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GETTING BACK TO NORMAL: Information for persons who had Coronavirus (COVID-19) Infection

The document provides you with basic information that can help you rehabilitate your body and mind and help you return to your “before COVID” or a better quality of life.

Common problems with COVID-19 include a feeling of intense tiredness, weakness, difficulty in breathing, difficulty in walking and doing daily routine activities. These difficulties with daily activities can make a person feel sad, stressed out, depressed, anxious, and fearful. Early intervention and mild exercises that can build back the daily routine can help calm the person, bring about a positive feel while encouraging and motivating the person to reach back to their normal state.

There are 4 simple elements that you can focus on as you self-isolate or during home isolation or as you recover from COVID-19.

  • Breathing Exercises- Simple exercises that can re-align your breathing and improve lung capacity.
  • Building your balance- aligning eyes, head, ears and the body movements
  • Building back your muscle strength and your endurance for physical activity
  • Building your mental strength

These 4 sets can improve with exercises:
• Cardio-pulmonary systems or the heart and lungs
• Neuro-vestibular systems or balance and coordination
• Musculoskeletal system or Muscles and Joints
• Cognitive and Mental processes -Brain, Thinking, Mind

Do not begin exercises if:

  • You have a fever,
  • You have any shortness of breath or difficulty breathing while resting or during light activity,
  • You have any chest pain or palpitations (“fluttering” of heart in the chest) at any time,
  • You have new swelling in your legs, especially around the ankles.

STOP exercise immediately if you develop any of the following symptoms:
• Dizziness
• Shortness of breath more than normal
• Chest pain
• Cool, clammy skin
• Excessive fatigue
• Irregular heartbeat

Seek medical help immediately for chest pain, shortness of breath and dizziness that does not resolve with rest or any change in mental status from your normal capacity. Do not continue the exercise and start again only after a medical consultation.


EARLY PHASE OR BEGINNING THE ROUTINE


BREATHING
DEEP BREATHING- Lying on back
TIME: One Minute


• Choose a flat firm surface to lie on.
• Lie on your back with face upwards.
• Bend your knees so that the bottom of your feet rests flat on the bed.
• Place your hands on top of your stomach.
• Close your lips.
• Curl your tongue and touch on the roof of your mouth. Let the tongue be flat if you cannot touch the roof of your mouth with the tongue.
• Breathe in through the nose and pull air down into your stomach where your hands are. Try to spread your fingers apart with your breath.
• Slowly exhale your breath through the nose.
• Repeat deep breaths for one minute.
• Do not try to control the breath.
• Just take deep breaths naturally and let the breath settle into a rhythm. Do not force a rhythm.

DEEP BREATHING- Lying Face Down
TIME: One Minute

• Lie on your stomach with the face facing downwards.
• Rest your head on your hands. Do not press face into a pillow.
• Make sure you are breathing comfortably.
• Close your lips.
• Curl your tongue and touch on the roof of your mouth. Let the tongue be flat if you cannot touch the roof of your mouth with the tongue.
• Breathe in through the nose and pull air down into your stomach. Feel your stomach pressed into the bed.
• Slowly breathe out through the nose
• Repeat deep breaths for one minute.
• Do not try to control the breath.
• Just take deep breaths naturally and let the breath settle into a rhythm. Do not force a rhythm.

Humming 1 to 3 minutes
• Sit upright on a bed or on a chair.
• Close your lips and curl your tongue to touch the roof of your mouth or keep your tongue flat.
• Breathe in through your nose.
• Take a deep breath but do not force it.
• Slightly open your lips (purse your lips)
• Breathe out with a humming sound (Hmmm) for as long as you can. Do not force it.
• Breathe in again and repeat the process.
• You can bring your arms to shoulder level, place your fingers on your forehead and head and use the thumb to close the ear while breathing in and out. If that is difficult, just let the arms rest on your knees and breathe in and out.

Eye and Head Movements 1 minute

• Sit upright on the bed or on a chair.
• Look Upwards and then downwards with your eyes keeping the head and face still.
• Look to the right and then to the left keeping head and face still.
• Move your head gently to the left and move the eyes in the same direction as the head. Keep your chin at shoulder level.
• Move your head upwards to a central position looking upwards.
• Move your head towards the right and look right. Keep your chin at shoulder level.
• Move your head downwards. Let the chin gently touch or come close to the chest (as much as possible without forcing)
• All movements of the eyes and head must be slow and gentle without any force.

Body Rolls 1 to 2 minutes
• Lie on your back comfortably.
• Look to the right with your eyes and rotate your head to the right.
• Slowly roll your body to the right.
• Breathe in and out in this position.
• Slowly come back to the centre.
• Look to the left with your eyes and rotate your head to the left.
• Slowly roll your body to the left.
• Breathe in and out in this position.
• Slowly come back to the centre.
• Repeat for 1 to 2 minutes. Do not force any movement. Move slow and gentle with gentle breaths.

Cross Touch Body 1 minute
• Lie on your back comfortably. You can place a small pillow under your head.
• Keep your arms by the side of your body.
• Take your right hand and touch your left thigh or knee.
• Bring your hand back to the side of your body.
• Take your left hand and touch your right thing or knee.
• Bring your hand back to the side of your body.
• Breathe in and out naturally as you do this.
• Repeat for one minute.

