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Editorial

COVID‑19 Patient Guide to At‑Home Exercises

This guide was created to help COVID‑19 patients perform
gentle exercise in their own home. These exercises are designed
to be done alone by the patient in their room. The caregiver
can assist by providing instructions over the telephone if the
patient is still on isolation.
This manual is provided free for distribution as a courtesy by
the author and the Department of Rehabilitation Medicine,
Montefiore Medical Center, NY, USA. It has been accepted
for publication by the Journal of International Physical
and Rehabilitation Medicine in its upcoming issue. For the
complete instructions, please refer to the article.
Exercise
This illness is highly debilitating. We don’t 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 through 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.
Progress to the next level when the patient is able to easily
complete exercises in the previous level. Gradually start adding
in exercises from the next higher level until they are able to
able to completely transition to the next level.
Precautions
a. You can start gentle exercises if:
i. You have not had a fever for at least 7 days
ii. You have no shortness of breath, palpitations, or
chest pain while walking around in your room/
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.
Level 1 Lying Exercises
These are suitable for patients who are weak and have to lie
down most of the time. Start with the first three breathing
exercises and gradually add the rest [Table 1].
Level 2 Sitting Exercises
These exercises are suitable for patients who can easily
complete the Level 1 Exercises. Always do the breathing
exercises and gradually add the rest [Table 2].
Level 3 Standing Exercises
These exercises are suitable for patients who can easily
complete the Level 2 Exercises. Always do the breathing
exercises and gradually add the rest [Table 3].

Table 1: Lying Exercises

Exercise
Deep breathing exercises
Pursed lip breathing exercises
Blowing exercises
Ankle pumps
Hip and knee bends
Crossing your legs in bed
Overhead arm stretch
Touching back of the neck
Touching upper back
Sitting side of the bed
Sit to stand
Relaxation: Mindful meditation
Frequency/duration Rationale
2 min Aerating the lower parts of the lung
2 min Exercising the breathing muscles
Ten times Exercising the breathing muscles
Repeat 2-3 times. Increase gradually to eight times (one set) Improve leg circulation. Prevent ankle contractures
Repeat 2-3 times. Increase gradually to eight times (one set) Maintain hip and knee range of motion
Repeat 2-3 times. Increase gradually to eight times (one set) Maintain hip external rotation
Repeat 2-3 times. Increase gradually to eight times (one set) Maintain shoulder abduction and extension
Repeat 2-3 times. Increase gradually to eight times (one set) Maintain shoulder external rotation
Repeat 2-3 times. Increase gradually to eight times (one set) Maintain shoulder internal rotation
As long as tolerated Improve sitting balance. Reduce postural dizziness
Ten times (one set) Improve ability to get up
10 min

32 © 2020 The Journal of the International Society of Physical and Rehabilitation Medicine | Published by Wolters Kluwer - Medknow
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Ambrose: Montefiore

Table 2: Sitting Exercises

Exercise Frequency/duration Rationale
Deep breathing exercises 2 min Aerating the lower parts of the lung
Pursed lip breathing exercises 2 min Exercising the breathing muscles
Blowing exercises Ten times Exercising the breathing muscles
Chin up and down 1-2 times, increasing to eight times Neck range of motion. Vestibular exercises
Head turns 1-2 times, increasing to eight times Neck range of motion Vestibular exercises
Shoulder rolls Eight times forward and eight times backward Shoulder range of motion
Finger stretch Hold for a count of 8 Wrist and finger stretch
Calf stretch Hold for a count of 8 Hamstring Stretches
Wrist curls Hand and wrist muscle strengthening
Biceps curls 1-2 times, increasing to eight times Forearm strengthening
Seated overhead extension 1-2 times, increasing to eight times Shoulder muscle strengthening
Seated shoulder abductions 1-2 times, increasing to eight times Shoulder muscle strengthening
Tummy twists 1-2 times, increasing to eight times Core strengthening
Seated knee lifts Start 2-3 times. Increase to eight times Hip flexor stretches and strengthening
Seated knee extensions Start 2-3 times. Increase to eight times Hamstring stretches Quad strengthening
Relaxation: Mindful meditation 10 min

Table 3: Standing Exercises

Exercise Frequency/duration Rationale
Deep breathing exercises 2 min Aerating the lower parts of the lung
Pursed lip breathing exercises 2 min Exercising the breathing muscles
Blowing exercises Ten times Exercising the breathing muscles
Overhead stretch Count of 8 Full-body stretch
Side stretch Count of 8. Repeat 2-4 times Full-body stretch
Triceps stretch Hold 15-30 s. Repeat 2-4 times Arm stretch
Quadriceps stretch Hold 15-30 s. Repeat 2-4 times Thigh muscle stretch
Groin stretch Hold 15-30 s. Repeat 2-4 times Hip muscle stretches
Calf stretch Hold 15-30 s. Repeat 2-4 times Hamstring stretch
Standing shoulder flexion Start 2-3 times and increase to eight times Shoulder stretch
Standing shoulder abduction Start 2-3 times and increase to eight times Shoulder stretch
Upright front row Repeat eight times Shoulder strengthening exercise
Biceps curls Repeat 2-3 times on each side and increase gradually to eight times Arm strengthening exercise
Core exercises Start with 1-2 times and slowly increase to eight times Core strengthening exercise
Leg abduction Hold for a count of 8 Hip strengthening exercise
Start with 2-3 times and increase to eight times
Hamstring curls Hold for a count of 8
Start with 2-3 times and increase to eight times
Leg strengthening exercise
Supported lateral lunge Hold for a count of 8 Leg strengthening exercise
Start with 2-3 times and increase to eight times
Supported squats Hold for a count of 8 Leg strengthening exercise
Start with 2-3 times and increase to eight times
Wall push-ups Hold for a count of 8 Chest strengthening exercise
Start with 2-3 times and increase to eight times
Walking 10 min Cardiovascular fitness
Increase to three times a day
Relaxation 10 min

The Journal of the International Society of Physical and Rehabilitation Medicine  ¦  Volume 3  ¦  Issue 2  ¦  April-June 2020 33
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Ambrose: Montefiore

Anne Felicia Ambrose

Access this article online
Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, NY Quick Response Code:
10467, USA Website:
www.jisprm.org
Address for correspondence: Dr. Anne Felicia Ambrose,
Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx,
NY 10467, USA. DOI:
E‑mail: ambrose924@gmail.com 10.4103/jisprm.jisprm_7_20

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How to cite this article: Ambrose AF. COVID-19 patient guide to at-home
exercises. J Int Soc Phys Rehabil Med 2020;3:32-4.
Submitted: 08-Apr-2020; Accepted: 08-Apr-2020; Published: 16-May-2020

34 The Journal of the International Society of Physical and Rehabilitation Medicine  ¦  Volume 3  ¦  Issue 2  ¦  April-June 2020