Objective To improve the tolerability of prone positioning and the effect of ventilation in awake patients. Methods Seventy-five patients with common type COVID-19 were randomly assigned to a control group of 39 and an intervention group of 36, receiving either usual or rock-climbing prone positioning besides conventional treatment, respectively. The effect was evaluated after 1 week of treatment. Results The intervention group had significantly longer length of time proned on the 2nd and 7th 24-h period of prone positioning and the total prone positioning time, higher oxygenation index at 48 h in prone position, and lower incidence of cervical and lumbar pain at 24 h in prone position compared with the control group (all P<0.05), and no pressure injury occurred. Conclusion Rock-climbing prone position is better tolerated than conventional prone ventilation in awake patients, yielding notable and safe outcomes during the early stage of treatment.