Yoga practiced in the integrative protocol is aimed at improving the lung function, primarily by helping the collapsed lung to expand and thereby assisting the remaining lung to fill-up void spaces created by the surgical intervention

(I) Pranayam: is a set of controlled breathing exercises, which forms part of Yoga.

• Bhastrika: to conduct this Pranayam, the patient is assisted to sit comfortably with his back resting against the folded bed. The patient is requested to take a deep inhalation, to the best of his capacity exerting maximum force, and thereafter allow the air to be exhaled out completely as an involuntary process, without any effort or exertion from his part. The transition for inhalation to exhalation is separated by a small amount of time, which is explained to the patient as a rising wave ebbing before falling, where inhalation is the wave rising. Patients are encouraged to repeat this Pranayam 10 times

• Kapalbhati (only pre-surgical): with the patient in sitting position as above, he is requested to exhale forcefully to push out every bit of air in his lungs, by voluntarily tightening and contracting his chest muscles. Thereafter he is asked to ease his chest muscles, so that the air flows into the chest as a natural process, with no voluntary involvement in inhalation. Kapalbhati Pranayam is also repeated for 10 times

• Anulom-Vilom: with the patient seated as before, he is requested to inhale and exhale normally three times. There after he is requested to close his right nostril with his right thumb and inhale through the left nostril to maximum possible extend of his lung capacity. Thereafter he is instructed to close his left nostril with his right index finger and exhale through the right nostril. Then he is instructed to repeat the process with closing his left nostril and inhaling through the right nostril and then closing the right nostril and exhaling through the left. The two cycles of alternate inhalation and exhalation makes for one cycle of anulom-vilom. The patient is guided to repeat anulom-vilom 10 times

• Nadi shodhan: nadi shodhan Pranayam is exactly like anulom-vilom but for a small difference. In nadi shodhan Pranayam the inhalation and exhalation is done through the same nostril. That is, inhale through left, and exhale through left, then inhale and exhale through right, which makes a full-cycle. This Pranayam is also repeated 10 times

• Brahmaree: with the patient sitting, he is asked to raise both his hand to the sides to the face, and using his index and middle finger close his eyelids, and with his thumb close his ears. There after he has to take a deep inhalation and while exhaling make a humming sound from the throat, similar to the buzz of bee. He has to exhale through the nose and should keep his mouth closed during this process. This Brahmaree Pranayam is also repeated 10 times

• Udgeet: the seated patient is asked to take a deep inhalation and exhale through the mouth (Udgeet is the only Pranayam where one has to exhale through the mouth) making the sound, originating from the throat region, similar to the pronunciation of “Om”

(II) Asan

• Uttanapadasan (modified): the patient has to lie on his back, without a pillow with hands resting on the sides. There after he has to raise his left foot, so that the left heel is not more than 10 cm above the bed, with both legs straight (not bend at the knees) and hold the leg up for 5 seconds. Thereafter he has to relax and exhale, while simultaneously bringing the left leg down to rest on the bed. This he has to repeat with the right leg, to complete one cycle. He has advised to do 10 such cycles

• Ardha-pavanamuktasana (for post-surgical patients, only after drain removal): the patient has lie on his back, without a pillow with hands resting on his sides. There after he has to raise his left leg, bent at the knee and held and pulled towards his chest with both his inter-locked palms, while at the same time raising his head and bending forwards the stomach, so as to try touching his knee with his nose. He has to exhale during this process. After holding the position for a second, he has to relax, bringing down his leg and the head to resting position, while inhaling at the same time. Then he has to repeat the whole exercise with his right leg to complete one cycle. The number of repetitions of this Asan is as per the patients’ ability to perform the same, but never more than 10 times a day is advised while the patient is admitted in the hospital

• Pavanamuktasana (only pre-surgical): similar to ardha-pavanmktasan, but both legs are pulled towards the stomach at the same time. Also repeated a maximum of 10 times

(III) Small exercises

• Finger flicking: holding the hands extended, the fingers are spread opened and closed to a tight fist, repeatedly

• Wrist rotation: holding the hands extended, and fingers folded as fists, the hands are brought together to touch at the wrist and rotated, rolling one over the other, in clockwise and anti-clockwise directions, 10 times each

• Shoulder rotation: open palms resting on the thighs, the shoulders are rotated forwards and backwards, 10 times each

• Butterfly movement of the hip: the patient sitting on the bed with back support, and legs folded at the knees, raises and lowers the knees repeatedly giving rise to the image of the fluttering wings of a butterfly