COVID-19: Survivors Of Coronavirus Must Stay Fit; Here Are Exercises They Must Do

COVID-19 is an infectious disease caused by the recently discovered coronavirus. The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes. The virus enters the body via nose, mouth and eyes. Some recent studies suggest that virus may be airborne and can be spread through fine infected droplets that remain suspended in the air in closed air-conditioned environments of offices, AC cabs-buses, shopping malls and theatres due to absence of cross-ventilation, even when you are not in direct contact with an infected person. It is essential that, after recovery, a person follows a certain routine to ensure he/she remains fit.

Post COVID-19: Regaining your strength

Due to the damage caused by the virus to the lungs and other organs, the body takes time to recover and get back to its former state. You should reach out an occupational therapist for help in adjusting to your new energy levels and limitations. Additionally, some of the things that could help are:

• Taking support from your family members and friends.
• Take gradual steps towards regaining strength.
• Re organizing some things in your life so they require less energy over the next few weeks and months while you recover. Organizing daily routines to allow completion of essential activities when you have most energy.
• Keep frequently used items in easily accessible places.
• Don’t plan multiple activities for same day as it may cause fatigue. Keep low pace for doing activities so as to sustain energy level throughout the activities.
• Prioritize the activities- do only those which are absolute necessary. Eliminate unnecessary tasks and steps of activity.
• Eating a balanced protein- rich diet, with at least five daily servings of different fruits and vegetables.
• Give plenty of rests in between the activities.
• Store items at convenient level of height so as to avoid excessive stretching. Keep optimum height of all work place surfaces.
• Facilitate bathing by using shower seat/ hand held shower head.
• Breathe easily and properly during the activities.
• Don’t do strenuous activities which cause lot of physical exertion.
• Doing breathing exercises regularly.

Breathing Exercise

Self- Awake Proning:

30 minutes- 2 hours: laying on your belly. If patient is on oxygen support then oxygen should not be removed in this position, turn head to left/ right side & continue O2 support. Place the pillows under the head, chest and pelvis for support but abdomen should not be compressed

• 30 minutes- 2 hours: laying on your left side
• 30 minutes- 2 hours: sitting up
• 30 minutes- 2 hours: laying on your left side
• Then go back to position 1: lying on your belly

Pranayam- Alternate Nostril Breathing:

• Close the right nostril with thumb. Breath in left nostril – 4 count.
• Close the left nostril as well and retain the breath to a count of 16.
• Release the right nostril and exhale fully through it to a count of 8.
• Keeping the left nostril closed, inhale through the right to a count of 4.
• Close both nostrils and retain the breath to a count of 16.
• Release the left nostril and exhale to a count of 8 to complete.

Chest Exercise

Incentive Spirometry:

• Put the mouthpiece in your mouth and close your lips tightly around it. Do not block the mouthpiece with your tongue.
• Inhale slowly and deeply through the mouthpiece to raise the indicator. Try to make the indicator rise up to the level of the goal marker.
• When you cannot inhale any longer, remove the mouthpiece and hold your breath for at least 3 seconds.
• Exhale normally.
• Repeat these steps in a day as advised.
• Keep a log of the highest level you are able to reach each time. This will help healthcare providers see if your lung function improves.

The Balloon Exercise:

You can practice this simple exercise by blowing up a certain number of balloons each day. Blowing balloons works out the intercostal muscles that are responsible for spreading and elevating your diaphragm and ribcage. This allows your lungs to take in oxygen during inhalation and expel carbon dioxide as you exhale. The more oxygen you supply to the body during exercise, the longer you will last without becoming breathless and fatigued.

Positions to ease breathlessness

High side lying: Lying on your side propped up by pillows, supporting your head and neck, with your knees slightly bent.

Forward lean sitting: Sitting at a table, lean forwards from the waist with your head and neck resting on the pillow, & your arms resting on the table. You can also try this without the pillows.

Forward lean sitting: (no table in front): Sitting on a chair, lean forwards to rest your arms on your lap or the armrests of the chair.

Forward lean standing: While standing, lean forwards onto a windowsill or other stable surface.

Standing with back support: Lean with your back against a wall and your hands by your side. Have your feet about a foot away from the wall and slightly apart.

RELAX!

Relax. You deserve it, it is good for you, and it takes less time than you think.

When we relax, the flow of blood increases around our body gives us more energy. It helps us to have a calmer and clearer mind which aids positive thinking, concentration, memory and decision making.

You may choose any of the relaxation techniques from following based on your interest:

• Take a deep Breath.
• Do meditation.
• Be present, take a break from all other things and be present in the moment like enjoying each bite of food.
• Reach out to your social network.
• Laugh out Loud.
• Listen to your favourite music.
• Doing exercise in any form which you like walking, yoga etc.

