The coronavirus that causes COVID-19 attacks the lungs and respiratory system, sometimes resulting in significant damage. COVID-19 often leads to pneumonia and even acute respiratory distress syndrome (ARDS), a severe lung injury. Recovering lung function is possible but can require therapy and exercises for months after the infection is treated.

“Working toward recovery starts simple: with a focus on breathing,” says Johns Hopkins physical therapist Peiting Lien. She offers a series of breathing exercises to aid in recovery for those who had COVID-19 or another serious illness.

Benefits of Breathing Exercises

“Deep breathing can help restore diaphragm function and increase lung capacity. The goal is to build up the ability to breathe deeply during any activity, not just while at rest,” notes Lien.

Deep breathing exercises can also lessen feelings of anxiety and stress, which are common for someone who experienced severe symptoms or was admitted to a hospital. Sleep quality may also improve with these breathing exercises.

Anyone can benefit from deep breathing techniques, but they play an especially important role in the COVID-19 recovery process. The exercises can be started at home during self-isolation and easily incorporated into your daily routine.

Precautions

Do not begin exercises, and contact your doctor, if:

• You have a fever
• You have any shortness of breath or difficulty breathing while resting
• You have any chest pain or palpitations (“fluttering” of the heart in the chest)
• You have new swelling in your legs

STOP exercise immediately if you develop any of the following symptoms:

• Dizziness
• Shortness of breath more than normal
• Chest pain
• Cool, clammy skin
• Excessive fatigue
• Irregular heartbeat
• Any symptoms you consider an emergency

Call 911 immediately if these symptoms don’t stop with rest or if you experience any change in mental status from your normal capacity.

Diaphragmatic Breathing (Belly Breathing)

Deep breathing restores lung function by using the diaphragm. Breathing through the nose strengthens the diaphragm and encourages the nervous system to relax and restore itself.

When recovering from a respiratory illness like COVID-19, it’s important not to rush recovery. This deep breathing exercise is broken up into phases to take into account individual ability. Start with Phase 1, and only increase repetitions or move to the next phase when you can complete the exercise without feeling too out of breath.

Phase 1: Deep Breathing While On Your Back

1. Lie on your back and bend your knees so that the bottom of your feet are resting on the bed.
2. Place your hands on top of your stomach or wrap them around the sides of your stomach.
3. Close your lips and place your tongue on the roof of your mouth.
4. Breathe in through the nose and pull air down into your stomach where your hands are. Try to spread your fingers apart with your breath.
5. Slowly exhale your breath through the nose.
6. Repeat deep breaths for one minute.

Phase 2: Deep Breathing While on Your Stomach

1. Lie on your stomach and rest your head on your hands to allow room to breathe.
2. Close your lips and place your tongue on the roof of your mouth.
3. Breathe in through your nose and pull air down into your stomach. Try to focus on your stomach pushing into the mattress as you breathe.
4. Slowly exhale your breath through your nose.
5. Repeat deep breaths for one minute.

Phase 3: Deep Breathing While Sitting

1. Sit upright on the edge of a bed or in a sturdy chair.
2. Place your hands around the sides of your stomach.
3. Close lips and place your tongue on the roof of your mouth.
4. Breathe in through your nose and pull air down into your stomach where your hands are. Try to spread your fingers apart with your breath.
5. Slowly exhale your breath through your nose.
6. Repeat deep breaths for one minute.

Phase 4: Deep Breathing While Standing

1. Stand upright and place your hands around the sides of your stomach.
2. Close your lips and place your tongue on the roof of your mouth.
3. Breathe in through your nose and pull air down into your stomach where your hands are. Try to spread your fingers apart with your breath.
4. Slowly exhale your breath* through your nose.
5. Repeat deep breaths for one minute.

*You may practice humming exhalation here if desired.

Exercises to Facilitate Movement

Yawn to a Smile

This exercise incorporates motion with deep breathing, which helps increase coordination and build strength in the arms and shoulders. It also opens up the muscles in your chest to give the diaphragm space to expand.

1. Sit upright on the edge of your bed or in a sturdy chair.
2. Reach arms overhead and create a big stretching yawn.
3. Bring your arms down and finish by smiling for three seconds.
4. Repeat for one minute.

Humming

Humming while exhaling helps increase nitric oxide production in the body. Nitric oxide helps with neural plasticity (building and repair of the nervous system) and it dilates blood vessels, enabling more oxygen to be delivered throughout the body. Humming is also calming and soothing, it reduces stress and it can help the patient remain in restoration mode.

1. Sit upright on the edge of your bed or in a sturdy chair.
2. Place your hands around the sides of your stomach.
3. With your lips closed and your tongue on the roof of your mouth, breathe in through your nose and pull air down into your stomach where your hands are. Try to spread your fingers apart with your breath.
4. Once your lungs are full, keep your lips closed and exhale while humming, making the “hmmmmmm” sound. Notice how your hands lower back down.
5. Again, inhale through your nose, then exhale through your nose while humming.
6. Repeat for one minute.