Breathing Pattern of Longer Exhales Can Relieve Symptoms of Long COVID


This breathing pattern is called resonant breathing and has been shown to improve heart rate variability.

Long COVID—a syndrome caused by COVID-19 infection—disrupts autonomic nervous system functioning. Symptoms of long COVID include dysautonomia, fatigue, breathlessness, palpitations, dizziness, pain and brain fog.1 There is currently no cure for long COVID,2 but resonant breathing may improve many of these symptoms, according to a press release highlighting findings from a study conducted by researchers at the University of Leeds.1

Image credit: Justlight |

Image credit: Justlight |

“Long COVID can be highly debilitating, and many of the millions of patients around the world will experience pronounced disruption to employment, social and caregiving roles, and participation in society,” said study lead Manoj Sivan, MD, FRCP, an associate professor and consultant in rehabilitation medicine at the University of Leeds’ School of Medicine, in the article.1

Resonant breathing consists of 4-second inhales and 6-second exhales; this pattern of breathing changes the breathing rate to 5.5 to 6 breaths per minute, which some suggest is the optimal breathing pattern.

During this study, investigators evaluated the effects of resonant breathing on long COVID symptoms in 13 patients. Specifically, the team studied the effects of resonant breathing on patients’ heart rate variability in an intervention called Heart Rate Variability Feedback (HRV-B). Long COVID symptoms were scored using the COVID-19 Yorkshire Rehabilitation Scale (C19YRS).

Patients completed 2 rounds of 10-minute HRV-B via a mobile phone app which could track changes in HRV over the duration of the study. The effects of HRV were monitored with a chest strap heart rate monitor, and patients also wore smart watches to collect heart rate data.

After 4 weeks of the HRV-B intervention, patients experienced a reduction in symptom severity by 20% (6-point reduction on 30-point scale); patients also reported better sleep and physical functioning. Overall, the intervention improved global health, quality of life, and autonomic symptoms. Most patients said that they will continue exercises after the study.

Heart rate variability is the variation of time between heartbeats, and it can indicate a person’s health and stress levels; higher heart rate variability would be associated with a state of rest and recovery, and low heart rate variability reflects a state of ‘fight or flight,’ often present in individuals with anxiety, stress, pain, and fatigue. In previous literature, HRV-B was shown to improve symptoms associated with chronic conditions like asthma, depression, fibromyalgia, and post-traumatic stress.

“Our study provides further evidence of long Covid and highlights the presence of dysautonomia in the condition,” said Joanna Corrado, MRCP, DTM&H, MB ChB, specialist trainee and clinical research fellow in Leeds’ School of Medicine, in the press release. “It also demonstrates the feasibility of a potential simple intervention that will be useful in its management.”


1. Long Covid: Tech assisted breathing exercises relieve Long Covid symptoms. University of Leeds. News Release. January 29, 2024. Accessed on February 1, 2024.

2. Katella K. What Happens When You Still Have Long COVID Symptoms? News Release. October 27, 2023. Accessed on February 2, 2024.,symptoms%20associated%20with%20the%20condition.

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