Breathing comes naturally and easily when our lungs are healthy. However, shortness of breath and difficulty breathing are among the symptoms of COVID-19 that can linger for some patients after recovering from the virus.
As you would with any other part of the body, exercising is a key part of recovering your lungs following COVID-19 infection, Dr. Panagis Galiatsatos, the national volunteer medical spokesperson for the American Lung Association told Newsweek.
Getting the lungs to be used in an exercise fashion is going to help the healing process and make the healthy part of the lungs stronger, he said.
Practicing regular breathing exercises for COVID can help the lungs get rid of stale air, raise oxygen levels and ultimately get the diaphragm working at full capacity again.
COVID Breathing Exercises to Help With Your Recovery
Deep breathing and slow exhalation are useful for the lungs to keep them expanded, Galiatsatos said.
Although breathing during exercise is different from deep breathing, Galiatsatos noted, so "depending on the level of severity post-COVID-19," patients should talk to their doctor about starting pulmonary rehabilitation to monitor their breathing during exercise.
"During exercise, breathe in through your nose and out through your mouth and if you are struggling with shortness of breath, pause there."
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1. Pursed Lip Breathing
This exercise entails breathing in through your nose and breathing out for at least twice as long through your mouth while your lips are pursed.
Galiatsatos said: "From my standpoint, the thing that the lungs love is a nice long deep breath, and then slow exhalation. Air comes out slowly and you take your time," as seen with pursed lip breathing.
This form of breathing is taught to many patients with asthma and COPD (chronic obstructive pulmonary disease) and recommended for post-COVID-19 patients "because they are still having a lot of lung issues."
The pursed lip breathing exercise reduces the number of breaths you take and keeps your airways open longer. "More air is able to flow in and out of your lungs so you can be more physically active," the ALA explains.
2. Belly Breathing
Tamara Teragawa, a 500-hour RYT (Registered Yoga Teacher) told Newsweek one of the most effective breathing exercises is belly breathing, also known as diaphragmatic breathing.
Considered a core component of yoga and Tai Chi Chuan (TCC), diaphragmatic breathing involves "the contraction of the diaphragm, expansion of the belly, and deepening of inhalation and exhalation, which consequently decreases the respiration frequency and maximizes the amount of blood gases," explains a study published in June 2017 in Frontiers in Psychology.
The deep breathing exercise "contributes to emotional balance and social adaptation, as well as special rhythmic movements and positions," according to the study.
It's easiest to experience belly breathing while laying on your back, so you can relax and notice how your belly expands and relaxes as you inhale and exhale, said Teragawa .
As you allow your belly to expand and contract as you breathe, seal your lips together and slightly restrict the back of your throat with your tongue by pressing it to the roof of your mouth. Inhale and exhale fully through your nostrils.
Sealing your lips and pressing your tongue on the roof of the mouth will help you to focus on "utilizing your diaphragm as you breathe, which ultimately strengthens it." This breathing technique will also help calm your nervous system down, Teragawa said.
If your breathing is severely restricted, you can do this exercise while turned over on your side or stomach. You can also prop yourself up "so your lungs do not have to work so hard to fight against gravity," the yoga instructor advised.
3. Alternate Nostril Breathing
Teragawa said: "One of my favorite breathing techniques is known as alternate nostril breathing (Nadi Shodhan Pranayama). This technique helps to bring oxygen into the body, calm the mind and body, center and ground, and release toxins."
To perform this breathing exercise, start in a seated position, sitting up tall to stack your spine. "Allow yourself a few breaths to calm and become present as you close your eyes or simply soften your gaze," the yoga instructor said.
Using your right hand, place your ring and pinky fingers on your left nostril, while your thumb connects to your right nostril. "If you'd like, you could place your index and middle finger to the center of your forehead," Teragawa advises.
As you inhale, close your right nostril with your thumb. Then open your right nostril as you exhale and close your left nostril with your ring and pinky finger.
"Practice that for a few rounds, as it may take some getting used to in order to start to feel the effects of it. I recommend doing this if your symptoms from COVID-19 are mild and you may be struggling more with the anxiety or distress COVID-19 can cause," she said.
4. Humming
Humming while exhaling increases the production of nitric oxide (NO) in our body, which is naturally released in the respiratory tract and "known to be broadly antifungal, antiviral and antibacterial," according to a January 2006 study published in Medical Hypotheses, a peer-reviewed journal.
