Yoga and Long Haulers

By Kristine Kaoverii Weber | March 29, 2021


I know someone (and you probably do too) who has post-acute COVID syndrome. She recovered from COVID last spring, but now struggles with fatigue, breathing, and brain fog. She used to be an avid hiker, but now she’s lucky if she can take a shower. She can’t work very much, and without her husband’s support, she doesn’t know how she would survive.

I’ve been writing, teaching, and speaking to health care professionals and policy makers about yoga for chronic conditions for a while now, so, if you are a regular reader you know how passionate I am about bringing yoga into the conversation, as an adjunctive/integrative therapy.

Before COVID-19, according to the CDC, 60% of Americans had at least one chronic condition and 40% had two or more. Chronic illnesses suck up 90% of all health care dollars and the medical community often is at a loss as to how to effectively address the roots of these health challenges.

While infectious diseases were the puzzle twentieth century medicine needed to solve, chronic diseases were the most pressing medical problem of the twenty-first century.

But, as it turns out, COVID-19, at least in some cases, appears to be both.

It’s not only a virus that causes acute and sometimes fatal symptoms, but it can also trigger a long-term, chronic response. 

Estimates that those who contract COVID-19 will become long-haulers (most are 20-50 year-old women) range from 10-33%. These folks experience an array of symptoms including fatigue, shortness of breath, joint, muscle, and chest pain, brain fog, depression, headaches, fevers, heart palpitations, hair loss, rashes, smell and taste problems, insomnia, memory issues (here’s a comprehensive list from the CDC).  

Most of these folks had only mild to moderate symptoms when they caught the virus, but the long term effects have been debilitating and in many cases, prove very difficult to treat.

The medical world uses the umbrella term “dysautonomia,” to describe what’s happening. It means that the autonomic nervous system (ANS) has gone awry – it’s confused and doesn’t respond properly to changes in position, exertion, temperature, or stress. It ramps itself up into an inappropriate fight-or-flight response and has trouble regulating heart and breathing rates.


Physicians at Mt. Sinai Hospital in New York have been trying to figure out what to do for long haulers who are exhibiting dysautonomia. One clue they discovered is that many of these folks seem to have shallow, dysregulated breathing, and because of this problem, the dorsal branch of the vagus nerve doesn’t get the stimulation it needs. So, they’ve determined that a first step needs to be addressing breathing.

Dr. David Putrino and his team piloted a program using simple ratios (4:6 in the morning 4:4:4:0 in the afternoon) to help patients get their breathing rate to a point that they could participate in rehab programs (here’s a long read about it from the Atlantic).

The results have been promising. After just one week, all the patients in the program reported improvement.   

Since COVID-19 is a pandemic, these kinds of programs are going to be needed worldwide.

I can’t help but wonder if Dr. Putrino would be open to training some yoga professionals to help?

If you have been teaching breathing techniques and helping folks learn to tune into what’s going on in their respiratory and nervous system, you may very well have some important skills to share. If you’ve received training and have experience, you may have the capacity to gently guide someone into and help bring them out of ratios safely and effectively.

Frankly, I’m a little more conservative than the folks at Mt. Sinai when it comes to pranayama. I would never tell a long hauler to do a 4:6 ratio in the morning and a 4:4:4:0 ratio in the afternoon without teaching them how to gently get into and out of those ratios first and without watching them do it and giving them individualized guidance.

I started studying ratio breathing in the early 2000s – and it’s an fascinating, intricate, and nuanced science. Suffice it to say, someone who has been practicing and teaching ratios for many years most likely has a better grip on these practices than medical personnel who are simply handed a protocol and don’t practice pranayama themselves. That doesn’t mean that medical folks can’t teach ratios, what it means, in my mind, is that yoga professionals have a lot to offer to this conversation.

Here are 3 key reasons I believe yoga professionals should be trained, and then integrated into programs that address post-acute COVID syndrome:

  1. Person-Centered

Yoga professionals can learn protocols and also help tailor breathing practices to the needs of each individual. 

  1. Low Risk

Yoga is not a drug and as for affecting the ANS, it does so endogenously. The client is always in control and can stop whenever they like. There are many nuanced, even-lower-risk-than-ratio techniques that could be helpful, particularly those that emphasize interoceptive awareness. (For more interoceptive breathing techniques, check out my free 30 day pranayama challenge on YouTube).

  1. Agency

These practices can help people learn how to participate in their own healing process – and that is something that is very empowering and can support mental health during recovery.

Also, there’s much more that yoga can offer the healing process including slow, simple, mindful movement that prepare the respiratory structures for breathing practices, and provide another way to help start regulating a dysfunctional nervous system. Yoga practices should also be accompanied by interoceptive pauses. And they should be shared with a trauma informed approach that empowers clients to tune into their own nervous system and make informed choices about how much or how little to do.

Yoga professionals can also share meditation techniques and help clients cope with the mental health stress of chronic illness via reflection upon the yamas and niyamas.

Let me be perfectly clear – I would never suggest that a yoga professional alone can solve the problem of post acute COVID syndrome. But if you are a practitioner and teacher, you have a lot to offer in this conversation and you could potentially be part of an integrated team working to help those struggling with these debilitating after-effects.

Key links for more long haul info (many thanks to Dr. Helen Machen Pearce for her help with references):


Please check out my FREE guide for  yoga professionals: Get Healthcare on Your Side





Five Ways Yogic Meditation Benefits Your Brain – eBook


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