Background
Long COVID, also referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), encompasses a heterogeneous group of symptoms persisting for weeks to months after the acute phase of COVID-19. Symptoms commonly include fatigue, dyspnoea, cognitive impairment, autonomic dysfunction, and reduced quality of life, with significant variability in presentation and severity among individuals . The European Respiratory Society (ERS) clinical practice guideline on symptom management for adults with serious respiratory illness emphasizes a multidisciplinary approach to address persistent respiratory and systemic symptoms, focusing on evidence-based interventions such as pulmonary rehabilitation and symptom-targeted pharmacotherapy . However, the guideline does not include complementary or lifestyle interventions like the Wim Hof method among recommended strategies.
The Wim Hof method combines three core elements: controlled hyperventilation (breathwork), cold exposure, and meditation. Proponents suggest that these techniques may modulate autonomic nervous system activity, reduce inflammation, and improve immune regulation, which could theoretically benefit individuals with long COVID . Despite anecdotal reports and theoretical plausibility, the method remains controversial due to the absence of robust clinical trials specifically evaluating its efficacy in long COVID populations.
Current Evidence
No clinical trials or high-quality studies have directly evaluated the efficacy of the Wim Hof method in treating or alleviating symptoms of long COVID. A 2025 systematic review on long COVID preventive strategies identified vaccination and antiviral therapies as key measures, but did not include breathwork or cold exposure interventions in its recommendations . Similarly, the ERS clinical practice guideline on post-acute sequelae of COVID-19 (PASC) does not mention the Wim Hof method or related interventions, focusing instead on standardized diagnostic and management approaches .
A 2025 EULAR rapid review of integrative and complementary health practices for chronic pain identified meditation and relaxation techniques as beneficial for certain conditions, but explicitly excluded the Wim Hof method from its scope due to lack of evidence . The review highlights that while mind–body interventions may have roles in chronic symptom management, their application to long COVID remains unproven and unsupported by guideline recommendations.
Case reports and anecdotal evidence, such as a 2025 case report describing resolution of long COVID symptoms following an extended water fast, do not provide reliable evidence for the Wim Hof method, as the intervention described differs substantially from the method’s standard components . These reports lack control groups, standardized outcome measures, and reproducibility, limiting their clinical applicability.
European and national guidelines, including the SIGN guideline on managing long-term effects of COVID-19, emphasize individualized care plans, symptom management, and rehabilitation but do not endorse complementary techniques such as breathwork or cold exposure . The SIGN guideline underscores that most symptoms resolve within 12 weeks, with persistent symptoms requiring evidence-based multidisciplinary care rather than unproven interventions .
Clinical Implications
Given the absence of clinical evidence supporting the Wim Hof method for long COVID, clinicians should not recommend it as a therapeutic intervention. Current guidelines prioritize established approaches, including pulmonary rehabilitation for persistent dyspnoea and fatigue, vaccination for prevention, and symptom-targeted pharmacotherapy . Pulmonary rehabilitation, in particular, is supported by robust evidence for improving functional capacity and quality of life in chronic respiratory conditions and is endorsed by ERS guidelines, though not specifically for long COVID .
Potential risks associated with the Wim Hof method include exacerbation of autonomic symptoms such as dizziness, syncope, or fatigue, which are common in long COVID . Cold exposure may also pose risks in individuals with cardiovascular instability or autonomic dysfunction. Therefore, caution is warranted, and patients should be advised against attempting unsupervised interventions that lack evidence of benefit.
Conclusion
There is currently no clinical evidence supporting the use of the Wim Hof method for treating or alleviating symptoms of long COVID. European and national guidelines do not recommend breathwork or cold exposure techniques as part of long COVID management, and high-quality trials are lacking. Clinicians should prioritize evidence-based interventions and multidisciplinary care in accordance with established guidelines.
| Source | Year | Study Type | Key Finding |
|---|---|---|---|
| 2024 | National Guideline | Long COVID symptoms require individualized, evidence-based management; no mention of breathwork or cold exposure | |
| 2025 | Society Guideline | EULAR review identifies meditation and relaxation as beneficial for chronic pain but excludes the Wim Hof method due to lack of evidence | |
| 2025 | Society Guideline | ERS guideline on PASC focuses on standardized diagnostic and management approaches without endorsing complementary methods | |
| 2024 | Society Guideline | ERS guideline on symptom management emphasizes multidisciplinary care but does not include the Wim Hof method | |
| 2025 | Systematic Review | Vaccination and antiviral agents are key preventive strategies for long COVID; no evidence for breathwork or cold exposure |