Focus on Breathing Technique [End of Year Breathing Challenge: Part 2]
The science behind belly breathing
A common misconception is that highly active people, such as athletes, have stronger breathing than inactive individuals.
At least, that’s what I used to think.
Proper breathing, known as diaphragmatic breathing, involves the coordination of the upper and lower thorax and the abdomen. It also requires strength from the diaphragm and other respiratory muscles.
To explore this, researchers studied the breathing patterns of 69 young Polish endurance athletes and 44 nonathletes, who served as a control group.
The study found dysfunctional breathing in 44.92% of the athletes and 47.73% of the nonathletes.
Interestingly, those with a diaphragmatic breathing pattern tended to have better lung function as well.
While I couldn’t find a similar study on midlife women, I suspect the rate of dysfunctional breathing is likely higher.
Practicing slow, mindful breathing with the correct technique can improve your natural, spontaneous breathing throughout the day. That’s why we’re focusing on technique in part 2 of the end-of-year breathing challenge.
What is dysfunctional breathing?
Dysfunctional breathing (DB) refers to an abnormal breathing pattern that can be either caused by chronic disease (secondary DB) or occur without any underlying condition (primary DB).
In the example below, you can see a comparison between normal breathing and more erratic patterns, such as sighing, breath-holding, and hyperventilation.
DB often results in shallow breathing, with quick breaths filling the upper chest rather than the abdomen. It is also more likely to occur with mouth breathing rather than nasal breathing.
Try it yourself: when you breathe through your mouth, it’s harder to take a deep breath or engage your diaphragm. However, when you breathe through your nose, the air flows more easily into your lower lungs.
[For more about the benefits of nasal breathing, don’t miss my interview with Dr. Louise Oliver.]
Despite being studied for decades, DB remains poorly understood and underrecognized in the medical field. This is likely because there is no formal diagnostic criteria for it.
The Nijmegen Questionnaire is commonly used in studies to assess DB. It highlights typical symptoms such as chest pain, tension, shortness of breath, palpitations, and cold hands and feet. A score of 23 out of 64 or higher indicates the presence of DB.
Not only are there symptoms but health implications as mentioned in the last post.
DB Risk and Treatment
Although aging increases the risk of breathing changes for everyone, certain populations are at higher risk.
For example, people with stress and anxiety often experience breathing difficulties. Stress can lead to shallower breathing, increased muscle tension, and breathing fatigue. In particular, the abdominal muscle tension associated with stress and anxiety can limit diaphragmatic movement.
Those with asthma or allergies may find it harder to breathe through the nose. Research also shows that women are at a higher risk than men for these types of breathing difficulties.
Poor posture and tight hips can also compromise breathing. Since the hip flexor (iliopsoas) and diaphragm are connected at the L2 vertebra, tight hips may restrict diaphragm movement. Similarly, poor posture can have a negative impact on breathing.
Despite limited research and a lack of standardized treatment options, slow, controlled breathing offers a promising remedy.
A 2013 systematic review identified only one small randomized controlled trial (RCT) on this subject. In the study, patients with DB received relaxation therapy with and without slow breathing, and a control group was also included. Both relaxation groups showed a reduction in the number and intensity of hyperventilation episodes, but the slow breathing group experienced more significant improvements.
Additionally, a study on healthcare workers with long COVID showed that slow breathing can improve symptoms like brain fog and dyspnea (labored breathing).
So, a slow breathing practice can help improve natural breathing patterns—but technique is key.
The importance of diaphragmatic breathing
It wasn't until I understood the importance of diaphragmatic breathing that I made it a priority.
The diaphragm is the most important muscle for breathing, and like any muscle, it is subject to the effects of aging. People over the age of 65 experience a 20-41% decrease in diaphragmatic pressure and a 30% reduction in diaphragm strength.
When compromised, the diaphragm becomes less mobile, less elastic, and has fewer nerve endings. Even more concerning, a fatigued diaphragm can produce inflammatory substances.
In a study of middle-aged patients preparing for surgery, those with stronger trunk and diaphragm muscles performed better on lung function tests. It makes sense that better and deeper breathing helps our lungs get the oxygen they need.
Could a weak diaphragm be the reason lung function declines with menopause?
Unlike shallow breathing, diaphragmatic breathing involves expanding the abdomen. Shallow breathing (also called thoracic or chest breathing) draws only small amounts of air into the lungs, which means more breaths are needed.
Slow, diaphragmatic breathing is also a workout. While everyday passive breathing uses about 23 muscles, deep breathing exercises engage up to 89 muscles!
[Want a more intense breathing workout? Checkout my interview with researcher Daniel Craighead]
With this in mind, let's dive into this week's challenge, which focuses on technique—particularly the proper use of the diaphragm.