Therapies & Traditions · Breathing practice

Breathwork and Breathing Exercises

Q: What is breathwork?

It means deliberately changing the pace, depth or pattern of breathing. Reviews use it for slow paced breathing, diaphragmatic (belly) breathing, pranayama and faster styles such as holotropic or Wim Hof breathing.

Q: Can slow breathing lower blood pressure?

Three pooled analyses found modest falls in blood pressure, but trials were small and varied. Blinded trials of a guiding device found no significant effect against a sham device or music. It has not been shown to replace blood pressure medicines; ask a doctor.

Q: Does breathwork help with stress and anxiety?

A pooled analysis of 12 trials found a small fall in self-rated stress, with small effects on anxiety and low mood, mostly in healthy or mildly stressed adults. The authors warn that hype may be ahead of the evidence.

Q: Does breathing before bed help sleep?

A 2026 review of 9 studies found better self-rated sleep after slow breathing before bed, but wrist-monitor and sleep-lab results were inconclusive.

Q: Do they help COPD?

A review of 73 trials found pursed-lip and diaphragmatic breathing slightly eased breathlessness, below the size patients notice, and consistently improved quality of life. A separate review found diaphragmatic breathing inconsistent in COPD. Ask your care team.

Q: Can breathwork treat panic or post-traumatic stress?

Not proven. One 37-person trial and one uncontrolled study of a clinic-supervised, carbon dioxide-guided programme reported big drops in panic severity, and two small veteran trials of a breathing-based group programme reported lower trauma scores. Certainty is low to very low. Fast breathing can itself trigger panic or bring back traumatic memories.

Q: Is breathwork safe?

Gentle slow breathing is described as low risk for most healthy adults. Fast breathing, long breath holds and breath-hold diving are a different matter: sources describe dizziness, tingling, fainting, and in water, blackout and drowning.

Q: Who should avoid fast breathing styles?

A 2026 review says people with epilepsy, panic disorder or psychotic disorder are more vulnerable, that those with significant heart, brain-vessel or lung disease should only practise under close medical supervision, and that pregnant people and people with pheochromocytoma should avoid high-ventilation and breath-hold protocols. Ask a doctor first.

Q: Is it safe to practise near water or while driving?

No. Hyperventilating before holding the breath has caused loss of consciousness and drowning, including two healthy young men in one New York incident. Breathing that causes dizziness or faintness is also unsafe at the wheel; no source read tests driving, so that is the compiler's inference.

Breathwork (deliberately changing the pace, depth or pattern of breathing) · also called Breathing exercises, slow breathing, paced breathing, diaphragmatic breathing, belly breathing, pranayama, box breathing, Buteyko breathing, Wim Hof breathing, holotropic breathwork, respiración consciente, ejercicios de respiración

Breathwork means deliberately changing how you breathe: slower, deeper, through the belly, or in set patterns. In trials, slow breathing has been studied for blood pressure, stress, sleep, asthma and pain. Most results are small and the certainty is low or very low. Gentle slow breathing is described as low risk. Fast breathing and breath holding can cause dizziness and fainting, and are dangerous in or near water or while driving.

General information, not medical advice. Last substantive update October 31, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Breathwork and Breathing Exercises

Breathwork covers slow, belly and pattern-based breathing, and faster styles with breath holds. In trials, slow breathing gave modest falls in blood pressure and small gains in stress and self-rated sleep, and breathing exercises probably improve asthma quality of life, but most evidence is low quality. Gentle slow breathing is described as low risk; fast breathing and breath holding are not.

What breathwork is

Breathwork means deliberately changing how you breathe. Reviews use the word for many things: slow breathing at about 10 breaths a minute or fewer, belly (diaphragmatic) breathing, pursed-lip breathing, yogic pranayama, and patterned styles such as box breathing and cyclic sighing. A 2023 review also uses it for faster, high-ventilation styles, which it says have a long history of use for psychological distress.

The 2026 diaphragmatic-breathing review found trials using breathing rates of 2 to 10 breaths a minute and sessions of 3 to 45 minutes, so what counts as one practice varies a lot.

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Styles and forms

The trials read name several styles: slow paced breathing; diaphragmatic breathing; pursed-lip breathing in lung rehabilitation; a commercial device that cues slower breathing; clinic-supervised training guided by a carbon dioxide sensor; the Buteyko and Papworth methods in asthma; Sudarshan Kriya yoga in veterans; and the Wim Hof Method, which pairs fast breathing and breath holds with cold exposure and meditation. Holotropic breathwork is described as prolonged fast breathing.

Most reviews pool many styles, so a result is rarely tied to one. The unblinded trials and the manufacturer-linked trials of the guiding device found small blood pressure falls, while the blinded trials against a sham device or music did not.

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What trials found, by outcome

For blood pressure, three pooled analyses found modest falls with slow breathing (about 3 to 7 mmHg systolic), with high differences between trials. For stress, a 2023 analysis of 12 trials found a small fall in self-rated stress, with similar small effects on anxiety and low mood. A review of 9 studies found better self-rated sleep after slow breathing before bed, but not on sleep-lab or wrist-monitor measures.

In asthma, the Cochrane review found probably better quality of life and fewer over-breathing symptoms, with unclear effects on control and lung function. In COPD and other serious lung illness, pursed-lip and diaphragmatic breathing slightly eased breathlessness and improved quality of life. Pooled trials in chronic low back pain found less pain, but with low to very low certainty.

Evidence for panic disorder and post-traumatic stress is thin and comes from specific clinic-supervised or group programmes. Heart rate variability reliably rises with slow breathing, but that is a body measure rather than a health benefit. For Wim Hof style breathing the evidence is very low, and for holotropic breathwork no controlled trial was found.

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How trials were run, and getting help

Trials usually taught the method first and then set practice. Examples: 5 minutes a day for a month in the 2023 respiration trial; 4 weeks of home practice with a carbon dioxide sensor after clinician training in the panic study; a 15-hour group workshop followed by two 1-hour sessions a week for 5 weeks in the veterans' trial; and 10 to 29 days in the Wim Hof studies. The slow-breathing blood pressure review required at least 5 minutes on at least 3 days a week for at least 4 weeks. These describe what was studied, not what any person should do.

NCCIH advises talking to a health care provider about complementary approaches and says anyone with severe or long-lasting symptoms should see one. The 2026 safety review recommends professional training and structured, systematic practices for anything beyond gentle slow breathing.

