Diaphragmatic Breathing Exercises

Original Editor - Ahmed Essam Top Contributors - Ahmed Essam, Kim Jackson, Hing Long Yip and Khloud Shreif

Introduction

Diaphragmatic breathing is a type of breathing exercise that helps strengthen your diaphragm, an important muscle that helps you breathe as it represents 80% of breathing. This breathing exercise is also sometimes called( belly breathing or abdominal breathing).

When the diaphragm is functioning effectively in its role as the primary muscle of inspiration, ventilation is efficient and the oxygen consumption of the muscles of ventilation is low during relaxed (tidal) breathing. When a patient relies substantially on the accessory muscles of inspiration, the mechanical work of breathing (oxygen consumption ) increases and the efficiency of ventilation decreases.

Controlled breathing techniques, which emphasize diaphragmatic breathing are designed to improve the efficiency of ventilation, decrease the work of breathing, increase the excursion of the diaphragm, and improve gas exchange and oxygenation. 

Aims

  1. To mobilize secretions.
  2. To teach effective coughing and remove secretions.
  3. To teach relaxation.
  4. To teach breathing control.
  5. To teach postural awareness.
  6. To mobilize thorax and shoulder girdle.[2]

Physiological Effect

  1. It helps you cope with the symptoms of post-traumatic stress disorder (PTSD).
  2. It improves your core muscle stability.
  3. It improves your body’s ability to tolerate intense exercise.
  4. It lowers your chances of injuring or wearing out your muscles.
  5. It slows your rate of breathing so that it expends less energy.
  6. It helps you relax, lowering the harmful effects of the stress hormone cortisol on your body.
  7. It lowers your heart
  8. Improve respiratory capacity.[1]
  9. It helps lower your blood pressure

Techniques

  1. Lie on your back on a flat surface (or in bed) with your knees bent. You can use a pillow under your head and your knees for support if that's more comfortable.
  2. Place one hand on your upper chest and the other on your belly, just below your rib cage.
  3. Breathe in slowly through your nose, letting the air in deeply, towards your lower belly. The hand on your chest should remain still, while the one on your belly should rise.
  4. Tighten your abdominal muscles and let them fall inward as you exhale through pursed lips. The hand on your belly should move down to its original position.

You can also practice this sitting in a chair, with your knees bent and your shoulders, head, and neck relaxed. Practice for five to 10 minutes, several times a day if possible.[3]

[2]

Precautions

  • Never allow a patient to force expiration. expiration should be relaxed or lightly controlled. forced expiration only increases turbulence in the airways.leading to bronchospasm and increased airway restriction.
  • Do not allow a patient to take a highly prolonged expiration. this causes the patient to gasp with the next inspiration. the patient's breathing pattern then becomes irregular and insufficient.
  • Do not allow the patient to initiate inspiration with accessory muscles and upper chest.
  • Allow the patient to perform deep breathing for only three or four inspirations and expirations at a time to avoid hyperventilation.

Indication

  1. Post -operative pain
  2. Pulmonary disease (primary or secondary)
  3. Airway obstruction (COPD)[3]
  4. Atelectasis[4]
  5. Restriction of breathing due to musculoskeletal abnormality or obesity
  6. Central nervous system deficit
  7. Neurological patient with muscle weakness.
  8. Surgical procedure such as thoracic or abdominal surgeries.[5]

References

  1. Yong MS, Lee HY, Lee YS. Effects of diaphragm breathing exercise and feedback breathing exercise on pulmonary function in healthy adults. Journal of physical therapy science. 2017;29(1):85-7.
  2. jivan sharma. Diaphragmatic Breathing Technique. Available from: http://www.youtube.com/watch?v=0Ua9bOsZTYg [last accessed 3/4/2020]
  3. Mendes LP, Moraes KS, Hoffman M, Vieira DS, Ribeiro-Samora GA, Lage SM, Britto RR, Parreira VF. Effects of diaphragmatic breathing with and without pursed-lips breathing in subjects with COPD. Respiratory care. 2019 Feb 1;64(2):136-44.
  4. Westerdahl E, Lindmark B, Eriksson T, Hedenstierna G, Tenling A. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005 Nov 1;128(5):3482-8.[1]
  5. Chuter TA, Weissman C, Mathews DM, Starker PM. Diaphragmatic breathing maneuvers and movement of the diaphragm after cholecystectomy. Chest. 1990 May 1;97(5):1110-4. •