Breathwork Research and Application

Breathing practices, around since ancient times, have recently grabbed international attention and popularity among health and fitness enthusiasts. The Global Wellness Institute identified breathwork as one of the top nine most impactful wellness trends in 2021 and beyond (GWI 2021).

Science journalist James Nestor’s book, Breath: The New Science of a Lost Art (Riverhead Books 2020), an international bestseller, is now available in 30 languages. Wim Hof, the “Iceman,” creator of the Wim Hof Method, says, “Breathwork goes deeper into our physiology than has ever been known before [as shown by current research] and affects both biochemistry and muscle tissue. Anyone who does this will feel how to boost performance instantly.”

With all the hype and emergence of breathwork devices, apps and studios, clients are likely to ask what different practices there are, whether the benefits are real and how to integrate such methods into training programs. This article provides an overview of what scientific evidence supports, common breathing dysfunctions and a sampling of effective breathwork exercises.

What Research Tells Us

Proper breathing mechanics are essential for optimal function, good posture, core stability and normal motor control patterns.

Breathwork enthusiasts extol the benefits of breathing practices for healing multiple conditions, but more high-quality scientific research is needed. Existing studies examine proper breathing mechanics, dysfunctional breathing patterns, diaphragmatic breathing, mouth breathing and other widely practiced breathing techniques. Research substantiates that correct inspiration patterns—efficient breathing biomechanics—improve both health and athletic performance, but again, much more research is needed on the variety of methods available.

Breathing Pattern Disorders

Proper breathing mechanics are essential for optimal function, good posture, core stability and normal motor control patterns. In a healthy breathing pattern, the diaphragm descends symmetrically on inhalation; the lower rib cage moves proportionately in the direction of the front, back and sides; and the abdominal wall expands cylindrically (Chapman et al. 2016). At the end of each inhalation, the sternum moves forward and the ribs expand. For an overview of “breathing” muscles, see “Inhalation and Exhalation,” below.

Poor breathing patterns can increase the body’s acidity by changing pH levels, heighten fatigue and musculoskeletal pain, compromise trunk stability, cause premature breathlessness, impair sleep, and more (Chapman et al. 2016; Hansen-Honeycutt et al. 2016). Common breathing pattern dysfunctions include asymmetric movement during the breath cycle; excessive upward movement of the sternum and shoulders with minimal abdominal movement on inhalation; and paradoxical breathing, with the abdomen drawing inward on inhalation and expanding on exhalation.

Exercise professionals can assess breathing patterns during client intake sessions, initially without telling people (to avoid conscious adjustments). Experts recommend first assessing the breath while clients are standing, then informing them of an assessment while they’re in a supine position, with one hand on the chest and one on the belly. If you note any dysfunction, include proper diaphragmatic breath training at the beginning or end of sessions. Offer minimal instruction and guidance for home practice until a normal breathing pattern is restored.

See also: Deep Breathing and Mental Clarity

Mouth Breathing Versus Nose Breathing

Another body of research notes problems from habitual mouth breathing, a modern habit that researchers think contributes to sleep disruption, heightened stress, ADHD and other health issues. Paul Ehrlich, PhD, Bing professor of population studies, emeritus, at Stanford University, is a proponent of oral posture exercises to support the jaw and prevent mouth breathing. In a review study published in Bioscience, the authors—including Ehrlich and stress researcher Robert Sapolsky, PhD, Stanford professor of neurology and neurosurgery—write, “Surprisingly, jaw shrinkage since the agricultural revolution, leading to an epidemic of crooked teeth . . . and constricted airways, is a major cause of sleep-related stress” (Kahn et al. 2020).

Sleep disruption is a contributing factor to numerous health conditions, including high blood pressure, type 2 diabetes, heart disease, obesity and depression.

The inspiration for Nestor to write his bestselling book was his participation in a study led by Jayakar V. Nayak, MD, PhD, associate professor of otolaryngology (head and neck surgery and neurosurgery) at Stanford. The study evaluated the impact of mouth breathing for 10 days compared with nasal breathing for the same length of time. Nestor noted in his book that immediately after removing obstructions that prevented nasal breathing, his blood pressure dropped, carbon dioxide increased, heart rate normalized, snoring decreased 30-fold and a bacterial infection in his nose cleared up without treatment (Nestor 2020). His experience is reportedly not atypical.

