghese, who is also director of the Montefiore Einstein Center for the Aging Brain.

Many older patients who had COVID-19 are not getting proper rehab or physical therapy at home after their hospital stays, like they would have had prior to the pandemic.

Anne Felicia Ambrose, M.B.B.S., M.S.

The decision to create a guide became a family affair when Drs. Ambrose and Verghese were, in his words, “stuck at home,” along with their daughter, Tanya, a second-year medical student at Einstein, and their son, David, a senior at New York University. While the physicians were counseling some patients by phone, they wanted to do more. The family decided to design the manual, taking photos of each other practicing the exercises to help make it easier for patients to visualize the techniques. David, a digital media student, has also begun working on videos to accompany the guide.

Matthew N. Bartels, M.D.Faculty ProfileResearch Profile

Moving Forward for Patients

The manual could be useful for patients of any age, but Dr. Ambrose said that its design makes it possible for frail people to exercise unsupervised in their own homes. The exercises can be performed on three levels: lying down, sitting up, or standing with support. Since COVID-19 mainly affects the lungs, the authors first stress pulmonary rehabilitation exercises that can be done without special equipment. Deep breathing exercises to aerate the lower lung, followed by breathing through pursed lips and blowing are priorities. The guide also includes exercises for the ankles, hips, knees, shoulders, and other joints.

“We targeted the muscles and organs that are the worst first, so breathing is crucial, and there is a sequence of strengthening exercises and stretches that follow,” Dr. Ambrose said.

Telemedicine visits are ongoing with some patients, and "the guide is an integral part of that," said co-author Matthew Bartels, M.D., professor and chair of the Arthur S. Abramson Department of Physical Medicine and Rehabilitation at Einstein and Montefiore. "We also want to study the impact of the exercises on some of our patients."

Recently, the researchers received a COVID-19 pilot grant from the Institute for Clinical and Translational Research at Einstein and Montefiore which is funded through the National Institute of Health's Clinical and Translational Science Award program. The grant will fund a study involving 100 patients, comparing the pulmonary and physical functions of those who use the guide at home against those who use a telephone-based app with prompts that lead them through each exercise.