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At a glance

Traditional uses history, not proof

A 2023 review describes high-ventilation breathwork as practices with a long history of use to relieve psychological distress
The Cochrane asthma review names yogic breathing, the Buteyko technique and the Papworth method among the ways breathing has been retrained

Studied for research

Blood pressure with slow breathing: modest falls, low certainty; device-guided: mixed
Stress, anxiety and low mood: small effects, low certainty
Sleep quality (self-rated), low certainty
Asthma quality of life, moderate certainty; asthma control, low
Breathlessness and quality of life in COPD, low certainty
Chronic low back pain, low certainty
Heart rate variability, a body measure, moderate certainty
Panic disorder (clinic-supervised), low; post-traumatic stress, very low
Wim Hof style breathing, very low; holotropic breathwork, insufficient

Main compounds

Slow paced breathing
Diaphragmatic (belly) breathing
Pursed-lip breathing
Pranayama
Box breathing and cyclic sighing

Common forms

Device-guided breathing
Capnometry-guided breathing training
Buteyko breathing
Papworth method
Sudarshan Kriya yoga
Wim Hof Method
Holotropic breathwork

Research links: 2019 analysis: slow breathing and blood pressure (17 studies) · 2014 analysis: device-guided breathing in blinded trials · 2023 analysis: breathwork, stress and mental health (12 trials) · Cochrane review 2020: breathing exercises for adults with asthma · 2024 review: breathing techniques in serious lung illness (73 trials) · 2026 review: safety and contraindications of breathing practices · CDC report: hyperventilation before breath-holding and drowning · NCCIH: Relaxation techniques, what you need to know · Research Library · Genes & Biomarkers Library

What it is and its history

Accepted scientific name: Breathwork and breathing exercises (practices that deliberately change the pace, depth or pattern of breathing)
Common names: Breathwork (English); Breathing exercises (English); Controlled breathing (English); Slow breathing (English); Pranayama (yogic breathing) (English); Respiración consciente (Spanish); Ejercicios de respiración (Spanish); Técnicas de respiración (Spanish)
Family or group: Breathing practices (mind-body and respiratory-therapy techniques). Fast, high-ventilation styles are in a different risk class from gentle slow breathing.
Look-alikes and adulterants: Name: Yoga; Note: Often includes pranayama (breathing) alongside postures and meditation; has its own page.; Name: Meditation and mindfulness; Note: Breath awareness without changing the breath; the 2023 trial compared breathing with mindfulness.; Name: Respiratory muscle training; Note: Uses resistance devices to strengthen breathing muscles; excluded from the lung review used here.; Name: Biofeedback; Note: Uses sensors (for example heart rate or carbon dioxide) to guide breathing.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Long use in psychological distress	A 2023 review describes high-ventilation breathwork as practices with a long history of use to relieve various forms of psychological distress. The abstract does not name traditions, dates or places.	p37923236
Holotropic breathwork	A 2007 paper describes holotropic breathwork as a prolonged, voluntary hyperventilation procedure and asks whether it could help in psychotherapy. The abstract gives no origin or date.	p17931070
Named methods in modern trials	The Cochrane asthma review names the Papworth method, the Buteyko breathing technique, yogic breathing and deep diaphragmatic breathing as ways of changing the breathing pattern. The abstract does not give their origins.	p32212422

Traditional use shows how it was used. It does not show that it works or is safe today.

What it includes, and how it may work

The parts and styles of the practice, and how researchers think it may act on the body. Proposed mechanisms are not proven effects in people.

Main parts and styles

Part or style	Kind	Where it is used	Activity studied	Level of evidence
Slow paced breathing	technique	Reviews define it as 10 breaths a minute or fewer (the sleep review) or about 6 breaths a minute with natural breath size (the 2026 narrative review).	The most studied style; used in the blood pressure, sleep, stress and heart rate variability reviews. ^{6 9 25 16}	Human data
Diaphragmatic (belly) breathing	technique	The 2026 review of 48 trials found breathing rates of 2 to 10 a minute and session lengths of 3 to 45 minutes.	Reflux, anxiety and other conditions; evidence is varied. ¹⁵	Human data
Pursed-lip breathing	technique	Breathing out slowly through pursed lips; pooled with diaphragmatic breathing in the lung review.	Used in COPD and asthma care for breathlessness. ⁵	Human data
Device-guided breathing	technique	A commercial device gives tone cues to slow the breath; trials ran up to 9 weeks in the 2012 review.	Blood pressure trials; blinded trials found no effect. ^{19 17}	Human data
Capnometry-guided breathing training	clinical technique	A sensor shows end-tidal carbon dioxide so patients can raise it toward normal; delivered with a clinician in the studies.	Panic disorder trial and uncontrolled study. ^{20 26}	Human data
Pranayama (yogic breathing, including alternate nostril and bhramari breathing)	technique	Named in the search terms and results of the blood pressure reviews.	Heart rate and blood pressure trials in hypertension. ^{13 8}	Human data
Box breathing, cyclic sighing and cyclic hyperventilation with retention	technique	Box breathing is equal in, hold and out; cyclic sighing emphasises a long out-breath; cyclic hyperventilation with retention has longer in-breaths and shorter out-breaths, as defined in the 2023 trial.	Compared with mindfulness meditation over 1 month; cyclic sighing gave the largest mood gain. ¹	Human data
Buteyko breathing technique	technique	Taught as part of asthma care alongside standard treatment in trials.	Small improvement in asthma control scores in the 2026 review. ^{28 23}	Human data
Papworth method	technique	One trial in the Cochrane asthma review.	Asthma breathing retraining; no separate results in the abstract. ²³	Human data
Sudarshan Kriya yoga	breathing-based meditation programme	Taught in group workshops and sessions in the veterans' trials.	Post-traumatic stress symptoms in veterans. ^{24 2}	Human data
Wim Hof Method	multi-part method (fast breathing, breath holds, cold exposure, meditation)	Cyclic hyperventilation followed by breath retention plus cold exposure and meditation in the trials.	Laboratory chemistry and short-term self-rated energy; risks listed on the Safety tab. ^{14 12}	Human data
Holotropic breathwork	technique	Described as prolonged voluntary hyperventilation.	No controlled trial found; hypothesis only. ²²	Hypothesis
Breath-holding (static apnoea, freediving)	technique	Holding the breath, sometimes after hyperventilation.	Not a health practice; the sources read describe blackout and drowning. ^{4 18 27}	Human data

Mechanisms, receptors and pathways

Target or pathway	What was found	Level
Heart rate variability and the resting branch of the nervous system	Slow breathing increases heart rate variability and respiratory sinus arrhythmia in healthy people, with more EEG alpha and less theta power. The authors link this to the nervous system's resting branch and to emotional control. ^{29 16}	Human, correlational
Carbon dioxide and over-breathing	In panic disorder, raising end-tidal carbon dioxide toward normal with sensor feedback went with clinical improvement; the authors call the mechanism a hypothesis. Fast breathing lowers carbon dioxide and causes respiratory alkalosis, which explains dizziness and tingling. ^{20 25}	Human trial; mechanism hypothesis
Adrenaline release in cyclic hyperventilation with breath holds	In 24 healthy volunteers, the trained group had intermittent respiratory alkalosis and low oxygen with a big adrenaline rise, then a more anti-inflammatory response to endotoxin. ¹⁴	Human, small randomised trial
Why breathing may help anything	Explanations such as calmer nervous system, relaxed trunk muscles or better attention are proposals; most trials read measured symptoms, not mechanisms, and breathing was usually mixed with other elements. ¹⁰	Not established

Isolated compounds versus whole extracts

Breathing is rarely tested alone. Yoga, Sudarshan Kriya and the Wim Hof Method mix breathing with postures, meditation, group support or cold exposure, and no trial read compared a breathing practice with a sham breathing exercise matched for time and attention.

