Scientific References
The benefits of the deep breathing exercises shared on this site are based in scientific evidence. Below you'll find research supporting the physical and psychological benefits of slow, controlled breathing.
Cardiovascular / Blood Pressure
Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis - International Journal of Cardiology Cardiovascular Risk and Prevention, Dec 2023
"A total of 15 studies were included in the meta-analysis. Breathing exercises have a modest but significant effect on decreasing systolic blood pressure (-7.06 [-10.20, -3.92], P = 0.01) and diastolic blood pressure (-3.43 [-4.89, -1.97], P = 0.01) mm Hg. Additionally, breathing exercises were also observed to cause a significant decrease in the heart rate (-2.41 [-4.53, -0.30], P = 0.03) beats/minute. Conclusion: In a comprehensive systematic review and meta-analysis of breathing exercises and its effect on BP and HR, there is a moderate but significant positive effect. The studies are not deprived of bias."
Summary: breathing exercises lower blood pressure and heart rate
The effect of breathing exercise on hemodynamics and heart rate variability parameters in hypertensive patients: A systematic review - Journal of Bodywork and Movement Therapy, Oct 2024
"The findings suggest low to high-quality evidence for the effectiveness of four subgroups of BE (breathing exercises). When stratified by outcome, the level of evidence on the benefit of BE was low to moderate on attenuating systolic blood pressure and diastolic blood pressure . The evidence for heart rate reduction was low to high. Furthermore, there was moderate-quality evidence on lowering mean arterial blood pressure and...In conclusion, BE (breathing exercises) elicits a positive effect on hemodynamics and HRV parameters in hypertensive patients."
Summary: breathing exercises help lower blood pressure and heart rate
Device and non-device-guided slow breathing to reduce blood pressure: A systematic review and meta-analysis - Complement Ther Med. 2019 Aug
"Of 103 citations eligible for full-text review, 17 studies were included in the meta-analysis. Overall, slow breathing decreased SBP by -5.62 mmHg [-7.86, -3.38] and DBP by -2.97 mmHg [-4.28, -1.66]. Heterogeneity was high for all analyses. Conclusions: Slow breathing showed a modest reduction in blood pressure. It may be a reasonable first treatment for low-risk hypertensive and prehypertensive patients who are reluctant to start medication."
Summary: slow breathing lowers blood pressure
The hypotensive effect of Yoga's breathing exercises: A systematic review - Complementary Therapies in Clinical Practice, Aug 2017
"The aim of this review was to evaluate the effect of pranayama (Yoga's breathing exercises) on BP and its applicability in the treatment of hypertension. Thirteen trials, assessing acute (eight studies) and chronic (five studies) BP response to pranayama were included. Significant BP reductions after pranayama were found in both acute (2-10 mmHg mean SBP reduction, N = 5 studies; 1 mmHg mean DBP reduction, N = 1 study) and chronic studies (4-21 mmHg mean SBP reduction, N = 3 studies; 4-7 mmHg mean DBP reduction, N = 2 studies). The pranayama's effect on BP were not robust against selection bias due to the low quality of studies. But, the lowering BP effect of pranayama is encouraging. The pranayama with slower rhythms and manipulation of the nostrils, mainly with breaths by the left, present better results when compared with the other types and should be the main pranayama applied when the goal is to reduce blood pressure especially in hypertensive patients."
Summary: slow breathing exercises lower blood pressure
Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis - Neurosci Biobehav Rev. 2022 Jul
"Results indicate increases in vmHRV with VSB, DURING, IM-AFTER1, and AFTER-INT. Given the involvement of the PNS in a large range of health-related outcomes and conditions, VSB exercises could be advised as a low-tech and low-cost technique to use in prevention and adjunct treatment purposes, with few adverse effects expected."
Summary: heart rate variability is a sign of a more relaxed state, and voluntary slow breathing increases heart rate variability
Anxiety, Stress, Depression, Anger, and Aggression
A Systematic Review of Breathing Exercise Interventions: An Integrative Complementary Approach for Anxiety and Stress in Adult Populations - Journal of Holistic Nursing, Aug 2024
"309 studies identified, 19 were included. Twelve reported significant improvements in anxiety and nine reported significant improvements in stress following varying breathing exercise interventions (p < .05). No adverse events were reported. Conclusions: Breathing exercises were found to be effective in reducing anxiety and stress in adults, however, there continues to be limited evidence that includes large randomized controlled trials. Breathing exercises are a holistic care approach that can be safely implemented by nurses to decrease symptomatology among adults, including the post-COVID population."
