Breathing Exercises for Wellbeing Exercise

What are breathing exercises?

Breathing exercises are ways of controlling the breath to produce a physiological response, usually to feel relaxed. During the exercise you may vary where you breath into (your chest or your diaphragm), where you breath from (your mouth, your nose, or even which nostril), how long each part of your breath is, and other factors.

Breathing exercises have a long history in society. From the yogic pranayama exercises (15th century or earlier), to martial arts, to more recently things like Buteyko breathing (1950s) or the Wim Hof method (1990s). They also have a large body of research behind them, since they can have such a large impact on our nervous system.

The benefits of performing relaxation focused breathing exercises

Studies have shown that breathing exercises can help improve anxiety, mood, depression, cardiovascular function, and sleep quality. These effects tend to be long lasting, for example one study showing results that lasted 24 weeks after the 1-week of breathing exercises. Some of the interventions were short and the results immediate.

Overall breathing exercises can significantly improve wellbeing, some even suggesting them as a primary intervention for anxiety, with a small amount of daily effort (5-20 minutes).

Reduction in Anxiety

Reducing anxiety is one of the most commonly researched ways in which breathing exercises can help an individual. Studies primarily looked at reported anxiety through anxiety index surveys. Some [1][2] looked at related measures such as body temperature, heart rate, and breathing rate.

Many studies have looked at various groups of people and found support for the idea that breathing exercises can reduce anxiety. Some example groups are as follows:

• Those affected by COVID-19
• Outpatient psychiatry department patients
• Peri-operative cardiac surgery patients
• Children receiving local anesthetic at the dentist
• Burn patients receiving a dressing change
• Cancer patients undergoing adjuvant chemotherapy
• Pregnant women

All such studies found positive effects for the things being measured, for example the 2010 study on pregnant women in Korea found that Rotodrine and Atosiban dosages for women giving birth was lower than that of the control group.

One study from 2021 looked at 34 healthy participants and found a reduction in negative affect, anxiety, and perceived stress as well after performing a deep breathing practice daily for 10-20 minutes over a month. There is a large body of evidence supporting the idea that various breathing can have a lasting effect on anxiety in a wide variety of people.

Related Studies

• Effectiveness of short-term belly breathing training in individuals who work-from-home during the COVID-19 lockdown in India
• The Effectiveness of Diaphragmatic Breathing Relaxation Training for Reducing Anxiety
• Effect of short-term yoga-based-breathing on peri-operative anxiety in patients undergoing cardiac surgery
• Comparison and evaluation of two play therapy breathing exercises to reduce anxiety in children receiving local anaesthesia: A randomized clinical study
• The Effect of Rhythmic Breathing on the Anxiety of Dressing Change in Burning Patients
• Effects of a 4-week Breathing Protocol on Affect, Anxiety, and Perceived Stress
• Self-Regulation of Breathing as a Primary Treatment for Anxiety
• The effects of deep breathing on ‘tension–anxiety’ and fatigue in cancer patients undergoing adjuvant chemotherapy
• Effects of Abdominal Breathing on State Anxiety, Stress, and Tocolytic Dosage for Pregnant Women in Preterm Labor

Reduction in Stress

Several studies have looked at stress, usually measured by salivary cortisol, and found that their breathing intervention is associated with reduced cortisol levels. One study looking at healthy IT workers in China found a reduction of 1.39mmol/L over 8 weeks, or about 24% compared to the initial measurement. Another study looking at pregnant women in Korea found around a 20% reduction in stress scores over 3 days with modified Mason’s breathing technique.

Related Studies

• The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults
• Effectiveness of short-term belly breathing training in individuals who work-from-home during the COVID-19 lockdown in India
• Effects of a 4-week Breathing Protocol on Affect, Anxiety, and Perceived Stress
• Effects of Abdominal Breathing on State Anxiety, Stress, and Tocolytic Dosage for Pregnant Women in Preterm Labor

Reduction in Depression

Several studies [1][2][3][4] have shown that various breathing techniques, such as belly breathing, yogic breathing, and qigong can help reduce depression in individuals.

One 2006 study found that a 16-week qigong practice, a chinese practice of slow movements, slow breathing, and meditation helped reduce depression in elderly people in Hong Kong when compared to a newspaper reading group.