15benefits and uses looked at

32studies and sources checked

Moderate certaintybest evidence rating found

8lab markers tracked in trials

2 moderate certainty1 mixed findings9 low certainty2 very low certainty1 not enough evidence

What was looked at

The 15 benefits and uses checked for Breathwork and Breathing Exercises, each with how strong the evidence is. Tap one to open it.

Blood pressure: slow breathing practicesLow certainty
Blood pressure: device-guided breathingMixed findings
Stress, anxiety and low moodLow certainty
SleepLow certainty
Panic disorder: breathing training guided by carbon dioxide feedbackLow certainty
Post-traumatic stress symptoms: breathing-based meditationVery low certainty
Asthma: quality of life and breathing symptomsModerate certainty
Asthma control with the Buteyko breathing techniqueLow certainty
Breathlessness and quality of life in COPD and other serious lung illnessLow certainty
Dysfunctional breathing (over-breathing without a lung cause)Low certainty
Chronic low back pain and other long-term painLow certainty
Diaphragmatic breathing: reflux, anxiety and other conditionsLow certainty
Heart rate variability (a body measure, not a health outcome)Moderate certainty
Fast breathing with breath holds and cold exposure (Wim Hof style)Very low certainty
Holotropic breathwork (prolonged fast breathing)Not enough evidence

Lab markers tracked in the studies

Systolic blood pressure (the upper number)Self-rated stressSelf-rated sleep quality and durationPanic disorder severityVagally mediated heart rate variabilityBreathlessness (modified Medical Research Council scale)Asthma Quality of Life Questionnaire (AQLQ)Pain intensity in chronic low back pain

What is Breathwork and Breathing Exercises good for?

The main studied uses and how strong the human evidence is for each. These describe what trials found in the groups they studied. They are not advice to practise breathwork for any condition, and each result is for the breathing method tested.

Blood pressure: slow breathingLow certaintyThree pooled analyses found modest falls in blood pressure with slow breathing in adults with raised pressure. Trials were small and varied, and none followed people to heart attacks or strokes. Blood pressure: device-guided breathingMixed findingsSmall falls in the first review disappeared when manufacturer-linked trials were removed, and blinded trials against a sham device or music found no significant effect. Stress, anxiety and low moodLow certaintyTwelve trials found a small fall in self-rated stress, with similar small effects on anxiety and low mood. The authors warn that hype may be ahead of the evidence. SleepLow certaintyNine small studies found better self-rated sleep after slow breathing before bed, but sleep-lab and wrist-monitor results were inconclusive. Panic disorder (carbon dioxide-guided training)Low certaintyOne 37-person trial and one uncontrolled study of a clinic-supervised, carbon dioxide-guided programme reported large drops in panic severity. Preliminary. Post-traumatic stress (breathing-based meditation)Very low certaintyTwo small veteran trials of a breathing-based group programme reported lower post-traumatic stress scores; the programme includes more than breathing. Asthma: quality of lifeModerate certaintyThe Cochrane review of 22 trials found probably better quality of life and fewer over-breathing symptoms with breathing exercises, but unclear effects on asthma control and lung function. Asthma control: Buteyko techniqueLow certaintySeven trials found a small gain in asthma control scores when the Buteyko technique was added to usual care, and a quality-of-life gain only in children and teenagers. Breathlessness in COPD and lung illnessLow certaintyPursed-lip and diaphragmatic breathing slightly eased breathlessness (below the level patients notice) and consistently improved quality of life in 73 trials; diaphragmatic breathing was inconsistent in COPD. Dysfunctional breathingLow certaintyBreathing retraining usually showed positive effects, but the reviewers rate the evidence low quality. Chronic low back pain and other long-term painLow certaintyPooled trials found less low back pain and better function with breathing exercises, but the certainty is low to very low. Diaphragmatic breathing: reflux and other conditionsLow certaintyA review of 48 trials found consistent benefits for reflux and anxiety, but very few results came from trials at low risk of bias. Heart rate variabilityModerate certaintySlow breathing reliably raised heart rate variability in 223 studies. This is a body measure, not a proven health benefit. Fast breathing with cold exposure (Wim Hof style)Very low certaintyTwo studies found chemistry changes and short-term self-rated gains in healthy adults; breathing was not tested apart from cold exposure and meditation. Holotropic breathworkNot enough evidenceNo controlled trial was found; the papers read only propose the idea and call for research.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Blood pressure: slow breathing practices

Low certainty

Pooled trials of slow breathing (about 10 breaths a minute or fewer) found modest falls in blood pressure in adults with high or borderline-high blood pressure. The trials were small, short and varied a lot, so the certainty is low.

4 studiesTrials in the 2019 review had to use slow breathing of 10 breaths a m…

Studies, doses and limits

What the trials found

Three pooled analyses of randomised trials: a 2019 review of 17 studies of slow breathing at 10 breaths a minute or fewer (with or without a guiding device), a 2024 review of 15 trials of breathing exercises (including pranayama styles such as alternate nostril and bhramari breathing), and a 2026 review of 7 trials (683 people) of pranayama in hypertension.

Results

2019 review: systolic pressure fell by about 5.6 mmHg and diastolic by about 3 mmHg. 2024 review: systolic fell about 7 mmHg, diastolic about 3.4 mmHg and heart rate about 2.4 beats a minute. 2026 review: heart rate fell clearly; systolic pressure fell in a fixed-effects analysis and diastolic pressure and heart rate variability changed only modestly. All three describe high differences between trials or risk of bias.

Effect sizes as reported

2019: systolic -5.62 mmHg (95% CI -7.86 to -3.38), diastolic -2.97 (-4.28 to -1.66), high heterogeneity. 2024: systolic -7.06 (-10.20 to -3.92), diastolic -3.43 (-4.89 to -1.97), heart rate -2.41 (-4.53 to -0.30). 2026: heart rate SMD -0.43 (-0.52 to -0.34, I-squared 0 percent); systolic SMD -0.72 (fixed-effects).

Why this rating

Low, compiler's rating: three reviews agree on a modest fall, but the trials were small and varied, the 2024 authors say the studies are not free of bias, and none followed people for long or measured heart attacks or strokes. The 2019 and 2024 abstracts give no GRADE rating.

Form and dose studied

Trials in the 2019 review had to use slow breathing of 10 breaths a minute or fewer, for at least 5 minutes, on at least 3 days a week, for at least 4 weeks. These are the entry rules of the review, reported here as description, not advice. The other abstracts do not give session details.

Who was studied

Adults with hypertension or prehypertension, some already on blood pressure medicines (2019 review).

Limits

High differences between trials, short follow-up, unblinded designs, and no outcomes such as stroke or heart attack. NCCIH notes the same limits for the 2019 review.

Why researchers looked

Breathing rate and blood pressure are linked through the nervous system, so researchers asked whether training people to breathe slowly lowers pressure.

Proposed mechanism Hypothesis

Proposed: slow breathing with long out-breaths may shift the nervous system toward its resting state and relax blood vessels. The reviews read did not test this directly.

A proposed mechanism does not show that the effect happens in people.

The reviews did not report harms in their abstracts. People on blood pressure medicines should not change them because of a breathing practice; see the Safety tab.