The study said: "Nasal NO is known to be increased 15- to 20-fold by humming compared with quiet exhalation."
You can hum while doing the aforementioned belly breathing exercise in an upright seated position.
Peiting Lien, a physical therapist and board-certified neurology clinical specialist at Johns Hopkins Medicine, explained you should breathe in through your nose and once your lungs are full, keep your lips closed and exhale while humming, making the "hmmmmmm" sound. Inhale and exhale again while humming. Repeat the exercise for one minute.
5. Yawn to Smile
Yoga instructor Teragawa said: "It is important to physically expand and stretch out the muscles of the chest to help keep those muscles mobile and active. One of the easiest ways to do this is to expand your arms out as wide as you can as if you're going to give someone a giant hug as you inhale, and then relax your chest and arms as you exhale."
Lien from Johns Hopkins recommends raising the arms and adding a yawn and smile to this movement.
Sitting upright at the edge of a bed or a chair, stretch your arms overhead and create a big stretching yawn. Then bring your arms back down and finish by smiling for three seconds. Repeat the move for one minute, says Lien.
"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."
6. Head Nods
Head nods stimulate the vestibular system, which are located in your inner ears and are very important for balance, says Lien from Johns Hopkins, which is crucial for fitness and exercising.
This vestibular system controls balance and sensory input from the body and is turned on by moving our head and eyes.
To do the move, while standing, simply look up and down at a slow, easy pace. Then do the same by looking left and right.
"Don't move into the pain range," so the movement should not be causing a strain, and "if it makes you dizzy, just move your eyeballs," Lien advises, adding "remember to keep breathing" throughout the exercise.
7. Rocking
Rocking aims to help you ease into movement as you prepare to get back into exercising. "Babies do this before they start crawling and it feels great to get on your hands and knees," Lien said.
Start by getting on your hands and knees, with hands about shoulder-width apart and placed just below your shoulders. Your knees should be beneath your hips, while your feet can be left wherever it feels most comfortable. In that position, simply rock your body backwards and forwards a few times.
The move should feel great on your lower back and shoulders. "Remember to keep breathing as you rock away," the physical therapist said.
8. Core and Cardio Training
Dr. Tae Chung, assistant professor of physical medicine, rehabilitation and neurology at the Johns Hopkins University School of Medicine, told Newsweek gradual cardiovascular training is helpful for those recovering from COVID-19.
He explained: "The rationale behind cardiovascular training is to increase blood volume. Our patients usually start with core strengthening for at least a few months for pre-conditioning, followed by gradual cardiovascular training, typically in recumbent or sitting positions (such as stationary bike or rowing machine).
"It is important to advance their training very slowly and gradually. It typically takes more than several months to a year, and the key to success is persistence," the Johns Hopkins School of Medicine professor said.
Can My Breathing Get Back to Normal After COVID?
The ALA's Galiatsatos said it is possible for your breathing to return to how it was before your COVID-19 infection and typically it can take three to six months to get there.
During that period, either the lung injury will be completely healed and have gone away or for some patients, "the injury won't heal but they will compensate."
In some people, "scarring from COVID-19" starts to look more permanent. At that moment, we will let the patient know that that part of the lungs is likely lost, but the healthy parts of the lungs can likely compensate. You just have to make them stronger, and the way you do that is through exercise through pulmonary rehabilitation," Galiatsatos explained.
For other patients, especially those who faced severe COVID-19 illness that required them to go to ICU, the healing takes a while. "For those patients it takes longer because it isn't just their lungs that are trying to recover, they might have lost muscle mass in the hospital." the ALA spokesperson noted.
Teragawa noted how soon your lungs will recover also depends on the severity of your symptoms and how much practice you put into COVID breathing exercises to strengthen your lungs.
"For me, I was fortunate that it was mild. I started practicing breathing exercises when I first began feeling ill, which I strongly believe helped to keep my lungs strong throughout the time I was sick. However, despite how mild it was, it took about a month of consistency with my breathing exercises and easing back into my workout regimen to start to feel my breathing was normal again.
"Everyone is different and everyone's experience with COVID has been different so be kind and patient with your body and stay consistent," she added.