This document provides information and exercises for a home exercise program to improve lung capacity in COVID-19 patients. It describes COVID-19 symptoms and risks. The program includes 3 levels of exercises starting with breathing exercises like diaphragmatic breathing and pursed lip breathing. It provides instructions for each exercise and safety precautions. The goal is to help COVID-19 patients recover lung function over several months with a caregiver-guided home program.

1. CENTRE FOR PHYSIOTHERAPY AND REHABILITATION SCIENCES
JAMIA MILLIA ISLAMIA
TOPIC – Home exercise programme to improve lung capacity in
COVID-19 patient.
Presented by-
Purnima Kushwaha
MPT – 3 rd semester
(Cardiopulmonary)
Roll No. 18MPC003

2. What Is COVID- 19?
• SARS-CoV-2, the virus that causes COVID-19, is a new virus that is
causing serious illness in many countries of the world.
• Most patients have fever, dry cough, muscle pain, and extreme
weakness. In the majority of patients, symptoms last for 2–3 weeks and
often resolve spontaneously.
• In some patients, COVID-19 can be a more serious illness causing
pneumonia or affecting other organs and requiring hospitalization.
• Symptoms of a Covid-19 Infection
• These symptoms may appear 2–14 days after exposure.
• Fever
• Cough
• Shortness of breath
• Loss of smell or taste.

3. • Emergency warning signs (CDC.gov; Zhang,Y. 2020)
• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face.
• If you develop emergency warning signs for COVID-19, get medical
attention immediately.
CARING FOR A COVID- 19 PATIENT AT HOME
• These precautions should last until medical authorities clear the patient.
• Monitoring the patient
a. Check the patient’s temperature twice a day
b. Monitor for new symptoms such as chest pain, difficulty breathing, blue
fingers or face, palpitations, changes in mental status, confusion, or
swelling of legs. Contact your medical provider if any of these symptoms
occur.

4. • Isolation directions
a. Isolate the affected person. They should be in a separate room. It is
important to have good air circulation in the room. For example, air
conditioning or keeping a window open
b. The patient should avoid all contact with older people, pregnant women, or
anyone with compromised immunity
c. The patient should always wear a mask (see instructions below) and keep
at least six feet away if the caregiver has to come into the room. Keep
these interactions as brief as possible
d. If possible, the patient should have a separate bathroom. If this is not
possible, all other unaffected family members should use caution when
using shared facilities. Use diluted bleach to wipe down the door handles,
toilet seat and handles, sinks, etc., each time the patient uses the
bathroom. The patient should have their own toilet roll and towels, which
should be kept separately
e. The affected person should eat in their room, and if possible, use
disposable plates, knives, and forks. If not, use gloves when washing their
plates, spoons, knives, and forks. Use diluted bleach and rinse well.

5. • Hygiene and cleaning
a. Patients and caregivers should wash hands with soap and water for at least 20 seconds,
regularly
b. Encourage the patient to have a daily bath
c. The affected person’s clothes should be washed separately and with a bleach containing
detergent using a hot wash (90°C) for at least 30 minutes
d. Use disposable gloves and a mask when entering the affected person’s room
e. Dispose of the patient’s trash carefully. Use gloves and avoid handling it with your bare hands
f. SARS-CoV-2 can live on cardboard, plastic, and food surfaces for several days. Discard all
packaging or disinfect surfaces by wiping them down with a disinfectant solution. Wash all
fruit and vegetables for at least 20 seconds using soap and water. Heat appears to kill the
virus. However, frozen foods may harbor the virus, so make sure all food is heated well.
Microwaving until steam rises also appears to kill coronavirus.
• Emotional and mental health
a. Try to keep the patient’s spirits up. Communicate regularly with them via phone, video calls, or
social media
b. Confirmed COVID-19 patients often have symptoms such as regret and resentment, loneliness,
helplessness, depression, anxiety and phobia, irritation and sleep deprivation, and even panic
attacks.
i. Try slow breathing, relaxation, meditation, and mindfulness
ii. If these symptoms are persistent or recurring, please seek professional help.