Another study looked at yoga along with coherent breathing in people with Major Depressive Disorder, and found “During this 12-week intervention [...] depressive symptoms declined significantly in patients with MDD”.

Other studies have looked specifically at yogic breathing in response to trauma such as the COVID-19 lockdown, or the 2004 south-east asian tsunami and found that breathing exercises were effective ways to reduce depression in just 3-weeks in the case of COVID-19, and just 1-week for the tsunami victims. Both these studies found the effects of the breathing exercise persisted well beyond the exercise. In the case of the tsunami victims the effects persisted for at least 24 weeks afterward.

Related Studies

• Effectiveness of short-term belly breathing training in individuals who work-from-home during the COVID-19 lockdown in India
• Effects of a yoga breath intervention alone and in combination with an exposure therapy for post‐traumatic stress disorder and depression in survivors of the 2004 South‐East Asia tsunami
• Self-Regulation of Breathing as a Primary Treatment for Anxiety
• Effect of a qigong exercise programme on elderly with depression
• Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study

Improved Mood

Studies have shown that breathing exercises can significantly reduce the prevalence of negative mood (referred to as negative affect). One study looked at diaphragmatic breathing in healthy IT workers in China and found that over the course of the 8 week / 20 session study the breathing intervention group reduced their PANAS score, a measure of negative affect, by 2.55, or around 12%. Another study looked at a 4-week protocol in healthy adults in the US, and found a ~17% reduction in negative affect.

Related Studies

• The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults
• Effects of a 4-week Breathing Protocol on Affect, Anxiety, and Perceived Stress

Improved Cardiovascular Function

A 2021 study looked specifically at differences in breathing rates and heart rate variability and found that breathing at a frequency of 5 to 7 breaths per minute lead to the highest HRV. Heart rate variability is important as it helps us adapt to stress, and is associated with cardiovascular health.

Related Studies

• Effect of Slow Abdominal Breathing Combined with Biofeedback on Blood Pressure and Heart Rate Variability in Prehypertension
• Influence of respiration frequency on heart rate variability parameters: A randomized cross-sectional study

Reduction in Blood Pressure

A 2010 study looked at the effect of abdominal breathing on blood pressure in postmenopausal women and found a systolic decrease of 8.4 mm Hg and a diastolic decrease of 3.9mm Hg using a slow abdominal breathing technique combined with electric biofeedback after 10 sessions and daily practice.

Related Studies

• Effect of Slow Abdominal Breathing Combined with Biofeedback on Blood Pressure and Heart Rate Variability in Prehypertension

Improved Cognitive Functioning

Breathing exercises have been shown to have improvements on memory and focus. One study looking at how deep breathing helps retention of newly learned motor skills had participants learn to trace a freehand circle of a certain size. Participants quietly rested or did 30-minutes of alternate nostril breathing (8-10 times a minute). It was found that those who did alternate nostril breathing had better skill retention after 24 hours, showing almost no errors compared to around 18 for the control group.

Similarly, participants from a study on a Chinese IT company found great improvement in a number cancellation task. The test was meant to evaluate focus. Test scores improved by about 6.7 for the breathing intervention group compared to 4.19 for the control group over the 8 week study.

Related Studies

• Deep Breathing Practice Facilitates Retention of Newly Learned Motor Skills
• The effectiveness of mindfulness based stress reduction and sama vritti pranayama on reducing blood pressure, improving sleep quality and reducing stress levels in the elderly with hypertension
• The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults

Reduction in Perceived Pain

Pain reduction is the second most studied aspect of breathing exercises from our review. It’s also the most controversial, featuring mixed results.

Some studies support the idea that breathing exercises can help reduce pain perception. This 2019 study looked at Butekyo breathing and coherent breathing and their effects on women experiencing period pain, finding a 5% reduction in pain intensity. The Effect of Deep and Slow Breathing on Pain Perception, Autonomic Activity, and Mood Processing—An Experimental Study found that “The most striking finding in the present study was a significant increase of pain thresholds in our subjects only after the rDSB condition”. Another study looked at an exercise program with and without diaphragmatic breathing across 6 different pain scales in those with Fibromyalgia. The study found the diaphragmatic breathing group to have better results, seeing ~4x more improvement in the BPI Pain Severity scale compared to the control group.