Fitness professionals can educate clients about the benefits of nose breathing and the disadvantages of mouth breathing. More benefits include warming, moisturizing and filtering air before it enters the lungs. Nasal breathing also increases production of nitric oxide (NO), which is very important in oxygen uptake and healthy arterial function. Additionally, NO levels affect immune function, weight and mood.

Leading Buteyko Method expert Patrick McKeown, an Oxygen Advantage^® master instructor in Galway, Ireland, offers an effective exercise for unblocking the nose. See “Sample Breathing Exercises,” below. Another exercise that encourages nasal breathing is alternate-nostril breathing, often taught in yoga classes. A useful practice to avoid mouth breathing is to clean the nose, through blowing it with a tissue, inhaling saline spray or rinsing with a sterile solution. If you teach breathing exercises, keep tissues handy so clients can blow their noses, if needed.

In the 1990s, John Douillard, DC, CAP, author of Body, Mind, and Sport (Harmony 2001), an early proponent of nose breathing’s benefits during endurance sports, conducted research on professional athletes he was training. Douillard and a team of researchers found that athletes trained in nose breathing experienced consistently and significantly lower breath rates and lower perceived exertion levels while simultaneously experiencing significantly longer endurance, among other outcomes (Travis et al. 1996).

More recent research conducted at Colorado State University confirms these findings. In a small study, 10 healthy male and female runners underwent exercise testing using only mouth breathing and, separately, only nose breathing. When restricted to nose breathing, the participants could run at all intensity levels without loss of VO₂max and with superior breathing efficiency. However, these runners had practiced nasal breathing exclusively for 6 months before the study—and the scientists noted that the improvements in breathing efficiency occurred “following an extended period of time spent adapting to this practice” (Dallam et al. 2018).

Note that for high-intensity exercise, nasal breathing is not efficient or even possible. It’s ideally suited for moderate, steady-state cardiovascular activities, such as long-distance running or cycling. When people start training with nose breathing only, they typically experience worse performance before they realize gains (Dallam et al. 2018; Travis et al. 1996).

Heavy Breathing Versus Light Breathing

Another avenue of breathwork research focuses on issues related to heavy breathing or “overbreathing.” This often accompanies either mouth breathing or a “startle reflex”—which may be due to stress, emotions, trauma or other issues—and can lead to hyperventilation disorder (Ionescu et al. 2020; Hansen-Honeycutt et al. 2016).

McKeown explains that light breathing helps to improve blood flow and oxygen delivery. In contrast, heavy breathing can be a stressor that reduces blood flow and oxygen delivery to tissues and organs. “Carbon dioxide (CO₂) isn’t just a waste product of breathing,” he says. “It’s actually the catalyst that unlocks oxygen from your blood, releasing it for your body to use. Your muscles use oxygen for energy; your brain needs oxygen to think. In fact, because CO₂ has this function in the blood, it’s essential for life.

“CO₂ helps keep blood vessels open. Without CO₂, blood vessels narrow, reducing blood flow to your brain and body. When blood flow drops, you get less oxygen throughout your systems. . . . Low blood flow to your brain makes you feel stressed, tired and foggy-headed. Low CO₂ is a characteristic of people with panic disorder. What’s more, people with a poor tolerance to changes in blood CO₂ levels are more likely to experience breathlessness, irregular breathing, anxiety and sleep-disordered breathing.”

See also: Breath and Movement for Core Stability

Breathwork for Better Health and Performance

Fitness professionals can educate clients about the benefits of breathwork for better performance.

Integrating breathing assessments and exercises into a client’s program requires minimal time and effort, yet people of all ages and ability levels may see powerful results. Breathing pattern dysfunctions are common, even among athletes. Addressing breathing issues with clients supports overall health, benefits performance and gives people a useful, individualized tool. Fitness professionals who want to offer more sophisticated breathwork routines for clients should consider pursuing additional training.