Resuming your physical activities after coronavirus:

Post COVID-19 you may feel fatigued for a few weeks of longer even after other symptoms resolve and can make physical activity difficult. At the beginning of your physical activity, you will be able to do a lot less first and gradually build up to do what you were doing beforehand.

You should start with low intensity activity and gradually move towards more intense activities. Athletes should hold off on resuming regular training for at least 10 days from symptom onset and seven days from symptom resolution.

But if you are just feeling a little more short of breath than usual, get tired more quickly, or cough a little, you should focus on gradually increasing the duration of your physical activity as you get stronger.

Exercise is an important part of recovery after a severe COVID-19 illness. Exercise can help to:

• Improve fitness.
• Reduce breathlessness.
• Increase muscle strength.
• Improve balance and coordination.
• Improve your thinking.
• Reduce stress and improve mood.
• Increase confidence.
• Improve your energy.

These simple rules will help you exercise safely:

• Always warm-up before exercising, and cool down after exercising.
• Wear loose, comfortable clothing and supportive shoes.
• Wait at least an hour after a meal before exercising.
• Drink plenty of water.
• Avoid exercising in very hot weather.
• Exercise indoors in very cold weather.

If you feel any of the following symptoms, do not exercise, or stop exercising, and contact your healthcare professional:

• Nausea or feeling sick.
• Dizziness or light headedness.
• Severe shortness of breath.
• Clamminess or sweating.
• Chest tightness.
• Increased pain.

Warm-up exercises

Warming up prepares your body for exercise to prevent injury. Your warm-up should last around 5 minutes, and at the end you should feel slightly breathless.

Shoulder shrugs: Slowly lift your shoulders up towards your ears and then down again.

Shoulder circles: Keeping your arms relaxed by your side or resting on your lap, slowly move your shoulders round in a circle forwards, & then backwards.

Side bends: Start with your body straight & your arms by your sides Slide one arm, then the other, a short way towards the floor, bending sideways.

Knee lifts: Lift your knees up and down slowly, no higher than your hip, one at a time.

Ankle taps: Firstly, using one foot, tap your toes and then your heel on the ground in front of you; repeat with the other foot.

Ankle circles: Using one foot, draw circles with your toes; repeat with the other foot.

Fitness exercises

You should aim to do fitness exercise for 20-30 minutes, 5 days each week.

Marching on the spot:

• If needed, hold onto a stable chair or surface for support, and have a chair nearby to rest
• Lift your knees one at a time

Progressing this exercise:

• Increase the height you lift your legs, aiming to reach hip height if possible

When you might choose this exercise:

• If you cannot go outside to walk.
• If you are not able to walk very far before needing to sit down.

Step-ups:

• Use the bottom step of your flight of stairs.
• If needed, hold on to the handrail for support, and have a chair nearby to rest.
• Step up and down, changing the leg you start with every 10 steps.

Progressing this exercise:

• Increase the height of the step, or speed of stepping up & down.
• If your balance is good enough to do this exercise without holding on, then you can carry weights as you step up & down.

When you might choose this exercise:

• If you cannot go outside.
• If you are not able to walk very far before needing to sit down.

Fitness exercises

You should aim to do fitness exercise for 20-30 minutes, 5 days each week.

Walking:

• Use a walking frame, crutches, or stick if needed.
• Choose a route that is relatively flat.

Progressing this exercise:

• Increasing the speed or distance you walk, or if accessible, include walking uphill in your route.

When you might choose this exercise:

• If you can get outdoors to exercise

Jogging or cycling:

• Only do jogging or cycling if it is medically safe for you.

When you might choose this exercise:

• If walking is not making you out of breath enough.
• If you could jog or cycle before you became unwell.

Strengthening exercises

Strengthening exercises will help improve muscles that have become weaker as a result of your illness. You should aim to do three sessions of strengthening exercise each week. Strengthening exercises will not make you feel breathless in the same way as fitness exercises. Instead, your muscles will feel like they have worked hard.

You should aim to complete up to 3 sets of 10 repetitions of each exercise, taking a short rest in between each set. Do not worry if you find these exercises hard. If you do, start with a smaller number of repetitions in each set and build up to achieving sets of 10.

Bicep curl:

• With your arms by your side, hold a weight in each hand with your palms facing forwards
• Keep the top part of your arm stationary. Gently lift the lower part of both arms (bending at the elbows), bringing the weights up
• You can do this exercise sitting or standing

Progressing this exercise:

• Increase the weight you use while doing this exercise

Wall push off:

• Place your hands flat against a wall at shoulder height, with fingers facing upwards, and your feet about a foot away from the wall.
• Keeping your body straight at all times, slowly lower your body towards the wall by bending your elbows, then gently push away from the wall again, until your arms are straight.