However other studies [1][2] found mixed or inconclusive results. This study which looked at breathing as an intervention in those with arthritis found that pain intensity was not alleviated, though patients found it easier to cope with the pain.

Related Studies

• The Effect of Deep and Slow Breathing on Pain Perception, Autonomic Activity, and Mood Processing—An Experimental Study
• Effect of Deep Slow Breathing on Pain-Related Variables in Osteoarthritis
• Controlled breathing and pain: Respiratory rate and inspiratory loading modulate cardiovascular autonomic responses, but not pain
• Can Exercise Affect the Pain Characteristics in Patients with Fibromyalgia? A Randomized Controlled Trial
• Immediate Effect of Buteyko Breathing Exercise and Coherent Breathing Exercise on Subjects with Primary Dysmenorrhoea: A Randomised Clinical Trial

Improved Sleep Quality

Generally, anxiety and stress have a direct, bidirectional relationship with lower sleep quality. As such it’s not a surprise that reducing anxiety and stress would improve sleep quality, which is what several studies found. Such as this one looking at belly breathing during the COVID-19 lockdown, or this one which looked at box breathing in elderly patients.

Most measures of sleep quality in these studies were anecdotal, and we could not find a proper sleep study which showed the quantitative effects of breathing exercises.

Related Studies

• The effectiveness of mindfulness based stress reduction and sama vritti pranayama on reducing blood pressure, improving sleep quality and reducing stress levels in the elderly with hypertension
• Effectiveness of short-term belly breathing training in individuals who work-from-home during the COVID-19 lockdown in India

Why do breathing exercises work?

Breathing is associated with both sympathetic and parasympathetic nervous system regulation. Meaning it has the ability to both calm us down or put us in fight or flight mode. One study looked at how slow breathing affected the SNS (sympathetic nervous system) through skin conductance. Because sweat glands are controlled by the sympathetic nervous system, they are a good measure of fight or flight response. The study found that during rDSB (relaxing deep and slow breathing), skin conductance dropped significantly. This tells us what most of us already know, the breath has the ability to calm us down.

Reduced fight or flight activation reduces the amount of cortisol and stress we experience, as well as how anxious we feel, dilating our blood vessels (reducing blood pressure), dysregulation or neurotransmitters leading to mood disorder, and insulin resistance. Although cortisol is an anti-inflammatory, chronic sympathetic nervous system activation triggers inflammatory pathways. In summary, most of the benefits listed in this article can be explained as an effect of reducing chronic activation of the “fight or flight” nervous system.

Alternatives to consider to the exercises listed

Breathing exercises can come in many forms beyond just the deep breathing exercises described above. Evidence shows that a wide range of breathing exercises can help across symptoms in a similar fashion to what we described above. Indeed, the research referenced throughout this article covers a wide range of breathing exercise types.

We suggest starting with deep breathing as described at the top of this article in “How to do breathing exercises for relaxation”. Feel free to explore other breathing exercises and do your own research as to what suits you best. We’ve created a list below with other relaxation focused breathing exercises as a starting point.

• 4-7-8 Breathing
• Qigong breathing
• Unilateral nostril breathing (breathing through one nostril only)
• Alternate nostril breathing
• Diaphramatic breathing or belly breathing
• Box breathing, or Sama Vritti Pranayama
• Triangle breathing
• Pursed lip breathing
• Resonant or coherent breathing
• Breath focus
• Lion’s breath
• Equal breathing
• Sitali breathing
• Humming bee breathing
• Wim Hof Method breathing
• Buteyko breathing
• Ocean’s breath (Ujjayi)
• Victory breath (Viloma Pranayama)
• 3-part breath (Dirga Pranayama)
• Mason’s breathing technique, from Guide to Stress Reduction

Risks and considerations of breathing exercises

In general relaxation focused breathing exercises, that aim to slow the breath, are considered to be fairly safe. If you feel light headed, dizzy, out of breath, strained, or otherwise unwell then don’t continue with an exercise and consult a doctor if the problem persists.