Proning: Self-Care Breathing Exercise For COVID-19 Patients

Coronavirus has reached its deadly stage. It has been observed that the patients suffering from COVID-19 have difficulty in breathing which causes a rapid decrease in their blood oxygen levels. Usually, the symptoms of this disease are visible after the lung gets damaged by 25%, resulting in a dip in oxygen saturation level to 80- 85%. In such a situation, an immediate oxygen supply is required. If oxygen is not available during this period, the patient may face complications. The cells in our body require at least 89% of the oxygen saturation level while healthy individuals have a saturation level of 95 and above. Any significant drop in this level causes breathlessness. With an increased demand for oxygen supply, medical institutes are overburdened and also the availability of ventilators is limited. Therefore, the best way to reduce our dependency upon hospitals and ventilators can be achieved by managing blood oxygen levels at our home by a natural method of proning. Proning is a technique used to optimize oxygenation, it is an easy to do home exercise. A method of attaining prone position is required when the patient feels discomfort while breathing and also when the oxygen level decreases below 94. In this blog, we will discuss proning and how it increases your oxygen supply.

 

Proning or Prone positioning:

Patients who are on ventilators due to pneumonia spend long hours lying on their back, due to which the fluid begins to enter the back of the lungs. The air breathed in cannot mix well with the blood flowing through the lungs. This is because of the pooling of fluid causing the lung tissue to collapse. The lung tissue in the back of the chest undergoes inflammation and infection-causing a decrease in the transfer of oxygen to the blood.  The patient ultimately becomes tired of breathing and exhausted with the effort of keeping the blood completely oxygenated. The best way to support breathing is by keeping the patient on a ventilator. But ventilators can often damage the lungs. Therefore, a safe and simple method to improve oxygenation is by prone position or proning. Prone position or proning opens up the collapsed airways and increases blood oxygen levels. In a prone lying position, the heart rests on the breast bone giving space for the lungs to expand, this increases the airflow to the back, where the blood circulation is the most. So, both blood circulation and more oxygen, lead to effective oxygenation.

 

Positioning

The patient lies in a prone posture on their abdomen or on their belly by facing down towards the bed. Keep a pillow below the neck and chest. Keep two pillows below each shin. Make sure that the patient lies comfortably, if not so the patient might feel suffocated. Do not spend more than half an hour in each position.

·         Lying on your stomach:

             Begin by lying on a bed by stomach facing towards the bed for 30 minutes.

 

·         Side-lying position to right side:

             For side-lying, lie on your right side for 30 minutes.

 

·         Sitting up:

             Sit up in the bed with your back supported and both legs extended for 30 minutes.

 

·         Side-lying position to left side:

             While lying in the bed lie on your left side for 30 minutes.

 

·         Lying on your stomach:

             Return to lying on your stomach by facing towards the bed for 30 minutes.

 

Benefits

·         It is a safe and simple home method to improve oxygenation.

·         It improves ventilation.

·         Helps the body to get air into all areas of the lungs.

·         Prevents worsening of complications due to decreased oxygen circulation.

·         Delays the use of mechanical ventilators by maintaining the supply of oxygen to the body tissues.

 

Safety measure

·         Avoid prone position or proning immediately after meals.

·         Maintain prone position till the patient feels comfortable.

·         Pillows should be kept under pressure areas especially around bony prominences.

 

Contraindications

Prone position should be avoided in conditions like:

·         Pregnancy.

·         Deep venous thrombosis.

·         Major cardiac conditions.

·         Fractures like spinal, femoral, or pelvic fractures.

 

In the current situation, Covid-19 cases are increasing and it has become obligatory for us to take necessary precautions and help prevent the further spread of the disease.

 

Exercises to gain Strength and Mobility at home during COVID-19

Remaining active during this pandemic has become another big challenge for people all over the world. Social restrictions caused by COVID-19 continue to affect all of us. Being stuck at home and avoiding public gatherings has not only affected our mental health but also our physical activity. Therefore to maintain the overall strength of the body, few basic exercises should be done while staying at the home. These exercises won’t only boost your immune system but also will keep your mind busy. People who are at higher risk of COVID complications, such as old aged individuals, people suffering from Heart and Lung Disease, Cancer, HIV, and Diabetes should exercise on daily basis, whereas those infected with COVID-19 can do light to moderate intensity exercises while maintaining quarantine.  Vigorous-intensity exercises should be avoided for 2 weeks after a positive test, with close monitoring of the vital signs and symptoms. Here are some basic strengthening exercises, which you can do, while staying at home.

