A key symptom of long-COVID is dysfunctional breathing, characterised by an alteration in
the muscular and mechanical control of breathing, such as altered movement/coordination
of diaphragm and ribs. Long-COVID patients also experience symptoms such as dizziness and
fatigue, which have been linked to dysautonomia (dysfunction of the nervous system
controlling automatic body functions). Importantly, dysautonomia is connected to
alterations in breathing mechanics. Specifically, rapid breathing, high in the chest, is
associated with increased activity in the fight-or-flight system and decreased activity
in the rest-and-repair system. Given this link, interventions capable of improving
breathing mechanics could alleviate many long-COVID symptoms. However, current breathing
retraining methods lack visualisation of breathing mechanics and do not integrate a
whole-body approach to improving postural control.

We have developed a clinical system which can visualise breathing mechanics in real-time,
providing patients with a "window into their body". We propose to integrate this system
within a new intervention, known as Cognitive Muscular Therapy (CMT). CMT integrates
psychological informed physiotherapy with training to reduce overactivation of postural
muscles which can interfere with the mechanics of breathing. We propose to test this
combined intervention on 20 people with Long-COVD to understand if we can improve
respiratory function and symptoms associated with dysautonomia. If successful, this pilot
study could pave the way for large-scale studies in long-COVID