Summary: breathing exercises reduce stress and anxiety
Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials - Scientific Reports, Jan 2023
"The primary outcome self-reported/subjective stress included 12 randomised-controlled trials (k = 12) with a total of 785 adult participants. Most studies were deemed as being at moderate risk of bias. The random-effects analysis yielded a significant small-to-medium mean effect size, g = - 0.35 [95% CI - 0.55, - 0.14], z = 3.32, p = 0.0009, showing breathwork was associated with lower levels of stress than control conditions. Heterogeneity was intermediate and approaching significance, χ211 = 19, p = 0.06, I2 = 42%. Meta-analyses for secondary outcomes of self-reported/subjective anxiety (k = 20) and depressive symptoms (k = 18) showed similar significant effect sizes: g = - 0.32, p < 0.0001, and g = - 0.40, p < 0.0001, respectively. Heterogeneity was moderate and significant for both. Overall, results showed that breathwork may be effective for improving stress and mental health."
Summary: breathing exercises lower anxiety, stress and depression
Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature - Brain Sciences, Nov 2023
"Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies' 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions less than 5 minutes, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices."
Summary: for effective breathing practices, avoid fast breathing, sessions should be at less than 5 minutes long, a human-guided training initially, multiple sessions, and long-term practice associated with effectiveness. Standing, interruptions, and obstructing the diaphram can make exercises ineffective. Stress-reducing interventions incorporated five components: avoidance of fast breathing, sessions less than 5 min; inclusion of guided training, multiple sessions, and/or long-term practice.
Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review - JBI Database of Systematic Reviews and Implementation Reports - Sep, 2019
"All three studies demonstrated the effectiveness of diaphragmatic breathing on reducing stress. One study showed improvement in the biomarkers of respiratory rate and salivary cortisol levels, one showed improvement in systolic and diastolic blood pressure, and one study showed an improvement in the stress subscale of the Depression Anxiety Stress Scales-21 (DASS-21) after implementation of a diaphragmatic breathing intervention. Although there were limitations across the studies, such as sample size, and length and duration of the intervention over time, ranging from one 20-minute intervention to nine months, the studies demonstrated that diaphragmatic breathing had a positive effect on lowering physiological and psychological stress. Conclusions: The evidence suggests that diaphragmatic breathing may decrease stress as measured by physiologic biomarkers, as well psychological self-report tools. Given the benefits of diaphragmatic breathing on stress reduction, ongoing research is needed to continue to establish the evidence-base for this self-administered, low-cost, non-pharmacologic intervention."
Summary: breathing exercises decrease stress, cortisol levels and blood pressure
How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing - Front Hum Neurosci. 2018 Sep 7
"Slow breathing techniques promote autonomic changes increasing Heart Rate Variability and Respiratory Sinus Arrhythmia paralleled by Central Nervous System (CNS) activity modifications. EEG studies show an increase in alpha and a decrease in theta power. Anatomically, the only available fMRI study highlights increased activity in cortical (e.g., prefrontal, motor, and parietal cortices) and subcortical (e.g., pons, thalamus, sub-parabrachial nucleus, periaqueductal gray, and hypothalamus) structures. Psychological/behavioral outputs related to the abovementioned changes are increased comfort, relaxation, pleasantness, vigor and alertness, and reduced symptoms of arousal, anxiety, depression, anger, and confusion. Conclusions: Slow breathing techniques act enhancing autonomic, cerebral and psychological flexibility in a scenario of mutual interactions: we found evidence of links between parasympathetic activity (increased HRV and LF power), CNS activities (increased EEG alpha power and decreased EEG theta power) related to emotional control and psychological well-being in healthy subjects."
Summary: slow breathing exercises result in increased comfort, relaxation, pleasantness, vigor, alertness and a reduction of anxiety, depression, anger and confusion.
Psychological Interventions for Healthcare Providers With PTSD in Life-Threatening Pandemic: Systematic Review and Meta-Analysis - Frontiers in Psychiatry, July 2019
"A meta-analysis of the effect of interventions compared to placebo showed a significant reduction of PTSD symptom severity: Cognitive Behavioral Therapy-Brief (CBT-B) (M = 27.80, 95% CI: 17.12, 38.48), Cognitive Behavioral Therapy-Long (CBT-L) (M = 26.50, 95% CI: 15.75, 37.25), and Mindfulness-Based Stretching and Deep Breathing Exercise (MBX) (M = 17.2, 95% CI: 6.57, 27.83). CBT-L and CBT-B also showed a significant effect on depression severity. Conclusions: The most effective and feasible treatment option for HCP with PTSD is still unclear, but CBT and MBX have displayed the most significant effects based on current limited evidence. Future research in this area-preferably large robust randomized controlled trials-is much needed."