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Blood pressure: device-guided breathing

Mixed findings

A 2012 review of trials of a commercial breathing-guide device found small falls in blood pressure, but they vanished when trials linked to the manufacturer were left out. A 2014 analysis of blinded trials against a sham device or music found no significant effect. The evidence is mixed.

2 studiesThe abstracts describe the device only as a commercial breathing-guid…

Studies, doses and limits

What the trials found

2012 review: 8 trials of one commercial device in 494 adults, the longest lasting 9 weeks. 2014 analysis: 5 blinded, randomised trials of at least 4 weeks with an active control (sham device or music); individual patient data were not provided for 2 of the 5.

Results

2012 review: small falls in systolic and diastolic pressure, but five of the eight trials were sponsored by or involved the device maker, and without them no overall effect remained; no effect on heart rate or quality of life. 2014 analysis: compared with a sham device or music, office systolic pressure was 2.2 mmHg higher with the device (in favour of the control group, not significant) and diastolic pressure 0.2 mmHg lower (not significant). The authors made no treatment recommendation because follow-up was short.

Effect sizes as reported

2012: systolic -3.67 mmHg (95% CI -5.99 to -1.39), diastolic -2.51 (-4.15 to -0.87); no effect after excluding manufacturer-linked trials. 2014: systolic +2.2 mmHg (-2.7 to 7.0), diastolic -0.2 (-2.8 to 3.1).

Why this rating

Mixed: the unblinded or manufacturer-linked trials show small falls, while the blinded, active-controlled trials show none. Both reviews call for longer, independent trials.

Form and dose studied

The abstracts describe the device only as a commercial breathing-guide; session details are not given. No product is endorsed here.

Who was studied

Adults with hypertension.

Limits

Short trials (up to 9 weeks), industry involvement in most of the favourable trials, and few blinded comparisons.

Why researchers looked

A device that gives audio cues to slow the breath was developed to lower blood pressure, so researchers tested it against waiting lists, sham devices and music.

Proposed mechanism Hypothesis

Proposed: the device's cues slow breathing to a set rhythm, which may relax the body. Not tested in these reviews.

A proposed mechanism does not show that the effect happens in people.

Neither abstract reports device-related harms.

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Stress, anxiety and low mood

Low certainty

A pooled analysis of 12 trials found breathwork lowered self-rated stress a little compared with non-breathwork controls, with similar small effects on anxiety and low mood. The authors themselves warn that hype may be running ahead of the evidence.

3 studiesThe trial tested cyclic sighing (a long out-breath), box breathing (e…

Studies, doses and limits

What the trials found

2023 meta-analysis in Scientific Reports: 12 randomised trials with 785 adults for stress, 20 trials for anxiety and 18 for depressive symptoms; most at moderate risk of bias. A 2023 randomised trial compared three daily 5-minute breathing exercises with 5 minutes of mindfulness meditation for 1 month. A 2018 systematic review of 15 studies in healthy people looked at what slow breathing (under 10 breaths a minute) does in the body and mind.

Results

Breathwork was linked to lower stress than control conditions, with small-to-medium effects on stress and small effects on anxiety and depressive symptoms. In the remote trial, the exercise with long out-breaths (cyclic sighing) gave a bigger gain in mood and a larger fall in breathing rate than mindfulness. The 2018 review reports increased comfort, relaxation and alertness and reduced anxiety, depression, anger and confusion in healthy people.

Effect sizes as reported

2023 meta-analysis: stress g -0.35 (95% CI -0.55 to -0.14), I-squared 42 percent; anxiety g -0.32 (20 trials); depressive symptoms g -0.40 (18 trials). Trial: improvement in mood and reduction in breathing rate with cyclic sighing, p < 0.05 versus mindfulness; no further numbers in the abstract.

Why this rating

Low, compiler's rating: effects are small, most trials had moderate risk of bias and relied on self-rated scales, many controls did nothing, and the authors urge caution. The Zaccaro review is on healthy volunteers and describes mechanisms, not treatment.

Form and dose studied

The trial tested cyclic sighing (a long out-breath), box breathing (equal in, hold and out) and cyclic hyperventilation with breath retention, each for 5 minutes a day for a month. This describes the trial only. Meta-analysis trials used many different methods.

Who was studied

Mostly healthy or mildly stressed adults; not people diagnosed with an anxiety disorder.

Limits

Self-reported outcomes, no blinding, very varied methods, and control groups that did nothing. The remote trial compared breathing with meditation, not with a sham.

Why researchers looked

Fast, shallow breathing goes with stress and worry, so researchers asked whether changing the breath eases how people feel.

Proposed mechanism Hypothesis

Proposed: slow breathing raises heart rate variability and shifts brain activity toward calm; a systematic review in healthy people reports these changes alongside more comfort and relaxation. Whether the changes cause the benefit is not established.

A proposed mechanism does not show that the effect happens in people.

Adverse events were not reported in the abstracts. Some people feel more anxious when they focus on the breath; see the Safety tab.

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Sleep

Low certainty

A 2026 review of 9 small studies found that slow breathing before bed improved self-rated sleep quality and sleep length, but sleep measured by wrist monitors and sleep-lab tests gave no clear answer.

1 studiesProtocols used in the trials: one-day sessions in the objective studi…

Studies, doses and limits

What the trials found

2026 systematic review in Sleep Medicine Reviews: 9 studies, 457 participants, all using slow breathing at 10 breaths a minute or fewer before bedtime.

Results

Self-reported sleep duration and sleep quality improved (7 studies). Objective sleep measures were inconclusive: actigraphy in 2 studies and polysomnography in 3. The three objective studies used a one-day protocol, while the five self-reported sleep studies used 28 to 30 days.

Effect sizes as reported

The abstract gives no pooled numbers.

Why this rating

Low, compiler's rating: only 9 small studies, the favourable results are self-reported, and the objective results are inconclusive. The review used GRADE but the abstract does not report the ratings.

Form and dose studied

Protocols used in the trials: one-day sessions in the objective studies and 28 to 30 days in the self-report studies, always before bedtime. Reported for description only.

Who was studied

Adults in 9 studies; the abstract does not describe who had sleep problems.

Limits

Small studies; mismatch between self-rated and measured sleep; very short interventions for the lab studies.

Why researchers looked

Racing thoughts and a tense body keep many people awake, so researchers asked whether slowing the breath before bed helps sleep.

Proposed mechanism Hypothesis

Proposed: slow breathing calms the nervous system before sleep. The review found that heart rate variability measures changed in six studies, but this does not prove the cause of any sleep change.

A proposed mechanism does not show that the effect happens in people.

The abstract reports no harms.

⁹

Panic disorder: breathing training guided by carbon dioxide feedback

Low certainty

A small randomised trial and a larger uncontrolled study of a short course of breathing training guided by a carbon dioxide sensor reported big drops in panic severity. The evidence is preliminary and covers a specific clinic-supervised programme, not ordinary breathing exercises.

2 studiesA 4-week programme guided by a portable carbon dioxide sensor with cl…

Studies, doses and limits

What the trials found

2008 randomised trial: 37 people with panic disorder, capnometry-assisted breathing therapy versus a delayed-treatment control, followed for 12 months. 2017 uncontrolled multi-site study: 69 adults given 4 weeks of a home capnometer-guided programme, with a clinician monitoring remotely, compared to an earlier controlled trial.

