Breathing Exercises

Staying healthy involves things like eating properly and staying active. At times like these it is even more important. By sticking to social distancing and quarantining at home, it is the perfect opportunity to focus on our physical activity and nutrition.

During these times, it is also important to keep our respiratory system, and more specifically, good lung function in mind. Covid-19 is a virus that can affect the respiratory system in even its mild and moderate forms. When speaking of the respiratory system, it is concerned with breathing and the lungs are the organs that enable this.

A group of breathing exercises largely adopted by physiotherapists worldwide are The Active Cycle of Breathing Techniques (ACBTs). These breathing exercises target the lungs and aim to maintain good and functional breathing capacity. This technique consists of three phases:

[throughout the exercises, it is recommended to position oneself in sitting maintaining a good posture by keeping shoulders relaxed and the neck supported]. 

1.  Breathing Control

Breathing control helps to relax the airways which is useful for bouts of coughing or episodes of shortness of breath. This phase is best performed with the eyes closed to aid in a sensation of relaxation. This phase alone is useful to be carried out in states of fear, anxiety, and even during a panic attack. It also serves as a precursor to the following two stages if done within the cycle. 

To perform this stage, the person should breath in through the nose and out of the mouth, if possible. If not, both through the mouth instead. Any tension in the body should try to be relaxed with each breath out focussing on head and shoulder placement. This phase is to be repeated at least 6 times, gradually trying to control the breathing rate with each repetition. It can be done as many times as the person feels they need to move onto the next step.

2.  Deep Breathing 

During this phase, focus on breathing deeply. As per the previous step, the shoulders and chest should be relaxed. A long, slow, and deep breath inwards through the nose (if possible) should be taken). The breath should then be held for 2-3 seconds before breathing out through the mouth. The breath should not be forced out. It should be gentle, like a sigh. 

3.  Forced Expiration

For this step, it is advised to keep a tissue nearby in case the need to cough arises. As per WHO guidelines, the cough should be directed into the tissue and immediately disposed of. This portion of the exercise aims to clear the airways. It is called a huff and involves exhaling with a certain force through an open mouth. When performing this step, it helps to imagine steaming up a mirror. To complete this phase of the cycle, a normal-sized breath should be taken to then be followed by an active, long, breath out. The sensation of the lungs should feel ‘empty’. This is to be repeated twice. 

This cycle needs to be repeated for three times every time, twice daily. If symptoms develop such as shortness of breath you may perform them up to 4 times a day or as directed by a physiotherapist. The exercises can be performed by people of all ages. Should any symptoms arise of any concern, please do contact your local GP or your local Covid19 helpline.


Active Cycle of Breathing Technique. (2020, April 7). Physiopedia, . Retrieved April 10, 2020 from

Bronchiectasis Toolbox. (2018, June 18). The active cycle of breathing technique. Retrieved April 10, 2020, from

WHO. (n.d.). Advice for public. Retrieved April 10, 2020, from