Mouth and Face stretches 1 minute
• Sit on a chair.
• Raise your arms over and to the sides of your head midway. Form a V shape of your shoulders.
• Open your mouth wide like you are yawning.
• Stretch your face and neck muscles without moving your head.
• Then smile for 3 to 5 seconds.
• Bring hands down.
• Breathe in and out.
• Repeat for one minute.

Walk slowly 3 to 5 minutes
• Walk slowly in your room or inside the house.
• Keep breathing in and out naturally.
• Listen to your breaths.
• Do not force your breath.
• Take rest if you feel your breath is forced or becoming fast.
• Swing your arms while walking.
• Lift your heels off the floor and then lift the knee.
• Then place the foot back onto the floor toes first and heels next while walking.
• Walk at frequent intervals.

Sit and Relax for 3 to 5 minutes
• Sit on a chair preferably near a window.
• Listen to some soft music or just listen to the sounds around you.
• Calmly observe all things around you
• Let them just be and just watch everything.
• Let your body relax completely.

Continue these till you are comfortable with this (3 to 4 days) Add the following to the previous schedule once you are comfortable.

Rock your body front and back 1 to 2 minutes
• Sit on a chair comfortably.
• Keep both feet flat on the floor.
• Fix your gaze at a point directly in front of you.
• Lean back while looking at this point.
• Breathe in as you lean back.
• Slowly move the body forward while keeping your gaze fixed on a point in front of you.
• Breathe out as you move your body forward.
• Keep neck and head steady while moving backwards and forward. The body is moved backwards and forward at the waist or hip (the junction of the upper and lower body)
• Stand up after breathing out.
• Sit down.
• Lean back again and repeat the process.

Walk slowly 10 minutes for 2 to 3 times each day.
Sit and Relax for 10 minutes three times a day.

Continue these till you are comfortable with this (2 to 3 days) Add the following to the previous schedule once you are comfortable.

Rock your body front and back 1 to 2 minutes
• Get on to your hands and knees on the floor.
• Fix your gaze at a point directly in front of you. Keep the head up
• Lean the body back while looking at this point.
• Breathe in as you lean back.
• Slowly move the body forward while keeping your gaze fixed on a point in front of you.
• Breathe out as you move your body forward.
• Keep neck and head steady while moving backwards and forward.)
• Move head up and look at the ceiling.
• Slowly move the head back to centre,
• Lean back again and repeat the process.

Body Rolls 1 to 2 minutes
• Lie down flat on the floor.
• Move both arms sidewards to shoulder level.
• Turn your head to the left and look leftwards.
• Bend your knees and pull legs up in the air
• Move both legs to the right and touch the floor.
• Try to keep both shoulder blades on the floor without raising them.
• Bring your head to the right and look rightwards.
• Move both legs to the left and touch the floor.
• Try to keep both shoulder blades on the floor without raising them.
• Repeat for one minute.

Stretch to the Mountain 1 minute
• Stand Straight with both feet placed flat on the feet and in line with the shoulders.
• Stand on toes and lift heels.
• Lift both arms sidewards to shoulder level and then upwards above the head with both arms touching the ears and pointing upwards.
• Bring both arms down and let heels touch the floor again.
• Repeat for 1 minute.

Sit on a chair 1 minute
• Stand Straight with both feet placed flat on the feet and in line with the shoulders.
• Bend knees and stretch hands forward in front of you keeping hands at shoulder distance.
• Slowly lower body keeping back straight, and hands stretched in front of you like sitting on a chair.
• Go down as much as you can without forcing yourself. Make sure your back does nor go lower than the knees.
• Come back up.
• Repeat.
• Breathe naturally throughout without forcing the breath.

Walk slowly 20 minutes for 2 to 3 times each day. Stop and Smile at everyone you see for 5 seconds.

Sit and Relax 20 minutes three times a day. Listen to soft music and Meditate.

Do not force any movements or do more than you feel you can. Listen to your body and it will guide you to increase the time you spend on each activity.

Select References

  1. Spruit, M., Singh, S., Garvey, C., et al. (2013). An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 188(8): e13-e64
  2. Weitzberg, E., Lundberg, J.O. (2002). Humming greatly increases nasal nitric oxide. American journal of respiratory critical care medicine. 166(2): 144-5.
  3. Couck De, M., et al. (2019). How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases. International Journal of Psychophysiology. https://doi.org/10.1016/j.ijpsycho.2019.02.011
  4. Taneja MK. Modified Bhramari Pranayama in Covid 19 Infection. Indian J Otolaryngol Head Neck Surg. 2020 Sep;72(3):395-397. doi: 10.1007/s12070-020-01883-0. Epub 2020 May 20. PMID: 32719737; PMCID: PMC7239502.

Dr Praveen Nirmalan

Written by Dr Praveen Nirmalan

Dr. Nirmalan did his basic medical education from Thrissur, Kerala and followed it with a PG Diploma in Ophthalmology from Aravind Eye Care System, Madurai and a Vitreo-retinal Fellowship from Mumbai. Subsequently, he completed his MPH and a Public Health Ophthalmology Fellowship from the Johns Hopkins School of Public Health in the USA. He has led community-based and clinical research in some of the top eye care institutes of India and led a clinical research program at a top tier obstetric and neonate institute as well. He has experience chairing Ethics Committees and has helped with the setting up of Institutional Review Boards. Besides mentoring clinical faculty, he has mentored DNB and PhD students through their dissertation work and research methods.

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