6. Overview of exercise program

7. Level 1 exercise

8. Level 2 exercise

9. Level 3 exercise

10. • Exercise
• This illness is highly debilitating. We do not yet know how long most
patients will take to recover, but we think it will take several months to
recover fully.
• Please check with your physician before starting any exercises
• These exercises are designed to be done alone by the patient in their
room. The caregiver should not be in the same room
• The caregiver can provide remote instructions and supervision by
telephone from another room.
• Equipment required:
• Incentive spirometer: If this is not available, a packet of balloons and
a disposable straw can be used as a substitute
• Light weights: If this is not available, a water bottle can be used as a
substitute
• 12-inch exercise ball: If this is not available, a cushion or small pillow
can be used as a substitute.

11. • Precautions
a. You can start gentle exercises if:
i. You have not had fever for at least 7 days
ii. You have no shortness of breath, palpitations, or chest pain when walking
around in your house
iii. You have experienced no swelling of the legs.
b. STOP immediately if you develop any of the following.
Get help immediately
i. Shortness of breath
ii. Chest pain
iii. Palpitations
iv. Exhaustion
v. Dizziness or Lightheadedness.
( Ambrose et al., 2020)

12. Breathing exercises to improve lung capacity
• Diaphragmatic breathing
• Pursed lip breathing
• Rib stretch exercise

13. Diaphragmatic breathing
• Diaphragmatic breathing, which is also known as abdominal breathing,
involves contracting the diaphragm muscle in order to make it stronger.
• You should do the following to practice diaphragmatic breathing:
• Relax your shoulders and sit back or lie down.
• Place one hand on your belly and one on your chest.
• Inhale through your nose for two seconds, feeling the air move into your
abdomen and feeling your stomach move out. Your stomach should move
more than your chest does.
• Breathe out for two seconds through pursed lips while pressing on your
abdomen.
• Repeat.

14. Pursed lip breathing
• Pursed-lips breathing can slow down your breathing, reducing the work of
breathing by keeping your airways open longer. This makes it easier for the
lungs to function and improves the exchange of oxygen and carbon
dioxide.
• This breathing exercise is often easier for beginners than diaphragmatic
breathing, and you can do it at home even if no one has showed you how.
It can be practiced at any time.
• To practice the pursed-lips breathing technique:
• Inhale slowly through your nostrils.
• Purse your lips, as if pouting or about to blow on something.
• Breathe out as slowly as possible through pursed lips. This should take at
least twice as long as it did to breathe in.
• Repeat.

15. Rib stretch exercise
• The rib-stretch exercise is also referred to as a rib cage stretching exercise.
Basically, this is an exercise that improves rib cage flexibility so that your
internal intercostal muscles can expand better.
• This muscle group includes several groups of muscles between the ribs
that facilitate the chest's movement. These muscles help promote one's
involuntary movement of breath.
• To do this exercise, stand up straight and exhale all of the air from your
lungs. Inhale slowly and fill your lungs with as much air as possible. Hold
the air in for about 15 seconds before slowly letting it out. Repeat this
three times each day to help increase your lung capacity.
• To add to this, put your hands on your hips and bend toward one side and
then the other. Lift your hands over your head, and put your left hand on
the left side of your waist and lean to the left. This will help you stretch
out your right side. Repeat this on the other side. Do this a few times
before finishing up with some rib-stretch breaths.

16. References
1. Ambrose AF, Bartels MN, Verghese TC, Verghese J. (2020) Patient and caregiver
guide to managing COVID-19 patients at home. J Int Soc Phys Rehabil Med
;3:53-68.
2. CDC.gov https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/ steps-
when-sick.html
3. Zhang,Y. (2020) The Novel Coronavirus Pneumonia Emergency Response
Epidemiology Team. The Epidemiological Characteristics of an outbreak of 2019
novel coronavirus diseases (COVID19) China CDC weekly, online date: February
17th, Vol 2/Number 8.http://weekly.chinacdc.cn/en/article/id/e53946e2 c6c4-
41e9 9a9bfea8db1a8f51.

18. THANK YOU