Diaphragmatic breathing: how to do it, step by step

What is diaphragmatic breathing?

Your diaphragm is a dome-shaped sheet of muscle under your lungs. When it tightens it flattens and pulls air into your lungs, pushing your tummy out a little. When you are calm, it does most of the work of breathing. When you are stressed, breathless or in pain, many people switch to faster, shallower breathing from the upper chest, using the muscles in the neck and shoulders. That uses more effort and can keep the stress response going.

Diaphragmatic breathing retrains the calm pattern on purpose: low, slow and quiet. Physiotherapists call it breathing control, and it is the foundation of breathing retraining for asthma and breathing pattern disorder. How your lungs and diaphragm work explains the mechanics.

When should you use it?

• Daily, for 5 to 10 minutes, to make relaxed breathing your habit.
• When you feel stressed or anxious, to slow things down.
• In bed, to help you wind down.
• To recover after exertion, once you are resting (with pursed-lip breathing if you are breathless).

What the research shows

Diaphragmatic breathing has rarely been tested on its own, but it is the main ingredient of the breathing retraining programmes that have been. A Cochrane review of 22 trials with 2,880 adults with asthma found breathing exercises improved quality of life, by about 0.4 points on the asthma quality of life scale at three months, with moderate-certainty evidence. The largest trial, run in 34 UK GP surgeries with 655 people, found that breathing retraining taught by a DVD and booklet or by a physiotherapist improved quality of life over a year, though it did not change lung function.

In healthy adults, a small randomised trial of 40 people found that 8 weeks of diaphragmatic breathing training lowered negative mood and the stress hormone cortisol and improved sustained attention compared with no training.

There is one important exception. In a small study of people with severe COPD, deliberate diaphragmatic breathing made breathing less efficient and tended to increase breathlessness. If you have severe COPD, use the techniques your physiotherapist recommends, such as pursed-lip breathing.

Common mistakes

• Breathing too deeply. It is a low breath, not a big one. Huge breaths can make you light-headed.
• Pushing your tummy out. Let the breath move it. Forcing your stomach out is not the same thing.
• Lifting your shoulders. Check the hand on your chest. If it rises, slow down and soften the breath.
• Practising only when stressed. It works best as a habit you have already built.

Make it easier or harder

• Easier: lie on your back with your knees bent and a light book on your tummy, and watch it rise and fall. Use shorter counts, such as 3 in and 4 out.
• Harder: practise sitting, then standing, then while walking. Lengthen the out-breath towards 8 seconds, keeping it comfortable.