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5 steps to therapeutic breathing to combat COVID-19

SuuntoRun — 11 June 2020

Freediving world champion William Trubridge explains how therapeutic breathing can support recovery from COVID-19.

Suunto ambassador William Trubridge knows a thing or two about deep breathing. In 2016, he set a new world record by diving to 102 m on one breath. In 2019, he became the first man to complete an 'underwater crossing' of one of the world’s major channels, swimming across the wild Cook Strait as a series of 934 breath hold dives.

William has recently taken another deep dive, this time into the medical world and its treatment of COVID-19. Concerned about the impacts of the virus, he researched how it attacks the body and the medically accepted treatments that help people recover from it. In the process, he learned therapeutic breathing can play a valuable role. Read on for his in-depth report!

Scroll down to see William demonstrate a deep breathing exercise!


Therapeutic breathing for COVID-19

By William Trubridge


SARS-CoV-2 is a virus that targets the respiratory system. It attacks our ability to breathe. Now it’s emerging that a strategy to combat this infection may be through breathing itself.

First, I need to state clearly I am neither an epidemiologist nor pulmonologist. Everything I describe in this article has been recommended by experts (who I will reference) in one or both of these fields, and I will not speak or extrapolate beyond their recommendations. My career in freediving has meant that I have spent almost two decades harnessing the power of breathing, and I hope to use this experience to help describe and demonstrate how to achieve the recommendations of the experts.
For example, the instruction to ‘breathe deeply’ is like telling someone to ‘swim smoothly’– there is a lot of technique inherent in the action. A ‘deep breath’ could have vastly different results depending on whether you start at the base of the lungs, sucking air into the belly, or if instead you simply lift the shoulders and ‘gasp’ the air in. These are the distinctions where I hope to add value.

When JK Rowling contracted Covid-19 in April, she employed a technique described by physician Sarfaraz Munshi from Queen Hospital UK that is aimed at maintaining lung function and preventing secondary pneumonia during the illness.1 The Youtube video of his description is here, and the sequence he advises can be summarised as follows:

1. Sit with a straight spine and feet flat on the floor (I add this instruction, since deep breathing while standing risks fainting).
2. Breathe in deeply, hold for 5 seconds and exhale – repeat 5 times.
3. Breathe in and do a big cough from the base of the lungs (covering your mouth)
4. Repeat Steps 2 & 3.
5. Lie flat on your front with a pillow in front of you, taking fairly deep breaths for 10 minutes.

This sequence is taught by respiratory physiotherapists also, where it sometimes goes by the name of ‘Active Cycle of Breathing Technique.’
 It is important to remember it's a therapeutic treatment, not preventative: there is no reason to expect that it will help to protect against infection with the virus in the first place.

The deep breaths help to ventilate alveoli and remove debris that has accumulated on the walls of the alveoli due to damage from the virus. This debris is what blocks oxygen from being absorbed into the blood, which can lead to a condition called ARDS. Lying on your stomach benefits aperture of the smaller airways: since these are distributed closer to your spine if you are lying on your back the weight of your torso will impede them from opening fully.

Here is where I will add some extra directions/descriptions to ensure the exercise is as efficient and targeted as possible.


STEP 0 - Motivation


Many reports from Covid patients describe how it completely cripples energy levels. Even sitting up can be an ordeal, and the idea of committing to an exercise like this might require more motivation than what is in the tank. If that’s the case, then don’t commit to it to begin with. Just tell yourself you’re going to change position (which is recommended by pulmonologists to help prevent pneumonia) and come into a seated position. Once you’re there, the idea of one full breath might be feasible. Then see if you can complete just one round of steps 2 & 3. If that’s your limit go straight to Step 5, otherwise stick with it for another round. This way we only commit to doing something easy, that we know we can manage.