Results

Trial: treated patients improved in panic severity, avoidance, anxiety sensitivity, disability and breathing measures, with moderate to large effects, and gains held at follow-up; the waiting group did not improve. Uncontrolled study: 83 percent responded and 54 percent were in remission (intent-to-treat), carbon dioxide moved from slightly low to normal, and gains mostly held at 12 months.

Effect sizes as reported

Moderate to large effect sizes in the trial (the abstract gives no figures); response 83 percent and remission 54 percent in the 2017 study.

Why this rating

Low, compiler's rating, and arguably very low: one randomised trial of 37 people with a waiting-list control and no blinding, plus an uncontrolled study. The authors call the trial evidence preliminary.

Form and dose studied

A 4-week programme guided by a portable carbon dioxide sensor with clinician training; session counts are not given in the abstracts. This is a clinic-supervised treatment, not a home breathing exercise.

Who was studied

Adults with panic disorder, with or without agoraphobia.

Limits

Small trial, no blinding, waiting-list control, no sham sensor, and the second study had no control group. It tests one specific device-based programme.

Why researchers looked

People with panic disorder often breathe faster than they need to, which lowers carbon dioxide in the blood. Researchers asked whether training that raises carbon dioxide toward normal eases panic.

Proposed mechanism Hypothesis

Proposed: raising end-tidal carbon dioxide (the carbon dioxide at the end of an out-breath) toward normal may reduce panic-related breathing symptoms. The authors call this a hypothesis needing further testing.

A proposed mechanism does not show that the effect happens in people.

Neither abstract lists harms. Fast breathing can itself trigger panic symptoms in some people; see the Safety tab.

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Post-traumatic stress symptoms: breathing-based meditation

Very low certainty

Two trials in military veterans of a breathing-based programme called Sudarshan Kriya yoga reported lower post-traumatic stress scores. They were small, and the programme included more than breathing, so the certainty is very low.

2 studiesThe 2022 programme was a 15-hour group workshop followed by two 1-hou…

Studies, doses and limits

What the trials found

2014 randomised trial: 21 male veterans of the Iraq or Afghanistan wars, programme versus waiting list, followed to 1 year. 2022 randomised non-inferiority trial: 85 veterans, the breathing programme versus cognitive processing therapy (CPT), 59 completed.

Results

2014: the programme group had lower PTSD scores (d = 1.16), less anxiety and a slower breathing rate; the waiting list group did not. 2022: both treatments lowered the PTSD checklist score by the end of treatment (about 5.6 points with the breathing programme, 6.8 with CPT); the breathing programme was within the non-inferiority margin at end of treatment, 1 month and 1 year. At 1 year it was inferior to CPT on depression and mood scores. Dropout was similar (27 and 34 percent).

Effect sizes as reported

2014: d = 1.16 (95% CI 0.20 to 2.04). 2022: difference in change CPT minus programme -1.2 points (95% CI -5.7 to 3.3) at 6 weeks, margin 10 points.

Why this rating

Very low, compiler's rating: 21-person trial against a waiting list, and a non-inferiority trial where 59 of 85 finished; the programme combines breathing with other elements, so breathing alone is not tested. The 2022 trial found both groups improved only modestly.

Form and dose studied

The 2022 programme was a 15-hour group workshop followed by two 1-hour sessions a week for 5 weeks, taught by trained instructors. This describes the trial, not a recommendation.

Who was studied

US military veterans, almost all men.

Limits

Small and unblinded; one programme, not generalisable to other breathing methods; both studies in veterans only.

Why researchers looked

Standard treatments do not help everyone with post-traumatic stress, so researchers tested a breathing-based group programme in veterans.

Proposed mechanism Hypothesis

Proposed: slower breathing may lower arousal; the 2014 trial found that falls in the startle reflex went with falls in hyperarousal symptoms. This is a link, not proof of cause.

A proposed mechanism does not show that the effect happens in people.

Neither abstract lists harms. Fast-breathing practices can bring back traumatic memories in some people; see the Safety tab.

^{24 2}

Asthma: quality of life and breathing symptoms

Moderate certainty

The Cochrane review of 22 trials found that breathing exercises probably improve asthma quality of life and may ease the sensation of over-breathing, in people with mild to moderate asthma. They did not clearly improve asthma control scores. They are an addition to asthma medicines, not a replacement.

1 studiesFourteen of the 22 trials were yoga programmes; the rest used breathi…

Studies, doses and limits

What the trials found

Cochrane review (search to April 2019): 22 randomised trials, 2,880 adults with mild to moderate asthma treated as outpatients. Fourteen trials used yoga, four breathing retraining, two the Buteyko method (one with pranayama), one the Papworth method and one deep diaphragmatic breathing. Twenty compared with inactive controls and two with asthma education.

Results

Versus inactive control: asthma quality of life (AQLQ) was better at 3 months (4 trials, 974 people, moderate certainty). Hyperventilation symptoms on the Nijmegen questionnaire were lower at 4 to 6 months in two trials (moderate certainty), but not at 6 months in two other trials. Asthma control was inconclusive (low certainty). Lung function in litres was inconclusive (very low certainty), while FEV1 as a percent of predicted rose. Versus asthma education, one trial found no difference at 3 months and a gain at 4 to 6 months. The review did not count side effects as an outcome.

Effect sizes as reported

AQLQ MD 0.42 (95% CI 0.17 to 0.68); Nijmegen MD -3.22 (-6.31 to -0.13); ACQ MD -0.15 (-2.32 to 2.02); FEV1 MD -0.10 L (-0.32 to 0.12); FEV1 percent of predicted MD 6.88 (5.03 to 8.73).

Why this rating

Moderate for quality of life and hyperventilation symptoms, per the Cochrane reviewers' GRADE. Low or very low for asthma control and lung function. The trials differed widely in method, and risk of bias was hard to judge because of poor reporting.

Form and dose studied

Fourteen of the 22 trials were yoga programmes; the rest used breathing retraining, Buteyko, Papworth or diaphragmatic breathing. The abstract does not give session details.

Who was studied

Adult outpatients with mild to moderate asthma.

Limits

Very different methods and follow-up lengths, incomplete reporting, and no side-effect data in the review.

Why researchers looked

Many people with asthma breathe in a way that adds to their symptoms, so breathing retraining has long been tried alongside medicines.

Proposed mechanism Hypothesis

Proposed: retraining the pattern, depth and rate of breathing may reduce over-breathing and the sense of breathlessness. The review did not test how it works.

A proposed mechanism does not show that the effect happens in people.

The review did not look at side effects. People with asthma should keep to their prescribed treatment; see the Safety tab.

²³

Asthma control with the Buteyko breathing technique

Low certainty

A 2026 analysis of 7 trials found that adding the Buteyko technique to standard asthma care gave a small improvement in asthma control scores, and a quality-of-life gain only in children and teenagers.

2 studiesThe technique is taught by trained instructors; the abstract does not…

Studies, doses and limits

What the trials found

2026 systematic review in Explore: 7 randomised trials of the Buteyko technique plus standard care versus standard care alone, 7 for asthma control and 4 for quality of life; adults and children or teenagers.