Summary: deep breathing combined with mindfulness based stretching showed signifcant reduction of PTSD symtom severity
A meta-analytic review of anger management activities that increase or decrease arousal: What fuels or douses rage? - Clinical Psychology Review, Apr 2024
"Some anger management activities focus on decreasing arousal (e.g., deep breathing, mindfulness, meditation), whereas others focus on increasing arousal (e.g., hitting a bag, jogging, cycling). This meta-analytic review, based on 154 studies including 184 independent samples involving 10,189 participants, tested the effectiveness of both types of activities. The results indicated that arousal-decreasing activities decreased anger and aggression (g = -0.63, [-0.82, -0.43]), and the results were robust. Effects were stable over time for participants of different genders, races, ages, and cultures. Arousal-decreasing activities were effective in students and non-students, in criminal offenders and non-offenders, and in individuals with and without intellectual disabilities. Arousal-decreasing activities were effective regardless of how they were delivered (e.g., digital platforms, researchers, therapists), in both group and individual sessions, and in both field and laboratory settings. In contrast, arousal-increasing activities were ineffective overall (g = -0.02, [-0.13, 0.09]) and were heterogenous and complex. These findings do not support the ideas that venting anger or going for a run are effective anger management activities. A more effective approach for managing anger is "turning down the heat" or calming down by engaging in activities that decrease arousal."
Summary: deep breathing exercises can help decrease anger and aggression
Pain Management
Effects of Breathing Exercises on Neck Pain Management: A Systematic Review with Meta-Analysis - Journal of Clinical Medicine, Jan 2025
"Five studies were included. Meta-analysis showed a statistically significant reduction in pain (standardized mean difference (SMD), -10.16; 95% CI: -14.82, -5.50) and disability (SMD, -0.80; 95% CI: -1.49, -0.11), in favor of breathing exercises. Qualitative synthesis for pulmonary functional parameters resulted in a statistically significant improvement for FVC, MIP, MEP, and MVV, in favor of breathing exercises. Conclusions: Breathing exercises showed significant short-term effects in reducing pain and disability for persistent neck pain. They also provided benefits for functional respiratory parameters. However, the evidence certainty is low."
Summary: breathing exercises can help with neck pain
Effects of breathing exercises on low back pain in clinical: A systematic review and meta-analysis - Complementary Therapies in Medicine, Dec 2023
"Results showed that the effective rate of LBP patients after breathing exercises was significantly higher than those in the control group, and the VAS (Visual Analogue Score) and ODI (Oswestry Disability Index) scores of LBP patients were significantly lower than those in the control group [VAS: MD = -0.50, 95% CI (-0.88, -0.11), I2 = 76%, p = 0.0009; ODI: MD = -2.46, 95% CI (-3.41, -1.52), I2 = 20%, p = 0.28]. The results of subgroup showed that the duration of treatment had little effect on the effect of breathing exercises, and breathing exercises alone could also have a positive effect on LBP. However, there were methodological limitations in the included studies, future studies should ensure blinded outcome assessors and full reporting to reduce bias risks. Because this review is a study of breathing exercises as an intervention without any adverse events, all studies did not involve safety assessments. Conclusions: The results indicated that breathing exercises have a positive effect on alleviating LBP"
Summary: breathing exercises can help with low back pain
Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials - Journal of Evidence-Based Integrative Medicine, 2022
"Meta-analysis of post-intervention pain scores demonstrated that SDB was associated with significantly lower pain scores compared with a control group, but with high levels of heterogeneity. Subgroup analyzes demonstrated that trials of burn pain were associated with a larger reduction in pain which partially explains the heterogeneity. Very low certainty evidence suggests that SDB may reduce acute pain intensity. Further research is needed to identify patients who are candidates for SDB and determine the best approach to deliver this therapy."
Summary: slow deep breathing may reduce acute pain intensity
Pain and respiration: a systematic review - Pain, Jun 2017
"The findings suggest that pain influences respiration by increasing its flow, frequency, and volume. Furthermore, paced slow breathing is associated with pain reduction in some of the studies, but evidence elucidating the underlying physiological mechanisms of this effect is lacking."
