Intervention
INFLAMMATION, CONTRACTION
We built a yoga protocol adjusted to isolated patients and staff, including delivery through tele-(videos) and in-person intervention. The recorded videos were used for the asynchronous delivery of tele-intervention. Instructional short videos were prepared in different languages constituting the intervention. While these videos were self-explanatory, yoga was delivered as supervised sessions with modules presented as recorded videos supervised by trained yoga therapists along with the distribution of practical training materials including both audio and video inputs. On day 1, the hands-on intervention was carried out in the COVID-19 wards through teams of certified yoga therapists in personal protective suites, within 4 h of randomization. The intervention was further continued in the hospital settings using tele-mode until discharge day using tele-(videos) along with facilitation through the physical presence of an instructor. The intervention was delivered daily two times for a duration of 10 min. For those who were discharged before 14 days post-randomization, tele-yoga sessions were continued from their home settings. Typical morning sessions were of 15-min duration and included flexibility exercises [hands in and out breathing (2 min), hands stretch breathing (2 min), and shoulder rotation (2 min) as part of their regular warm up]. These exercises were followed by quick relaxation and subsequent 8 min of pranayama (breathing exercises), consisting of abdominal breathing (3 min), alternate nostril breathing or Nadishuddhi pranayama (3 min), and Bhramari pranayama (2 min). These practices have been reported to have effects on the strengthening of the respiratory muscles, and respiratory function, including the development of awareness of expansion and contraction of the airways and continuous and rhythmic breathing, which has been reported to aid in thorough oxygenation of the lungs and reduce inflammation. The practice sessions ended with guided relaxation of 2 min with a resolve. Evening sessions were 10 min and focused on the aforementioned breathing exercises and concluded with guided meditation.Clinical guidelines were followed up for treating patients via tele-yoga and hands-on techniques in cooperation with the medical heads of departments. The instructor or therapist monitored and ensured that the practices were done as per the module protocol and corrected the patients along with the doubt clarifications.