Since the virus that causes COVID-19 is respiratory in nature, significant lung damage can sometimes result from an infection. It’s possible to regain lung function once the infection has been treated, but it may require months of physical therapy. A good place to start recovery, says Johns Hopkins physical therapist Peiting Lien, DPT, is with gentle breathing exercises. Here are just a few to get you started. 

Why Practice Conscious Breathing?

A dome-shaped muscle at the base of the chest, the diaphragm contracts and flattens when inhaling, pulling air into the lungs in a kind of vacuum; when exhaling, the muscle relaxes, pushing air back out of the lungs. 

By practicing deep breathing, a person can help strengthen the diaphragm and restore lung capacity. Lien says the aim is to “build up the ability to breathe deeply during any activity, not just while at rest.”

Along with rebuilding the lungs, practicing deep breathing through the nose promotes relaxation and reduces stress and anxiety, which can be especially helpful for people recovering from severe COVID-19. It can also improve sleep quality. 

While anyone can benefit from deep breathing, the exercises are particularly useful in COVID-19 recovery and can easily become part of one’s daily routine.

Before Starting

Signs that you should not exercise and should contact your doctor are:

• Fever
• Difficulty breathing at rest
• Chest pain or heart palpitations
• New leg swelling

You should stop exercising immediately if you experience:

• Dizziness
• Breathlessness (more than usual)
• Chest pain
• Cool, clammy skin
• Excessive tiredness
• Abnormal heartbeat
• Abnormal mental changes

*Call 911 if these or other symptoms seem severe or do not resolve with rest. 

Diaphragmatic (Belly) Breathing

Four variations of diaphragmatic breathing are presented below, but it’s important to go slowly when recovering from COVID-19. Lien suggests starting with just the first position, without increasing repetitions or advancing to the next exercise until you can do so without growing short of breath. (Performing the exercise one time equals one repetition.)

Deep breathing lying face up

Positioning: Lie on your back with knees bent and feet flat on a bed. Place one hand flat on your belly and one on your chest. 

Performance: With your lips closed and your tongue resting against the roof of your mouth, inhale through your nose, drawing air into your stomach. Allow your belly to expand as you inhale, until it is full. Slowly exhale through your nose. Repeat for 1 minute.

Other positions in which to practice deep breathing include:

• Deep breathing lying face down. Lie on your stomach with your hands beneath your forehead to create space to breathe. 
• Deep breathing seated. Sit tall in a firm chair or on the side of a bed, with one hand on your chest and the other on your stomach. 
• Deep breathing standing. Stand tall with one hand on the chest and the other on the stomach. Lips should be closed with the tongue resting on the roof of the mouth.

Performance instructions are the same for all position variations. 

In the brief video below, Dr. Lien reviews diaphragmatic breathing while standing, in addition to several exercises to help regain functional movement. 

Yawn to Smile

Combining deep breathing with movement, this exercise also helps coordination, strengthens the shoulders and arms, and lengthens chest muscles to allow the diaphragm to expand.

Positioning: Sit tall in a firm chair or on the side of a bed.

Performance: Lift your arms overhead to form a “Y” as you open your mouth in a “big stretching yawn.” Bring your arms back down and smile for three seconds. Repeat for 1 minute.

Humming

Humming while exhaling has interesting and important benefits:

• It promotes nitric oxide production, which helps to build and repair nerves, and dilate (enlarge) blood vessels for increased oxygen flow.
• It is calming and soothing, reducing your stress to help your recovery. 

Positioning: Sit tall in a firm chair or on the side of a bed with one hand on the chest and the other on the stomach. Lips should be closed with the tongue resting on the roof of the mouth.

Performance: With your lips closed and your tongue resting against the roof of your mouth, inhale through your nose, drawing air into your stomach. Allow your belly to expand as you inhale, until it is full. Slowly exhale through your nose. Keeping your lips closed, slowly exhale through your nose while making a prolonged “hmm” sound. Repeat for 1 minute.

*Lien, P. (2021, May 11). Coronavirus Recovery: Breathing Exercises. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-recovery-breathing-exercises