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
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
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.
Sample Breathing Exercises
These exercises are suitable for every level of breathing practitioner.
This method, also known as belly breathing, reinforces a proper breathing pattern, reduces anxiety and improves sleep quality, in addition to having other benefits.
Purpose: Normalize breathing patterns, improve breath awareness and reduce stress.
- Sit or lie supine with a lengthened spine. Place one hand on your chest, the other on your belly.
- Inhale gently through the nose, feeling the belly rise. The hand on the chest remains still. If the chest lifts, soften the shoulders and release muscle tension throughout the body. Encourage relaxation.
- Exhale gently through the nose, noticing the belly fall.
- Practice for up to 10 minutes.
This method, supported by research, shows that consistent practice increases heart rate variability
and significantly increases relaxation (Lin, Tai & Fan 2014).
Purpose: Regulate and calm the breath. Coordinate breathing with heart rate and the nervous system to create “coherence.”
- Choose a timing method and have it ready.
- Sit or lie on your back with a lengthened spine. Exhale.
- Inhale gently through the nose for 5.5 seconds.
- Exhale gently through the nose for 5.5 seconds, for an 11-second breath cycle or 5.5 breath cycles per minute.
- Continue for up to 10 minutes.
This exercise is from the Buteyko Method (Buteyko Clinic International 2021). Leading Buteyko Method expert Patrick McKeown, an Oxygen Advantage® master instructor, notes that unblocking the nose enables light nasal breathing, which promotes relaxation and better sleep.
Purpose: Unblock the nose.
- Sit, stand or lie supine.
- Exhale slowly through the nose.
- Pinch nose with fingers to hold breath.
- While holding the breath, nod head gently up and down.
- Hold breath until there is a medium-to-strong need for air.
- Release nose and breathe through it.
- Calm breathing as soon as possible.
- Rest 1 minute, breathing normally.
- Repeat five times.
Wim Hof Method With Pushups
Wim Hof recommends this exercise as a starting point to understand his breathing method, with the optional addition of pushups for a higher challenge level (Wim Hof Method 2021).
Purpose: Invigorate the body, train the mind and improve endurance and performance.
- Assume a comfortable meditation posture, either seated or lying. Make sure you can expand your lungs freely without restriction.
- Close your eyes and become conscious of the breath.
- Inhale deeply through the nose or mouth, as is comfortable; exhale, without force, through the mouth.
- Fully inhale through the belly, then the chest; exhale without force.
- Repeat 30–40 times in short, powerful bursts. You may experience light-headedness and finger-tingling sensations.
- After the last exhalation, inhale as deeply as you can one final time. Let the air out and stop breathing.
- Hold until you feel the urge to breathe again. For an extra challenge, do pushups while holding the breath.
- When the urge is there to breathe again, draw one big breath to fill your lungs, expanding the belly and chest. When at full capacity, hold the breath for around 15 seconds, then let go.
- That completes round one. Repeat three to four times without interval.
Buteyko Clinic. 2014. Nose unblocking exercises. Accessed Sep. 2, 2021: buteykoclinic.com/nose-unblocking-exercises/.
Chapman, E.B., et al. 2016. A clinical guide to the assessment and treatment of breathing pattern disorders in the physically active: Part 1. International Journal of Sports Physical Therapy 11 (5), 803–09.
Dallam, G.M., et al. 2018. Effect of nasal versus oral breathing on VO2max and physiological economy in recreational runners following an extended period spent using nasally restricted breathing. International Journal of Kinesiology and Sports Science, 6 (2).
GWI (Global Wellness Institute). 2021. Global Wellness Summit releases in-depth
trends report, “The Future of Wellness 2021.” Accessed Sep. 2, 2021: globalwellnesssummit.com/press/press-releases/gws-releases-in-depth-2021-trends-reort/.
Hansen-Honeycutt, J., et al. 2016. A clinical guide to the assessment and treatment of breathing pattern disorders in the physically active: Part 2, a case series. International Journal of Sports Physical Therapy, 11 (6), 971–79.
Ionescu, M.F., et al. 2020. Cardiopulmonary exercise testing in the assessment of dysfunctional breathing. Frontiers in Physiology, doi:10.3389/fphys.2020.620955.
Kahn, S., et al. 2020. The jaw epidemic: Recognition, origins, cures, and prevention. BioScience, 70 (9), 759–71.
Lin, I.M., Tai, L.Y., & Fan, S.Y. 2014. Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. International Journal of Psychophysiology, 91 (3), 206–11.
Nestor, J. 2020. Breath: The New Science of a Lost Art (page 208). New York: Riverhead Books.
Travis, F., et al. 1996. Invincible athletics program: Aerobic exercise and performance without strain. International Journal of Neuroscience, 85 (3–4), 301–08.
Wim Hof Method. 2021. Wim Hof Method breathing. Accessed Sep. 2, 2021: wimhofmethod.com/breathing-exercises.
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