Support behind the spine is fine, as long as the spine is kept straight. What you want to avoid is being hunched, as you would be if you’re sitting up in bed leaning back against the headboard, or seated in a soft couch. Instead, try sitting in a chair or on the edge of the bed, with your feet on the ground in both cases. This allows you to access the full range of movement of your breathing muscles, and gives your torso space for your lungs to fully inflate.




This is the key part of the exercise. The aim is to maximally inflate the alveoli (air sacs in your lungs, similar to how a sponge has tiny air chambers). In order to do this, we need to ensure that we are ventilating the entire volume of the lungs. Most of that volume is in the base of the lungs (they’re shaped like pyramids), and we actually have to think about breathing ‘into our belly’ in order to inflate this part. This activates the diaphragm muscle: a plate-like muscle that sits flat in your torso and separates the lungs and heart above from the digestive organs below. It works like a plunger, so that when it contracts and moves downwards then it pulls air into the lungs above it. The effect is also to push the stomach down and out, so it looks like the belly itself is inflating.

This ‘diaphragmatic’ breath is the most efficient way of breathing, and it is how you should start the deep breaths. Visualise the air being sucked deep into the base of your torso. If you have one hand on your stomach and the other on your chest then your lower hand should move outwards as the stomach ‘inflates’, while the upper hand stays still during this phase.

During the second phase you will breathe into the chest. This uses the intercostal muscles to expand the ribcage, and is how we breathe when we ‘gasp’. You will feel outwards movement in your upper hand, and also expansion as the ribs separate away from each other. It is important in this, and all phases of deep breathing, to stop if you ever experience sharp pain. It’s also important to try and maintain relaxation in all muscles that aren’t involved in the breath - check that your head, neck, arms and hands are all completely relaxed. Contraction there can inhibit your ability to breathe deeply.

In the final phase of the inhale you will breathe into the upper ‘clavicular’ zone of the chest. Raise the shoulders and chin slightly and continue inhaling until you reach your limit. This phase has a lot less airflow than the previous two phases, and can be removed from the sequence if you’re already experiencing any discomfort or pain.


So Step 2 is actually:

2.1 Breathe powerfully into the belly, using the diaphragm
2.2 Breathe into the torso by expanding the ribcage
2.3 Elevate the shoulders to allow your breath to fill the upper part of the torso

Again, stop at any point if you experience sharp pain or dizziness.
Also, breathe through the nose to avoid irritating a dry cough, as the nose warms and moistens the air you take in.


Watch William demostrate here and try to follow along. 




The deep inhale should be the same as those in step 2. When you cough, in order to activate the base of the lungs, focus on squeezing your abdominal wall as you cough - this will make it more powerful and explosive, which should help to expel debris accumulating inside the lungs.




Again, only if you feel comfortable. Also, give yourself a break between the two cycles. During the break you can relax and breathe normally (shallow).




While lying on your front, the breathing doesn’t need to be as deep as it is in Step 2. You might want to concentrate on just the first phase of the breath - the diaphragmatic inhale - in order to ensure the air arrives at the base of the lungs. If you’re breathing in this way you should feel your belly swell underneath you, pushing down against the floor.

There is no recommendation on exactly how many times to repeat this exercise in a day, but there should not be any disadvantage to performing it several times or as much as you are comfortable with.

Also, even if you are reading this and not sick, it may be a wise move to perform it once just in case, so that your body has a kind of ‘benchmark’ for how it should feel when you’re well. That way, if the worst comes to the worst and you do contract the virus then you won’t have to learn the technique while sick, and you will be able to get an idea of the condition of your lungs from how it compares to when you were well.

As always with any infection, keep hydrated, monitor your symptoms and report them to a doctor – don’t try to self-manage with these breathing exercises alone.


Lead images:

Photo by Fusion Medical Animation on Unsplash

© Alex St Jean



    2. lung pathologist Sanjay Mukhopadhyay:
    3. Ema Swingwood, chair of the Association of Chartered Physiotherapists in Respiratory Care: