All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

REHABILITATION FOR COVID-19 PATIENTS

Exercise is an important part of recovery in covid-19 illness.

It can help to:

  Improve fitness

  Reduce breathlessness

  Improve muscle strength

  Reduce stress, improve mental status and psychosocial growth

  Increase confidence, socialization and improves energy
Before initiating your Rehabilitation protocol, please take care of basic bodily needs like:

  Get enough good quality sleep

  Eat sufficient healthy food and drink plenty of water

  Be physically active

  Stay socially connected

  Do relaxing activities

  Pace yourself while performing activities by doing control breathing

  Gradually increase your involvement in your daily activities, exercise or hobbies
*WHILE PERFORMING EXERCISES, PATIENTS SHOULD BE CLOSELY MONITORED BY SOMEONE (NURSING STAFF/ RELATIVE AT HOME) AS PATIENT MAY SUFFER ACCIDENTAL FALL INJURY
THREE PRIMARY STEPS IN REHABILITATION
1. POSITIONING
These are some positions that may reduce breathless. Patient can also try breathing techniques described below (in any of these positions) to help ease breathing.
Prone position

  

Page|1 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203



Forward lean position

Covid awake repositioning prone protocol:

 30min to 2 hours lying fully prone (bed flat)  30 min to 2 hours lying on right side (bed flat)  30 min to 2 hours sitting
 30 min to 2 hours lying on left side (bed flat)  30 min to 2 hours lying prone again

Continue to repeat the cycle as per comfort

Fowler’s position

Side lying position

   

* In Severe ARDS, prone position is recommended for 12-16 hours

* Note: Monitor oxygen saturations initially for 15 min after each position change to ensure oxygen saturation has not decreased. If saturation is fine or increase, continue with the position for 2 hours. However, if patients feels discomfort or oxygen saturation falls below 90% or overall decline of >4% from baseline oxygen saturation, then return to comfortable position.

2. BREATHING EXERCISE

These techniques will help you to relax and control your breathing.

Page|2 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

Pursed lip breathing /control breathing

Diaphragmatic breathing/ deep breathing in fowler’s position

Diaphragmatic breathing in sitting Diaphragmatic breathing in prone

Active cycle of breathing technique:

  If patient is having problem in clearing the secretion or unable to do effective cough, then repeat following step to produce effective cough.

  After huffing if patient feels secretion in throat then cough.

            

Page|3 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

  

Coughing

Huffing



Incentive spirometer

Page|4 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

3. RANGE OF MOTION EXERCISE

  

Shoulder exercise Elbow exercise Hand exercise

  

Wrist exercises

 

Hip and Knee exercises

   

Knee exercise in sitting: Knee straight Marching in sitting

Page|5 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

     

Ankle exercises

Strengthning exercise

  These exercise will help to improve muscle that become weaker as a result of your illness.

  Patient should aim to do two sessions per day with 5-10 repetition of each exercise.

  Start with the weight that can be tolerated eassily for 5-10 repetition. As patient get
better with the exercise, use more weight to make muscle work harder. Patient can use
tines of food or bottles of water as weight.

  Some strengthening exercise for arm and leg are described below. This can be done in
any order. Keep a good posture, with back straight and complete exercise slowly.

         

Shoulder exercise with weight Elbow exercise with weight Wrist exercise with weight

Knee press Heel press

 

Page|6 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

Aerobic exercise/ fitness exercises

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

  Some exercises to improve fitness are described below.

  Time duration of fitness exercise and gradully build up the amount of time patient can
manage.

  It may take a while to return to the level of activity that patients were able to do before
they became unwell.
Walking Stair climbing Cycling
INDICATION FOR EXERCISE

  After Pneumonia, evidence of exudative consolidation, LRTI and ARDS

  Patient with or after oxygen therapy by nasal prongs/ face mask/ bag mask/ HFO/
BIPAP/ CPAP

  Non-productive cough or dificulty with secretion clearence

  Patients at significant risk of developing functional limitations. eg., patients who are
fragile or have cardiac, neurological, diabetes or pulmonary comorbid conditions

  Patients above the age of 55

  Significant functional decline and ICU acquired weakness.

  Oxygen saturation less than 95%

  Nausea or feeling sick

  Dizziness or light headedness

  Sever shortness of breath, desaturation during exercise (SpO2 88-85%)

  Clamminess or sweating

  Chest tightness

  Increased pain

  Heart rate increse +20-30 bpm from resting rate

    

INDICATION TO STOP THE EXERCISE AND CONTACT YOUR HEALTHCARE



PROFESSIONAL

Page|7 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

REHABILITATION FOR COVID-19 PATIENTS

Exercise is an important part of recovery in covid-19 illness.