Cervical strengthening:

·         Start in a sitting position.

·         Place your hand on your forehead.

·         Apply pressure by pushing your hand towards the head, resist it back and hold.

·         Place your hand on the back of your head, apply pressure by pushing your hand towards the head, resist it back and hold.

·         Place your hand on the side of your head and apply pressure by pushing your hand towards the head, resist it back and hold.

·         Place your hand on the other side of your head and apply pressure by pushing your hand towards your head, resist it back and hold.

Bicep strengthening:

·         Sit in a chair.

·         Hold a weight in your hand, bend your elbow to raise your hand towards your face.

·         Relax and bring the elbow to the starting position.

Overhead strengthening, with dumbbell:

·         Hold a weight in your hands.

·         Raise your arm above your head and keep it straight.

·         Bring back your arm to the starting position and repeat.

Plank on-the-ball" Core/scapular strengthening:

·        Pile up few pillows of the same height same as the length of your arms or use a ball. Roll over the top of the ball or keep both your feet over the pillows until you have your hands under your shoulders, and the ball under your legs.

·        Note, the closer the ball or pillows are towards your feet, the harder the exercise.

·        Maintain this position with your shoulders strong, your core engaged, and your back flat.

·        Do not allow your back or shoulders to dip down.

Push-ups:

·         Lie on your front with your hands just wider then your shoulders and toes on the floor.

·         Tighten your buttock and abdominal muscles as you push yourself up with the help of your arms, keeping your body straight.

·         Your shoulders and your heels should be in a straight line.

·         Place your hands on the floor so that you fix your shoulder blades fully against your rib cage.

·         Keeping your back straight and control at the shoulder blades, bend your elbows, dropping down into a press-up.

·         Straighten your elbows again by pushing back on your hands.

Bridging with lifting heel:

·         Lie on your back keeping both your feet on the floor and maintaining your legs at hips-width apart. Bring one leg upwards at a time.

·         Lift your hips upwards until you have a straight line from your shoulders to your knees.

·         Hold this position and now raise one heel of one foot, then bring this heel back and raise the other.

·         Repeat the movement by keeping your hip your body upwards.

Plank, side (low)" Core/scapular strengthening:

·        Lie on your side.

·         Keep your legs straight and stack them on top of one another.

·         Use your elbow and feet to take your body weight, keeping your head to your feet in a straight line.

·         Hold this position for as long as you can, preventing the hips from going down.

Gluteus sets:

·         Lie on your back keeping your legs straight.

·         Tighten your buttocks and hold this position.

·         Relax and then repeat.

Quadriceps sets:

·         Sit on a bed keeping your legs straight.

·         Keep a pillow under your knee and try to apply pressure to the pillow by pressing down your knee without using your hands, hold this position.

·         Relax and then repeat

Hamstring set:

·         Lie on your back.

·         Bend your knee to an angle.

·         Pull your toes towards you

.

·         Gently push your heel into the floor.

·         Hold this position as instructed.

Heel raises:

·         Stand up straight by holding the back support of a chair.

·         With your legs hip-distance apart.

·         Rise on the ball of both feet.

·         Transfer your weight onto one leg by lifting your other leg from the floor.

·         Keeping your heel raised, hold this position.

·         Place the other foot back on the floor and lower yourself back down using both legs.

·         Repeat.

Squat, on a wall, with heel lifts:

·         Stand straight with your back towards the wall.

·         Lean your back and buttocks against the wall and move your feet apart to hips-width.

·         You may also need to move your feet forward a little.

·         Slowly slide down the wall to attain a squatting position with your hips and knees at 90 degrees.

·         Keeping your back and buttocks against the wall, hold this position while sliding back on the balls of your feet.

·         Lower your heels and then repeat.

Stay home, stay safe, and stay healthy.