Results

Asthma control improved overall, in adults and in children or teenagers. Quality of life showed no overall benefit but improved in children and teenagers. No adverse events were reported. The authors call the evidence limited.

Effect sizes as reported

Asthma control SMD -0.33 (95% CI -0.54 to -0.13; I-squared 0 percent); adults SMD -0.28 (-0.52 to -0.05); children and teenagers SMD -0.48 (-0.88 to -0.07). Quality of life overall SMD 0.13 (-0.23 to 0.49); children and teenagers SMD 0.44 (0.03 to 0.84).

Why this rating

Low, compiler's rating: few trials, no blinding possible, limited evidence according to the authors, and no long-term follow-up.

Form and dose studied

The technique is taught by trained instructors; the abstract does not give session details.

Who was studied

Adults, children and teenagers with asthma.

Limits

Small number of trials, self-rated scores, and the review's authors ask for large long-term trials.

Why researchers looked

The Buteyko technique teaches slower, lighter, mostly nose-based breathing and has been promoted for asthma, so trials tested it on top of usual care.

Proposed mechanism Hypothesis

Proposed by the method's supporters: reducing over-breathing. The review did not test a mechanism.

A proposed mechanism does not show that the effect happens in people.

No adverse events were reported in the review.

^{28 23}

Breathlessness and quality of life in COPD and other serious lung illness

Low certainty

A review of 73 trials found that pursed-lip and diaphragmatic breathing slightly eased breathlessness, by less than the amount patients notice, and consistently improved quality of life in people with COPD and asthma. A separate review found mixed results for diaphragmatic breathing in COPD.

2 studiesPursed-lip breathing (breathing out slowly through pursed lips) and d…

Studies, doses and limits

What the trials found

2024 systematic review in the European Respiratory Review: 73 randomised trials, 5,479 people, mostly with COPD or asthma. A 2026 systematic review of diaphragmatic breathing (48 randomised trials across many conditions) also reported on COPD.

Results

Pursed-lip and/or diaphragmatic breathing lowered the breathlessness score (modified Medical Research Council scale) compared with usual care, but not by enough to pass the minimal important difference. Yoga breathing lowered the score by more but the range included no change. Quality-of-life gains were consistent and generally exceeded the minimal important difference. No adverse events were reported. The 2026 review found the evidence inconsistent for COPD.

Effect sizes as reported

Pursed-lip and/or diaphragmatic: MD -0.40 points (95% CI -0.70 to -0.11; 8 studies, 323 people). Yoga breathing: MD -1.05 (-2.45 to 0.35; 3 studies, 175 people).

Why this rating

Low, compiler's rating: the review gives no GRADE in its abstract, the breathlessness change was below the important threshold, and the diaphragmatic-breathing review rates inconsistent evidence in COPD.

Form and dose studied

Pursed-lip breathing (breathing out slowly through pursed lips) and diaphragmatic breathing were the techniques pooled; session details are not in the abstract.

Who was studied

Adults with COPD, asthma or other serious respiratory illness.

Limits

Trials differed widely; small groups; breathlessness change below the level people notice.

Why researchers looked

Breathlessness is the main symptom of COPD, and breathing techniques are a long-standing part of lung rehabilitation.

Proposed mechanism Hypothesis

Proposed: pursed-lip breathing slows the out-breath and keeps airways open longer; diaphragmatic breathing may reduce the work of breathing. Not tested in the reviews read.

A proposed mechanism does not show that the effect happens in people.

No adverse events related to breathing techniques were reported in the 73 trials. People with lung disease should check with their care team; see the Safety tab.

^{5 15}

Dysfunctional breathing (over-breathing without a lung cause)

Low certainty

A 2025 review found that breathing retraining was the most studied treatment for dysfunctional breathing and usually showed positive effects, but the quality of the evidence was low.

1 studiesBreathing retraining protocols varied and were inadequately reported.

Studies, doses and limits

What the trials found

2025 systematic review in J Allergy Clin Immunol Pract: 68 studies, 2,119 people (26 cohort studies, 20 case series, 19 randomised trials and three non-randomised trials).

Results

Breathing retraining, with or without biofeedback, showed positive effects in 29 of 34 studies measuring blood gases or related chemistry, 10 of 10 on breathing mechanics and 15 of 19 on psychological and physical measures. Methods and outcomes varied widely and were poorly described.

Effect sizes as reported

No pooled numbers.

Why this rating

Low: the authors state low-quality evidence; most studies were at high or unclear risk of bias.

Form and dose studied

Breathing retraining protocols varied and were inadequately reported.

Who was studied

Adults with a diagnosis of dysfunctional breathing.

Limits

Mostly observational designs, high bias, poor reporting of what was done.

Why researchers looked

Some people breathe in a way that causes breathlessness, dizziness or tingling without a lung disease to explain it. Breathing retraining is the usual non-drug approach.

Proposed mechanism Hypothesis

Not tested in the review.

A proposed mechanism does not show that the effect happens in people.

The abstract does not report harms.

Chronic low back pain and other long-term pain

Low certainty

Pooled trials found that breathing exercises eased chronic low back pain and improved function, but the certainty is low to very low. A review in other long-term pain conditions found gains in six of ten trials.

2 studiesTrials ran 2 to 12 weeks. In the two best trials, the pattern was dai…

Studies, doses and limits

What the trials found

2026 systematic review in J Back Musculoskelet Rehabil: 17 randomised trials, 633 people with chronic non-specific low back pain, breathing exercises (diaphragmatic, slow or deep, forced exhalation) versus interventions without breathing exercises. 2026 review in Scandinavian Journal of Pain: 10 randomised trials, 638 adults with chronic neck pain, low back pain, fibromyalgia or tension-type headache.

Results

Low back pain: lower pain and better function, plus better lung function, core muscle activity and fear-avoidance scores; effects looked bigger in athletes. Other long-term pain: breathing therapy improved pain or quality of life in six studies; the two trials rated low risk of bias, both of daily slow diaphragmatic breathing, reported pain reductions of up to 37 percent. The reviewers say the evidence base is sparse.

Effect sizes as reported

Low back pain: pain SMD -1.11 (95% CI -1.71 to -0.51); Oswestry disability SMD -0.56 (-0.88 to -0.25); forced vital capacity SMD 0.46 (0.18 to 0.74); fear-avoidance SMD -0.56 (-0.97 to -0.15).

Why this rating

Low: the low back pain reviewers rate GRADE certainty low to very low with high heterogeneity and five trials at high risk of bias; the other review says quality ranged from high to critically low.

Form and dose studied

Trials ran 2 to 12 weeks. In the two best trials, the pattern was daily slow diaphragmatic breathing for 15 minutes, as reported in the review.

Who was studied

Adults with chronic non-specific low back pain; chronic neck pain, fibromyalgia, tension-type headache.

Limits

High heterogeneity, unblinded designs, self-rated pain, and short follow-up.

Why researchers looked

Pain and tension affect the breath, and trunk muscles work with the diaphragm, so researchers tested breathing exercises for pain.

