There is no vaccination available till now in the market to fight against COVID-19. The whole world is suffering due to this. We know the virus attacks the human body and lungs become the worst affected organ. Patients of COPD, bronchial asthma, renal disease, cancers are at high risk to get affected by COVID-19. We have to increase our Lung Capacity to fight against COVID-19. Total lung capacity (TLC) differs from person to person. Among healthy adults, the average lung capacity is about 6 litters. Age, gender, body composition, and ethnicity are factors affecting the different ranges of lung capacity among individuals. There are several breathing exercises and pranayama to increase lung capacity. I have mentioned the most effective exercises which increase lung capacity if can be practice regularly.  All the muscles should relax especially the muscles of thorax and shoulders. Be calm & relax so you can do the exercise properly.

1) Diaphragmatic Breathing

You should be in a comfortable position in which gravity assists the diaphragm, such as a semi- Fowler’s position. So you have to be in an approximately 45 degrees elevated position as shown in the picture. 

Procedure: Place your hand on the rectus abdominis muscle, so the hand will be on the upper abdomen shown in the picture. Your hands are supposed to give gentle pressure on your abdomen (above the diaphragm). Breathe in through your nose slowly & deeply and exhale through the mouth slowly, maintain the pressure over the diaphragm throughout the procedure. This can be practiced for 4 to 5 times.

Progression: once the previous exercise is done, your hand should be directed upwards while inspiring through the nose and drawback when you are exhaling through your mouth. This also can be practiced for 4 to 5 times.

Diaphragmatic Breathing

2) Segmental Breathing 

Segmental breathing targets the lateral and posterior segments of the lower lobes. However, segmental breathing techniques also may need to be directed to the middle and upper lobes if there is an accumulation of secretions or insufficient lung expansion in these areas.

Lateral costal expansion

Procedure: Hook-lying position; later progress to a sitting position. Place your hands along the lateral aspect of the lower ribs to direct the movement of the lung. Take your position, lying/sitting and then breathe out, and feel the rib cage move downward and inward. As you breathe out, place pressure into the ribs with the palms of your hands. Place your hands in the position shown in the picture where the therapist's hand is placed. 

Lateral costal expansion in sitting
Lateral costal expansion in supine

Posterior basal expansion

It emphasizes the posterior segments of the lower lobes. Sit and lean forward on a pillow, slightly bending the hips. Place your hands over the posterior aspect of the lower ribs, and follow the same procedure just described for lateral coastal expansion. 

Posterior basal expansion

3) Pursed-Lip Breathing

Pursed-lip breathing is a strategy that involves lightly pursing the lips together during controlled exhalation. This breathing pattern often is adopted spontaneously by patients with COPD to deal with episodes of dyspnoea (difficult breathing).  Procedure: (see the video)Assume a comfortable position and relax as much as possible. Breathe in slowly and deeply through the nose and then breathe out gently through lightly pursed lips as if blowing on and bending the flame of a candle but not blowing it out. You can do it in a sitting position.

4) Box Breathing/four square breathing

This is a very popular method for relaxation and mental calmness. It is also known as four-square breathing. Procedure: (see the video at the end of the article). Sitting is the best position to do this exercise. 1st step is to exhale and empty your lung in 4 seconds. Then hold it for 4 seconds. Inhale in 4 sec and hold the breath for 4 sec, then again exhale in the same period of time and repeat the cycle 10 times.

5) Huffing

This is a maneuver used to move secretions, mobilized by deep breathing/thoracic expansion exercises, downstream towards the mouth2. A huff is exhaling through an open mouth and throat instead of coughing. Huffing helps moves sputum from the small airways to the larger airways, from where they are removed by coughing3 as coughing alone cannot remove sputum from small airways4. Procedure:  (see the video)You can do it in a sitting position. You have to exhale forcefully with a repeated manner. Forceful exhalation should be a shorter period of time. It increases the lung capacity by mobilizing the secretion of the lung. 

6) Pranayama

There are several pranayamas to increase the lung capacities, here we will describe some of them. 

Procedure 1: (see the video) Sit straight in the ground, deep breath in with your nose and breath out with your mouth. Now what you have to be careful over here that breath in and breath out should be in same duration, if you are taking the time of 5 sec to breathe in then you have to breathe out in 5 sec. The progression of this exercise will be breath in (eg. 5sec), hold (5sec) and then breath out (5 sec).  

Procedure 2: (see the video) Stand straight and place your both hand just beside the nipple along with your rib cage as you are holding your rib cage. Now inhale deeply with your nose and drawback your both elbow backward simultaneously. Once you have complete inspiration, decrease the holding force of your hand, repeat this for 8 to 10 times.

Procedure 3: (see the video) Stand straight and place your hand above your head. Inhale deeply in that position and start exhaling, bend down and touch your knee at the time of exhaling. Once exhalation completely come to your starting position (hand above your head) by inspiring through your nose. Repeat this for 8 to 10 times.  

Points to ponder:

Mobilize your thorax: you have to do some exercises to mobilize your thorax to enhance the capacity of the lungs. These exercises can be done in freehand basis. This exercise includes back bending, rotation, and side bending of the thorax. Apart from this you can do shoulder and neck free hand exercises and can add some stretching exercises.

Posture: maintain a good posture while you are sitting or standing to get maximum efficiency of your lung. Try to avoid sleep on your tummy which compromises lung function.

Meditation: those who are in the practice of meditation can do these exercises in a better manner, so practice meditation.

Diet: try to have lots of vegetables and fruits and maintain your wellbeing which also has a great impact on your lung.

Smoking: it is an established fact that smokers usually has less lung capacity than others. COVID-19 is a warning for smokers to quit it.






5. YOGABALE ROG-AROGYA: Smt Swami Shivananda Saraswati

6. Therapeutic Exercise 5th ed; Kisner, Colby