It can help to:

  Improve fitness

  Reduce breathlessness

  Improve muscle strength

  Reduce stress, improve mental status and psychosocial growth

  Increase confidence, socialization and improves energy
Before initiating your Rehabilitation protocol, please take care of basic bodily needs like:

  Get enough good quality sleep

  Eat sufficient healthy food and drink plenty of water

  Be physically active

  Stay socially connected

  Do relaxing activities

  Pace yourself while performing activities by doing control breathing

  Gradually increase your involvement in your daily activities, exercise or hobbies
*WHILE PERFORMING EXERCISES, PATIENTS SHOULD BE CLOSELY MONITORED BY SOMEONE (NURSING STAFF/ RELATIVE AT HOME) AS PATIENT MAY SUFFER ACCIDENTAL FALL INJURY
THREE PRIMARY STEPS IN REHABILITATION
1. POSITIONING
These are some positions that may reduce breathless. Patient can also try breathing techniques described below (in any of these positions) to help ease breathing.
Prone position

  

Page|1 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203



Forward lean position

Covid awake repositioning prone protocol:

 30min to 2 hours lying fully prone (bed flat)  30 min to 2 hours lying on right side (bed flat)  30 min to 2 hours sitting
 30 min to 2 hours lying on left side (bed flat)  30 min to 2 hours lying prone again

Continue to repeat the cycle as per comfort

Fowler’s position

Side lying position

   

* In Severe ARDS, prone position is recommended for 12-16 hours

* Note: Monitor oxygen saturations initially for 15 min after each position change to ensure oxygen saturation has not decreased. If saturation is fine or increase, continue with the position for 2 hours. However, if patients feels discomfort or oxygen saturation falls below 90% or overall decline of >4% from baseline oxygen saturation, then return to comfortable position.

2. BREATHING EXERCISE

These techniques will help you to relax and control your breathing.

Page|2 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

Pursed lip breathing /control breathing

Diaphragmatic breathing/ deep breathing in fowler’s position

Diaphragmatic breathing in sitting Diaphragmatic breathing in prone

Active cycle of breathing technique:

  If patient is having problem in clearing the secretion or unable to do effective cough, then repeat following step to produce effective cough.

  After huffing if patient feels secretion in throat then cough.

            

Page|3 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

  

Coughing

Huffing



Incentive spirometer

Page|4 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

3. RANGE OF MOTION EXERCISE

  

Shoulder exercise Elbow exercise Hand exercise

  

Wrist exercises

 

Hip and Knee exercises

   

Knee exercise in sitting: Knee straight Marching in sitting

Page|5 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

     

Ankle exercises

Strengthning exercise

  These exercise will help to improve muscle that become weaker as a result of your illness.

  Patient should aim to do two sessions per day with 5-10 repetition of each exercise.

  Start with the weight that can be tolerated eassily for 5-10 repetition. As patient get
better with the exercise, use more weight to make muscle work harder. Patient can use
tines of food or bottles of water as weight.

  Some strengthening exercise for arm and leg are described below. This can be done in
any order. Keep a good posture, with back straight and complete exercise slowly.

         

Shoulder exercise with weight Elbow exercise with weight Wrist exercise with weight

Knee press Heel press

 

Page|6 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh



All India Institute of Medical Sciences (AIIMS) Rishikesh, India – 249203

Aerobic exercise/ fitness exercises

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

  Some exercises to improve fitness are described below.

  Time duration of fitness exercise and gradully build up the amount of time patient can
manage.

  It may take a while to return to the level of activity that patients were able to do before
they became unwell.
Walking Stair climbing Cycling
INDICATION FOR EXERCISE

  After Pneumonia, evidence of exudative consolidation, LRTI and ARDS

  Patient with or after oxygen therapy by nasal prongs/ face mask/ bag mask/ HFO/
BIPAP/ CPAP

  Non-productive cough or dificulty with secretion clearence

  Patients at significant risk of developing functional limitations. eg., patients who are
fragile or have cardiac, neurological, diabetes or pulmonary comorbid conditions

  Patients above the age of 55

  Significant functional decline and ICU acquired weakness.

  Oxygen saturation less than 95%

  Nausea or feeling sick

  Dizziness or light headedness

  Sever shortness of breath, desaturation during exercise (SpO2 88-85%)

  Clamminess or sweating

  Chest tightness

  Increased pain

  Heart rate increse +20-30 bpm from resting rate

    

INDICATION TO STOP THE EXERCISE AND CONTACT YOUR HEALTHCARE



PROFESSIONAL

Page|7 @Nodalofficer(Covid-19)andRehabilitationteam(Dept.ofPulmonaryMed.&PMR),AIIMS,Rishikesh