Proposed mechanism Hypothesis

Proposed: the diaphragm shares work with the deep trunk muscles, and slow breathing may calm pain signals. The 2026 low back pain review also reports core muscle and fear-avoidance changes, which are possible pathways, not proof.

A proposed mechanism does not show that the effect happens in people.

The abstracts report no harms.

^{7 21}

Diaphragmatic breathing: reflux, anxiety and other conditions

Low certainty

A 2026 review of 48 trials found consistent benefits of diaphragmatic (belly) breathing for acid reflux, anxiety and some other conditions, but only about 2 percent of results came from trials at low risk of bias.

1 studiesProtocols varied hugely (2 to 10 breaths a minute; 3 to 45 minute ses…

Studies, doses and limits

What the trials found

2026 systematic review in Complement Ther Med: 48 randomised trials in adults, comparing diaphragmatic breathing with controls. Breathing rates ranged from 2 to 10 breaths a minute, session lengths from 3 to 45 minutes and total length from a single session to 12 weeks.

Results

Consistent benefits for gastro-oesophageal reflux disease (including less medicine use), anxiety, post-COVID-19 syndrome and gestational diabetes; acute cardiovascular benefits in healthy adults; inconsistent evidence for COPD; less effective than standard care after heart surgery. Safety was reported in only 18.75 percent of studies, with no serious adverse events.

Effect sizes as reported

No pooled numbers (narrative synthesis).

Why this rating

Low: the authors call the primary studies methodologically weak and heterogeneous, with only 2.12 percent of outcomes at low risk of bias.

Form and dose studied

Protocols varied hugely (2 to 10 breaths a minute; 3 to 45 minute sessions; up to 12 weeks).

Who was studied

Adults with many conditions plus healthy adults.

Limits

Very varied methods, weak designs, and little safety reporting.

Why researchers looked

Diaphragmatic breathing is widely taught, so this review gathered all randomised trials in adults.

Proposed mechanism Hypothesis

Not tested in the review.

A proposed mechanism does not show that the effect happens in people.

No serious adverse events were noted, but safety data were thin.

¹⁵

Heart rate variability (a body measure, not a health outcome)

Moderate certainty

A very large review found that slow breathing reliably raises heart rate variability, a measure of how flexibly the heart responds, during practice and after training. Higher variability is not by itself a proven health benefit.

1 studiesSlow voluntary breathing of varying rates; the abstract does not give…

Studies, doses and limits

What the trials found

2022 systematic review and meta-analysis in Neuroscience and Biobehavioral Reviews: 223 studies (172 measured during breathing, 16 right after one session, 49 after a multi-session programme).

Results

Vagally mediated heart rate variability rose during slow breathing, right after one session and after multi-session programmes. The authors say slow breathing could be used as a low-cost technique with few adverse effects expected.

Effect sizes as reported

The abstract gives no numbers.

Why this rating

Moderate for the narrow claim that the measure rises; this is compiler's rating because the abstract gives no bias rating. The rise is a stand-in measure and was not shown to improve health.

Form and dose studied

Slow voluntary breathing of varying rates; the abstract does not give a protocol.

Who was studied

Adults across 223 studies; the abstract does not describe the groups.

Limits

The abstract does not report quality ratings; heart rate variability is a physiological marker, not a health outcome.

Why researchers looked

Heart rate variability reflects the part of the nervous system that slows the heart, so researchers tested whether slow breathing raises it.

Proposed mechanism Hypothesis

Slow breathing is known to increase the natural speed-up and slow-down of the heart with each breath (respiratory sinus arrhythmia); the review's authors link this to the nervous system's resting branch.

A proposed mechanism does not show that the effect happens in people.

The authors expect few adverse effects, but the abstract reports no safety data.

¹⁶

Fast breathing with breath holds and cold exposure (Wim Hof style)

Very low certainty

Two studies of the Wim Hof Method, which combines fast breathing, breath holds, cold exposure and meditation, found body-chemistry changes and some short-term gains in energy and clarity in healthy adults. They did not test breathing alone, and the certainty is very low.

2 studiesThe 2014 training lasted 10 days; the 2025 trial ran 29 days. Describ…

Studies, doses and limits

What the trials found

2014 randomised trial in PNAS: 24 healthy volunteers (12 trained for 10 days in meditation, breathing and cold exposure; 12 untrained), then given a small injection of bacterial endotoxin. 2025 semi-randomised trial in Scientific Reports: 404 healthy adults, mean age 37, doing the Wim Hof Method in person, remotely, or meditation for 29 days.

Results

2014: the trained group had higher adrenaline and anti-inflammatory IL-10, lower levels of inflammatory TNF-alpha, IL-6 and IL-8, and fewer flu-like symptoms after endotoxin. 2025: the method gave larger daily gains in self-rated energy, mental clarity and ability to handle stress than meditation, though it gave smaller early reductions in stress, and little long-term change appeared over 29 days.

Effect sizes as reported

The abstracts give no pooled effect sizes.

Why this rating

Very low: a 24-person trial and a semi-randomised trial where people were not fully randomised; the method includes cold exposure and meditation, so the breathing part cannot be separated. The 2014 results are laboratory markers, not a treatment test.

Form and dose studied

The 2014 training lasted 10 days; the 2025 trial ran 29 days. Described as the trials did it, not as advice. The method includes hyperventilation, so read the Safety tab.

Who was studied

Healthy volunteers (2014); healthy adults (2025).

Limits

Multi-part method; self-rated outcomes; not randomised in the usual sense (2025); results in healthy people say nothing about people with illness.

Why researchers looked

Practitioners claim this method gives people some control over stress and inflammation, so researchers tested healthy volunteers.

Proposed mechanism Human data

Seen in the 2014 trial: cyclic fast breathing followed by breath holds caused short spells of low carbon dioxide (respiratory alkalosis) and low oxygen, with a big rise in adrenaline (epinephrine). This is a human finding in a small group.

A proposed mechanism does not show that the effect happens in people.

Fast breathing causes short-term respiratory alkalosis and low oxygen. See the Safety tab, especially for water, driving, seizures, pregnancy and heart conditions.

^{14 12}

Holotropic breathwork (prolonged fast breathing)

Not enough evidence

No controlled trial of holotropic breathwork was found in this search. The papers read only propose that prolonged fast breathing might help in psychotherapy and say that better studies are needed.

2 studiesHolotropic breathwork is described as a prolonged, voluntary hyperven…

Studies, doses and limits

What the trials found

A 2007 hypothesis-posing paper in J Altern Complement Med on holotropic breathwork, and a 2023 narrative review of high-ventilation breathwork in Neuroscience and Biobehavioral Reviews.

Results

The 2007 paper says further research with better methods is needed to confirm or refute the idea. The 2023 review describes unusual changes in experience and body function with high-ventilation breathwork and says reports of benefit in trauma-related, affective and bodily conditions invite rigorous clinical testing.

Why this rating

Insufficient: hypothesis papers and a narrative review, with no controlled trial read.

Form and dose studied

Holotropic breathwork is described as a prolonged, voluntary hyperventilation procedure; no session details are given in the abstracts.

Limits

No trial data; the reviews are narrative.

