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Breathing Exercises to Increase Lung Function

by
author image Dr. Tina M. St. John
Tina M. St. John runs a health communications and consulting firm. She is also an author and editor, and was formerly a senior medical officer with the U.S. Centers for Disease Control and Prevention. St. John holds an M.D. from Emory University School of Medicine.

Although your body cannot function long term without adequate food and water, it is the oxygen provided by breathing that sustains your life minute to minute. Breathing usually occurs automatically, but it can be controlled voluntarily. Breathing exercises harness this capability to potentially produce various health benefits. These exercises are most commonly recommended to improve lung function and exercise capacity, and to alleviate respiratory symptoms in people with lung disease, particularly asthma and chronic obstructive pulmonary disease (COPD). While experimental evidence is largely absent, breathing exercises might also improve the efficiency of breathing in people without lung disease.

Pursed-Lip Breathing

Pursed-lip breathing is a common, simple breathing retraining exercise -- meaning an exercise aiming to alter your breathing pattern. Pursed-lip breathing focuses on slowing your breathing rate and improving exhalation. It is most often recommended for people with COPD and, less commonly, asthma. These obstructive lung diseases are characterized by impaired exhalation, which ultimately limits the amount of fresh air entering the lungs with each breath. Pursed-lip breathing involves inhaling a normal breath through the nose and exhaling through the mouth with the lips pursed, such as when you're about to blow out a candle. Exhalation is ideally twice as long as inhalation, and neither should involve straining. Respiratory therapists often recommend counting in your head to help time inhalation and exhalation, for example: in-two, out-two-three-four.

Other Breathing Retraining Exercises

Several programs and health practices incorporate conscious breathing as part of a broader system of health and wellness. Examples include the Buteyko method, the Papworth method and yogic breathing practice, also known as pranayama. Many breathing exercises in these programs focus on breathing retraining by emphasizing slow, controlled inhalation and exhalation. The specific methods and techniques vary among the different exercises in these as well as other breathing training programs. For example, the Buteyko method employs brief breathing pauses or holds to train the individual to breathe more slowly. Controlled breathing with the Papworth method is less prescriptive, primarily emphasizing relaxation and conscious attention to slow breathing. Pranayama practice is complex and involves many different techniques and exercises, some relatively simple and others requiring a high level of yogic mastery.

Diaphragmatic Breathing

The diaphragm sits below the lungs, separating the chest and abdominal cavities. It is the primary muscle responsible for bringing air into the lungs. The diaphragm contracts and moves downward during inhalation, pulling air into the lungs. Diaphragmatic breathing, or belly breathing, involves consciously increasing use of your diaphragm during the breathing cycle. It is a respiratory muscle training exercise that increases the strength and endurance of your diaphragm, slows your breathing rate and improves air delivery to your lower lungs. Diaphragmatic breathing can be performed while sitting or lying down. One hand rests on the chest and the other on the belly. While gently breathing in through the nose and out through pursed lips, focus on your belly moving out and in to a greater extent than your chest. This breathing exercise takes some practice to master but gets easier as you learn to consciously control your diaphragm.

Other Respiratory Muscle Training Exercises

Several other muscles participate in moving the chest during breathing. The intercostal muscles between the ribs elevate the rib cage and expand the chest, aiding inhalation. Other muscles known as the accessory muscles of respiration participate when you breathe heavily or forcefully. These accessory respiratory muscles, located in the chest, abdomen and neck, bear much of the work of breathing in people with serious lung diseases.

Whereas belly breathing focuses exclusively on building diaphragm strength, other respiratory muscle training exercises aim to increase the strength and endurance of all respiratory muscles. This is accomplished with 2 main types of breathing exercises. Resistance respiratory muscle training employs a mouth device that limits airflow. Breathing through the device forces the user to work the respiratory muscles harder to pull air into the lungs and force it out. Exercising with an airflow-resistive device builds respiratory muscle strength, akin to lifting weights. Voluntary hyperventilation exercises involve prolonged, rapid, deep breathing to build respiratory muscle endurance.

Effects on Lung Function and Respiratory Symptoms

Most studies evaluating the effects of breathing exercises on lung function and respiratory symptoms have focused on potential benefits among people with COPD or asthma. The authors of an October 2012 "Cochrane Database of Systematic Reviews" article analyzed 16 studies examining the effects of breathing exercises on COPD. Overall, exercise capacity -- measured by 6-minute walking distance -- was significantly improved in people who performed pursed-lip or diaphragmatic breathing, or pranayama timed breathing exercises for 4 to 15 weeks. However, the effects on measures of lung function, shortness of breath and quality of life were inconsistent across the studies analyzed.

An October 2013 "Cochrane Database of Systematic Reviews" article similarly analyzed 13 studies evaluating the effects of breathing exercises among adults with mild to moderate asthma. Buteyko, yoga and diaphragmatic breathing were associated with improvements in lung function. Improved quality of life and reduced asthma symptoms and flareups were seen in study participants regularly practicing yoga, or Papworth, Buteyko or diaphragmatic breathing. A subsequent April 2016 "Cochrane Database of Systematic Reviews" report analyzed the results of 15 studies evaluating the effects of yoga practice, specifically, among adults with asthma. The authors concluded that research to date suggests regular yoga practice might enhance quality of life, reduce asthma symptoms and improve lung function in people with mild to moderate asthma. However, the authors caution that additional high-quality research is needed to confirm these possible benefits.

Warnings and Precautions

Breathing exercises are generally safe for healthy adults without heart or lung disease, or any other condition that might affect the respiratory system. However, if you have lung or heart disease, do not begin any type of breathing exercises or a general exercise program without first discussing it with your doctor. Depending on your individual circumstances, certain types of breathing exercises might aggravate your condition or precipitate a flareup.

If you perform breathing exercises as part of your approved medical treatment plan, follow your doctor or respiratory therapist's instructions carefully with respect to the daily frequency and duration. Stop performing breathing exercises if you become short of breath, dizzy or lightheaded. Seek immediate medical care if your symptoms persist or worsen.

Reviewed by: Mary D. Daley, M.D.

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