Will breathing exercises help my long covid?

They help the breathing-pattern component, which is common and produces a lot of the breathlessness. They do not address the whole condition, and where post-exertional worsening is present, pacing is the priority and pushing is harmful.

My oxygen is 98%. Why am I breathless?

Because breathlessness is a perception generated by many inputs, not a readout of oxygen. A disturbed breathing pattern with low carbon dioxide produces severe breathlessness with a perfect saturation reading, which is exactly the picture people are told is reassuring and does not feel it.

Only after establishing whether activity makes you worse a day or two later. If it does, pacing comes first and graded exercise is not appropriate. If it does not, gradual activity is reasonable — with specialist guidance rather than a generic plan.

Long-covid breathlessness: breathing pattern, pacing, and why not to push

Months after the infection, walking upstairs empties you. Your scans and your oxygen saturation are normal, which nobody finds reassuring including you, and the advice you have been given is to build it back up — which made things worse last time you tried.

Do this now

Reset the pattern, gently

5 minutes

Lie on your back or sit well supported. One hand low on the belly.
Mouth closed. Breathe in through the nose so the hand rises before the chest does. Small.
Out for slightly longer than in. Do not force either end.
Five minutes. Stop earlier if you feel worse rather than better — that response is information, not weakness.
Do nothing else afterwards for ten minutes. The rest is part of the exercise in this condition.

Run it with a timer

Breathing pattern disorder is common after covid

Post-covid breathlessness with normal imaging, normal oxygen saturation and normal spirometry is frequently accompanied by a disturbed breathing pattern — upper-chest dominant, fast, irregular, with frequent sighing. Specialist respiratory physiotherapy assessments in post-covid clinics found this in a large proportion of patients, and breathing retraining is a recognised part of post-covid rehabilitation. This is the part that responds well.

Why the usual exercise advice can be wrong here

A subset of people with long covid have post-exertional symptom exacerbation: a disproportionate worsening of symptoms hours to days after activity, mental or physical. In that group, graded exercise that pushes through symptoms causes harm, and guidance now explicitly cautions against it. So the order matters: identify whether exertion makes you worse for days, and if it does, pacing comes before any attempt to build capacity.

What pacing actually means

Working consistently below the level that provokes a crash, rather than doing as much as possible on good days. In practice: split activities, plan rest before you need it, keep a simple activity and symptom diary to find your ceiling, and hold that ceiling as a boundary rather than a target. Breathing work fits inside pacing as a low-cost, low-exertion practice — it is one of the few things that is usually safe to do daily in this condition.

What changes it, over a week

First, this week
Answer one question in writing: does activity make you worse hours or days later? Your answer decides everything else on this page.
Daily, five minutes
Low, slow nasal breathing, lying or well supported. Stop if you feel worse rather than better.
All day
Nasal breathing, and notice sighing and breath-holding. Pattern work is the part with the clearest benefit.
If exertion crashes you
Pace rather than build, and ask for referral to a post-covid service and a respiratory physiotherapist rather than a general exercise programme.

When this is not a breathing pattern

See a clinician — promptly, and before assuming any of this applies to you — if any of these describe you:

New or worsening breathlessness, chest pain, or a fast heart rate — get medical assessment, do not assume it is long covid
Oxygen saturation that falls with activity, calf pain or swelling, or coughing blood — urgent assessment
Fainting or near-fainting, particularly on standing
Worsening of symptoms for days after activity — stop graded exercise and ask for specialist advice
Any new symptom, because having long covid does not protect you from anything else

This page is education, not medical advice, and no part of it is a diagnosis. Full disclaimer.

Questions people ask

Will breathing exercises help my long covid?: They help the breathing-pattern component, which is common and produces a lot of the breathlessness. They do not address the whole condition, and where post-exertional worsening is present, pacing is the priority and pushing is harmful.
My oxygen is 98%. Why am I breathless?: Because breathlessness is a perception generated by many inputs, not a readout of oxygen. A disturbed breathing pattern with low carbon dioxide produces severe breathlessness with a perfect saturation reading, which is exactly the picture people are told is reassuring and does not feel it.
Should I exercise?: Only after establishing whether activity makes you worse a day or two later. If it does, pacing comes first and graded exercise is not appropriate. If it does not, gradual activity is reasonable — with specialist guidance rather than a generic plan.

What this page is built on

— Motiejunaite et al., 2021, and post-covid physiotherapy series — breathing pattern disorder after covid-19
— NICE guideline NG188 on managing the long-term effects of covid-19 — caution regarding graded exercise where post-exertional symptom exacerbation is present
— Lewthwaite et al., 2022, and post-covid rehabilitation reviews — breathing retraining within multidisciplinary rehabilitation

Named by author and year. The DOIs live in the journal.

Put a number on it

Most of what is on this page tracks one measurement: the Control Pause. It takes sixty seconds, needs no account, and it is the thing that tells you whether any of this is working.