From：https://www.verywellhealth.com/breathing-exercises-post-covid-5192842

Key Takeaways

The lungs are not muscles and cannot be "exercised," but there are ways to strengthen your lungs' support systems if they have been weakened by COVID-19.

Many exercises that work the diaphragm and surrounding muscles can be done at home.

If you had severe COVID-19, you might need to work with a respiratory therapist to rebuild your lung function safely.

Being able to take a deep breath is something that many of us take for granted, but like the millions of people who have survived COVID-19 are finding out, it can be hard to breathe easy after a severe respiratory infection.

Verywell spoke to experts in lung health about what it may take for recovered COVID patients to regain respiratory fitness after having the virus.

Can the Lungs Be Exercised?

MeiLan K. Han, MD, a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan, and the author of "Breathing Lessons: A Doctor's Guide to Lung Health," tells Verywell that the amount of lung strength that COVID patients can recover depends on the severity of their infection.

One common misconception is that the lungs themselves can be exercised. In fact, Han says that the lungs are not muscles and therefore cannot be strengthened.

"The lungs are literally balloons that exchange gas," says Han. "What allows the lungs to open is the diaphragm, which sits underneath the lungs. When it contracts, the lungs are pulled down and they expand and the air rushes in."

In addition to the diaphragm, secondary muscles connected to the rib cage, as well as those in the shoulders and back, help the chest cavity expand to allow air into the lungs. In patients that are extremely ill, those muscles are weakened from lack of use. Muscle weakness, in turn, can directly affect lung capacity.

The Problem of Lung Scarring

When patients have COVID-19, they may contract a form of pneumonia which brings on severe inflammation and lung damage. In the most extreme cases—where patients have needed to be put on a ventilator—some have developed acute respiratory distress syndrome (ARDS). This condition shows up as scarring in the lungs.1

A pulmonary function test can reveal the extent of lung damage, but cannot always discriminate between damage that is repairable versus scar tissue. Han says that there is not much that can be done to repair scarring.

Also, many doctors are finding blood clots in the lungs of patients post-COVID, which are typically treated with blood thinners.

What Can You Do?

For people with significant lung damage, Han says that working with a respiratory therapist is advisable. After completing the breathing tests to get a baseline, therapists can start patients on a series of exercises to build the accessory respiratory muscles over the course of four to six weeks.

Regardless of the severity of COVID-19 infection, many people are now looking for ways to lessen the effects of major lung injuries such as shortness of breath.

During the height of the pandemic, Han points out that many people started checking their blood oxygen levels with a pulse oximeter, which can give them an idea of whether it’s safe for them to start working toward normal health goals again.

"If you really want to double-check, using a pulse oximeter at home is a great tool," says Han. "If you're in the 95–99% range, it's fairly safe to assume that you can try to build your fitness levels back to normal."

Beyond specific exercises, Han suggests people start with sustained aerobic exercises at a lower intensity, such as walking or cycling. When those exercises can be completed without struggle for a few weeks, they can increase the intensity incrementally until they've reached normal intensity levels.

Building Lung Strength at Home

Ethel Frese, PT, DPT, and spokesperson for the American Physical Therapy Association, specializes in cardiovascular and pulmonary physical therapy.

Frese recommends three exercises that can help you locate and target the muscles that support lung function. However, Frese advises working with a physical therapist who will show you how to properly practice these exercises at home.

Diaphragmatic Breathing Exercises

To begin, locate and focus on your thoracic diaphragm (the large muscle wall that separates your thoracic cavity from your abdomen). Strengthening your diaphragm is one of the best ways that you can support your lung function.

Sniffing

Place your fingers just below your breast bone and sniff several times. The movement that you feel is your diaphragm working.

Breathe out slowly between each sniff. Progress this exercise by gradually prolonging the sniff and breathing out slowly through your mouth between each sniff.

Diaphragm Isolation

Sit in a comfortable position. Place your dominant hand over your upper abdominal area just below the breast bone. Place your non-dominant hand on the middle area of your breastbone.

Breathe in through your nose and direct the air so that your dominant hand rises during inhalation. There should be very little movement of your non-dominant hand.

Breathe out through your mouth after each breath that you take in.

Focus on the Lower Ribs

An additional exercise that you can do is to place your hands over the lower front/side of your rib cage to focus on lower rib movement on both sides.

Next, move your hands up and to the middle part of your chest to focus on the muscles there. Keep your shoulders relaxed.

Pursed-Lip Breathing Exercise

Pursed-lip breathing helps slow your breathing and increases the amount of air that you breathe out, which can help decrease the feeling of breathlessness.

Breathe in slowly and gently purse your lips while you breathe out. Do not force the air out.

Try breathing out while holding a tissue in front of your mouth and have the tissue move slightly to provide a helpful visual.

Start by practicing pursed-lip breathing at rest. Then, progress to doing pursed-lip breathing while you're standing and doing activities such as walking.

Inspiratory Muscle Training

The inspiratory muscles are the muscles that the body uses to take a breath in. These muscles can be trained using inspiratory muscle strength and endurance training devices.2

These devices help improve both strength and endurance of the muscles that we use for breathing in. They are usually used for 15 minutes two times a day.

A physical therapist can help you find the best device for you and show you the correct way to use it.

What This Means For You

Lung health after a severe respiratory infection like COVID-19 can take time to restore. For those with severe infections, working with a physical or respiratory therapist may help.

If you had a milder infection, targeting the muscles that support your lungs is a great place to start and these exercises can be done at home.Your digital breathing coach OPUMP can help you to effectively complete the breathing training course, providing a variety of breathing training courses, including enhancing lung capacity, enhancing lung function, training breathing rhythm, helping to restore lung damage and breathing health.