Summary: paced slow breathing can help reduce pain
Effects of breathing exercises on chronic low back pain: A systematic review and meta-analysis of randomized controlled trials - Journal of Back and Musculoskeletal Rehabilitation, 2024
"A total of thirteen studies (n= 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD =-0.84, 95% CI: -1.24 to -0.45, P< 0.0001), the Oswestry Disability Index (ODI) score (SMD =-0.74, 95% CI: -0.95 to -0.54, P< 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P= 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P= 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P= 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [-4.02, 20.45], P= 0.19). Conclusion: Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP."
Summary: breathing exercises can help reduce chronic low back pain
The Efficiency of Respiratory Exercises in Rehabilitation of Low Back Pain: A Systematic Review and Meta-Analysis - Journal of Sport Rehabilitation, Feb 2024
"A total of 14 publications were included in the meta-analysis, with a total sample size of 698 individuals, aged 60-80 years. Respiratory exercise was effective in relieving LBP (standardized mean difference = -0.87, P < .00001) and improving physical disability (standardized mean difference = -0.79, P < .00001). The type of breathing and the total duration of breathing exercises were found to be the source of heterogeneity in this study by subgroup analysis. Subgroup analysis revealed that the most significant effect sizes of breathing resistance exercise to reduce LBP and the most significant effect sizes of breathing relaxation techniques to alleviate physical disability were performed 3 to 5 times per week and period >4 weeks. Respiratory exercise reducing LBP and improving functional disability was most effective when the total duration of the intervention was >500 minutes. Funnel plots showed that the results of the 2 overall studies were reliable without publication bias. Conclusions: Respiratory exercise can effectively reduce LBP and improve physical disability. Therefore, these exercises can be regarded as a part of a LBP management plan. We recommend an exercise program with 30 to 50 minutes, 3 to 5 times per week, and >4 weeks of breathing resistance exercise program as the most effective for treating LBP."
Summary: breathing exercises can help reduce low back pain
Respiratory Health
Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: A Network Meta-analysis - Archives of Physical Medicine and Rehabilitation, Mar 2024
"A total of 43 RCTs involving 1977 participants were analyzed. To boost exercise capacity, the top 2 exercises were inspiratory muscle training (75%), Chinese traditional fitness exercises (13%); To improve pulmonary function, the top 2 exercises were Chinese traditional fitness exercises (32%), diaphragm breathing (30%); To raise patients' quality of life, the top 2 exercises were yoga (52%), diaphragm breathing (28%); To increase inspiratory muscle pressure, the top 2 exercises were pursed-lip breathing (47%), Chinese traditional fitness exercises (25%); To improve dyspnea, the top 2 exercises were yoga (44%), inspiratory muscle training (22%). Conclusions: Various breathing exercises for COPD patients confer benefits that manifest in diverse ways. Pulmonary rehabilitation specialists could administer personalized breathing exercises tailored to each patient's condition to attain optimal therapeutic outcomes."
Summary: diaphragm breathing increased pulmonary function and quality of life for COPD patients
Labor and Delivery
Influence of non-pharmacological methods on duration of labor: a systematic review - Cienca & Saude Coletiva, Jun 2024
"Warm bath, walking, exercises with a birthing ball, breathing techniques, supine position, acupuncture, acupressure and water birth reduced labor time. While spontaneous pushing, massage and immersion baths prolonged labor. Non-pharmacological methods capable of reducing the duration of labor were hot/warm shower, walking, birth ball exercises, breathing techniques, maternal mobility, dorsal position, acupuncture, acupressure and water birth, as well. associated applied techniques such as hot/warm bath, ball exercises and lumbosacral massage, as well as immersion bath, ball exercises, aromatherapy, vertical postures and maternal mobility with alternating vertical postures, shortened the birth time."
Summary: breathing exercises helps reduce the duration of labor
Effectiveness of breathing exercise on the duration of labour: A systematic review and meta-analysis - Journal of Global Health, Mar 2023
"The reviewed trials involved 1418 participants, and the study participants ranged from 70 to 320. The mean gestational weeks of the participants among the reported trials was 38.9 weeks. Breathing exercise shortened the duration of the intervention group's second stage of labour compared with the control group. Conclusions: Breathing exercise is a beneficial preventive intervention in shortening the duration of second stage of labour."
Summary: breathing exercises decrease duration of labor