Progressing this exercise:

• Stand further away from the wall.

Arm raises to the side:

• Hold a weight in each hand, with your arms by your sides, and your palms facing inwards.
• Raise both arms out to the side, up to your shoulder level (but not higher), and slowly lower back down.
• You can do this exercise sitting or standing.

Progressing this exercise:

• Increase the height that you lift your arms, but no higher than your shoulder level.
• Increase the weight you use while doing the exercise.

Sit to stand:

• Sit with your feet hip-width apart. With your arms by your side or crossed over your chest, slowly stand up, hold the position for the count of 3, and slowly sit back down onto the chair. Keep your feet on the floor throughout.
• If you cannot stand up from the chair without using your arms, try a higher chair. If this is still too hard at first, you may push with your arms.

Progressing this exercise:

• Make the movement as slow as possible.
• Perform the exercise using a lower chair.
• Hold a weight close to your chest whilst doing the exercise.

Knee straightening:

Sit in a chair with your feet together. Straighten one knee and hold your leg out straight for a moment, then slowly lower it. Repeat with your other leg.

Progressing this exercise:

• Increase the time holding your leg out straight to a count of 3.
• Perform the exercise more slowly.

Heel raises:

• Rest your hands on a stable surface to support your balance, but do not lean on them.
• Slowly rise up on to your toes, and slowly lower back down again.

Progressing this exercise:

• Stand on your toes for a count of 3.
• Stand on one leg at a time.

Squats:

• Stand with your back against a wall or other stable surface and your feet slightly apart. Move your feet about a foot away from the wall. Alternatively rest your hands on the back of a stable chair.
• Keeping your back against the wall, or holding on to the chair, slowly bend your knees a short distance; your back will slide down the wall. Keep your hips higher than your knees.
• Pause for a moment before slowly straightening your knees again.

Progressing this exercise:

• Increase the distance you bend your knees (remember to keep your hips higher than your knees).
• Increase the time you pause to a count of 3 before straightening your knees.

Cool down exercises:

• Cool down exercises allow your body to return to normal before stopping exercise. Your cool down should last approximately 5 minutes, and your breathing should be back to normal by the end.
• Walking at a slower pace or gently marching on the spot, for approximately 2 minutes.
• Repeat the warm-up exercises to move your joints; these can be done in sitting or standing.

Muscle stretches: Stretching your muscles can help to reduce any soreness you may feel over the one to two days following exercise. You can do these stretches in sitting or in standing. Each stretch should be performed gently, and you should hold each one for 15-20 seconds.

Side: Reach your right arm up to the ceiling and then lean over to the left slightly; you should feel a stretch along the right side of your body. Return to the starting position and repeat on the opposite side.

Shoulder: Put your arm out in front of you. Keeping your arm straight, bring it across your body at shoulder height, using your other hand to squeeze your arm to your chest so you feel a stretch around your shoulder. Return to the starting position, and repeat on the opposite side.

Back of thigh (Hamstring): Sit on the edge of a chair with your back straight and feet flat on the floor. Place your leg out straight in front of you with your heel resting on the ground. Place your hands on your other thigh as support. Sitting as tall as you can, bend slightly forwards at your hips until you can feel a slight stretch down the back of the leg that is stretched out. Return to the starting position, and repeat on the opposite side.

Lower leg (Calf): Stand with your feet apart and leaning forwards onto a wall or something sturdy for support. Keep your body upright and step one leg behind you. With both feet facing forwards, bend your front knee, keeping your back leg straight and your heel on the floor. You should feel a stretch in the back of your lower leg. Return to the starting position and repeat on the opposite side.

Front of thigh (Quads): Stand up and hold onto something stable for support. Bend one leg up behind you, and if you can reach it, use the hand on the same side to hold your ankle or the back of your leg. Take your foot up towards your bottom until you feel a stretch along the front of your thigh. Keep your knees close together and your back straight. Return to the starting position and repeat on the opposite side.

You can also do this stretch sitting down on a stable chair: sit near the front of the chair, off to one side (so that you are only sitting on about half of the chair). Slide the leg closest to the edge off the chair and position it so that your knee is pointing down in line with your hip and your weight is through your toes. You should feel the stretch along the front of your thigh. Repeat on the opposite side.

Gaining your physical strength back…

Breathlessness Scale: This is a scale that asks you to rate the difficulty of your breathing during exercise. It starts at number 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. It is expected that you have a scale of 3-4 during exercise for it to be effective.

References:

• Ministry of Health & Family Welfare Guidelines

• WHO guidebook for Support for Rehabilitation Self-Management after COVID19- Related Illness

• US- Centre for disease Control (CDC)

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