Paced breathing for stairs and walking: step by step

What is paced breathing?

When stairs make you breathless, the natural thing is to rush them to get it over with, and to hold your breath as you push up each step. You arrive at the top gasping and need a long time to recover. Paced breathing replaces the rush with a rhythm: breathe out during the effort of the step, and breathe in when you pause or on the easier moment. You go a little slower, but you arrive with breath to spare.

It is the same idea as blow as you go, applied to movements you repeat, and it uses the slow out-breath of pursed-lip breathing.

When should you use it?

• Stairs and steps, including getting on a bus or train.
• Walking, especially uphill, into the wind or carrying something.
• Any repeated movement, such as hoovering, sweeping, raking leaves or pushing a trolley.

How to find your rhythm

There is no single right rhythm. Start with one of these and adjust it until it feels steady:

Practise on a good day, on the flat or on a few stairs at home, so the rhythm is automatic when you need it. Counting your steps out loud at first can help.

What the research shows

Paced breathing is standard advice from NHS respiratory physiotherapists and is taught in pulmonary rehabilitation, but we found no trial that has tested it on its own. That is why we grade it as weak: not because it doesn’t work, but because its effect hasn’t been measured separately.

What has been tested is the wider package it belongs to. A Cochrane review of breathing exercises in COPD found they improved how far people could walk in six minutes. A Cochrane review of 65 trials of pulmonary rehabilitation, the NHS exercise and education programme that teaches pacing, found strong evidence that it eases breathlessness and fatigue and improves quality of life and exercise capacity. If you have COPD or another lung condition and find stairs hard, ask your GP to refer you. See breathing exercises for COPD.

Common mistakes

• Rushing. Speed is what makes stairs exhausting. Going slower is the point.
• Holding your breath on the push. Breathe out as you step up, never hold.
• Waiting too long to stop. Rest when you first notice your breathing quickening, not when you are gasping. Recovery is much quicker that way.
• Gulping air in through your mouth. Breathe in gently, through your nose if you can.

Make it easier or harder

• Easier: stand still to breathe in, then breathe out as you take one step. Rest after every few steps, or put a chair halfway up the stairs or on the landing.
• Harder: breathe in over one step and out over two without stopping, then build up to a whole flight. On walks, gradually go further at the same comfortable rhythm.