Why researchers looked

Supporters describe long sessions of fast breathing as a route to strong emotional experiences; researchers have asked whether this could help treat anxiety and depression.

Proposed mechanism Hypothesis

Hypothesis only: that hyperventilation may help reduce avoidance behaviours during psychotherapy.

A proposed mechanism does not show that the effect happens in people.

This is a fast-breathing practice with real risks; see the Safety tab.

^{22 11}

Connections to the rest of health

How Breathwork and Breathing Exercises connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Evidence status	Context	Studies
Blood Pressure	Low certainty	Blood pressure: slow breathing practices: Pooled trials of slow breathing (about 10 breaths a minute or fewer) found modest falls in blood pressure in adults with high or borderline-high blood pressure. The trials were small, short and varied a lot, so the certainty is low. Blood pressure: device-guided breathing: A 2012 review of trials of a commercial breathing-guide device found small falls in blood pressure, but they vanished when trials linked to the manufacturer were left out. A 2014 analysis of blinded trials against a sham device or music found no significant effect. The evidence is mixed.	^{6 13 8 32 19 17}
Heart Health	Low certainty	Blood pressure: slow breathing practices: Pooled trials of slow breathing (about 10 breaths a minute or fewer) found modest falls in blood pressure in adults with high or borderline-high blood pressure. The trials were small, short and varied a lot, so the certainty is low. Blood pressure: device-guided breathing: A 2012 review of trials of a commercial breathing-guide device found small falls in blood pressure, but they vanished when trials linked to the manufacturer were left out. A 2014 analysis of blinded trials against a sham device or music found no significant effect. The evidence is mixed.	^{6 13 8 32 19 17 16}
Stress Anxiety	Low certainty	Stress, anxiety and low mood: A pooled analysis of 12 trials found breathwork lowered self-rated stress a little compared with non-breathwork controls, with similar small effects on anxiety and low mood. The authors themselves warn that hype may be running ahead of the evidence. Panic disorder: breathing training guided by carbon dioxide feedback: A small randomised trial and a larger uncontrolled study of a short course of breathing training guided by a carbon dioxide sensor reported big drops in panic severity. The evidence is preliminary and covers a specific clinic-supervised programme, not ordinary breathing exercises.	^{10 1 29 20 26 24 2 15 16}
Mood Support	Low certainty	Stress, anxiety and low mood: A pooled analysis of 12 trials found breathwork lowered self-rated stress a little compared with non-breathwork controls, with similar small effects on anxiety and low mood. The authors themselves warn that hype may be running ahead of the evidence. Panic disorder: breathing training guided by carbon dioxide feedback: A small randomised trial and a larger uncontrolled study of a short course of breathing training guided by a carbon dioxide sensor reported big drops in panic severity. The evidence is preliminary and covers a specific clinic-supervised programme, not ordinary breathing exercises.	^{10 1 29 20 26 24 2}
Sleep Quality	Low certainty	Sleep: A 2026 review of 9 small studies found that slow breathing before bed improved self-rated sleep quality and sleep length, but sleep measured by wrist monitors and sleep-lab tests gave no clear answer.	⁹
Better Sleep	Low certainty	Sleep: A 2026 review of 9 small studies found that slow breathing before bed improved self-rated sleep quality and sleep length, but sleep measured by wrist monitors and sleep-lab tests gave no clear answer.	⁹
Breathing Support	Moderate certainty	Asthma: quality of life and breathing symptoms: The Cochrane review of 22 trials found that breathing exercises probably improve asthma quality of life and may ease the sensation of over-breathing, in people with mild to moderate asthma. They did not clearly improve asthma control scores. They are an addition to asthma medicines, not a replacement. Asthma control with the Buteyko breathing technique: A 2026 analysis of 7 trials found that adding the Buteyko technique to standard asthma care gave a small improvement in asthma control scores, and a quality-of-life gain only in children and teenagers.	^{23 28 5 15 3}
Lung Support	Moderate certainty	Asthma: quality of life and breathing symptoms: The Cochrane review of 22 trials found that breathing exercises probably improve asthma quality of life and may ease the sensation of over-breathing, in people with mild to moderate asthma. They did not clearly improve asthma control scores. They are an addition to asthma medicines, not a replacement. Asthma control with the Buteyko breathing technique: A 2026 analysis of 7 trials found that adding the Buteyko technique to standard asthma care gave a small improvement in asthma control scores, and a quality-of-life gain only in children and teenagers.	^{23 28 5 15}
Pain Relief	Low certainty	Chronic low back pain and other long-term pain: Pooled trials found that breathing exercises eased chronic low back pain and improved function, but the certainty is low to very low. A review in other long-term pain conditions found gains in six of ten trials.	^{7 21}
Digestive Support	Low certainty	Diaphragmatic breathing: reflux, anxiety and other conditions: A 2026 review of 48 trials found consistent benefits of diaphragmatic (belly) breathing for acid reflux, anxiety and some other conditions, but only about 2 percent of results came from trials at low risk of bias.	¹⁵
Energy Vitality	Very low certainty	Fast breathing with breath holds and cold exposure (Wim Hof style): Two studies of the Wim Hof Method, which combines fast breathing, breath holds, cold exposure and meditation, found body-chemistry changes and some short-term gains in energy and clarity in healthy adults. They did not test breathing alone, and the certainty is very low.	^{14 12}
Stress Anxiety	Very low certainty	Fast breathing with breath holds and cold exposure (Wim Hof style): Two studies of the Wim Hof Method, which combines fast breathing, breath holds, cold exposure and meditation, found body-chemistry changes and some short-term gains in energy and clarity in healthy adults. They did not test breathing alone, and the certainty is very low.	^{14 12}
Mood Support	Not enough evidence	Holotropic breathwork (prolonged fast breathing): No controlled trial of holotropic breathwork was found in this search. The papers read only propose that prolonged fast breathing might help in psychotherapy and say that better studies are needed.	^{22 11}

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Cardiovascular System	Biological association	Low certainty	Studied for: Blood pressure: slow breathing practices Studied for: Blood pressure: device-guided breathing	^{6 13 8 32 19 17 16}
Heart Circulation	Biological association	Low certainty	Studied for: Blood pressure: slow breathing practices Studied for: Blood pressure: device-guided breathing	^{6 13 8 32 19 17}
Nervous System	Biological association	Low certainty	Studied for: Stress, anxiety and low mood Studied for: Sleep	^{10 1 29 9 20 26 24 2 7 21 15 16 14 12 22 11}
Stress Mood	Biological association	Low certainty	Studied for: Stress, anxiety and low mood Studied for: Post-traumatic stress symptoms: breathing-based meditation	^{10 1 29 24 2}
Sleep Recovery	Biological association	Low certainty	Studied for: Sleep	⁹
Respiratory System	Biological association	Low certainty	Studied for: Panic disorder: breathing training guided by carbon dioxide feedback Studied for: Asthma: quality of life and breathing symptoms	^{20 26 23 28 5 15 3}
Musculoskeletal System	Biological association	Low certainty	Studied for: Chronic low back pain and other long-term pain	^{7 21}
Digestive System	Biological association	Low certainty	Studied for: Diaphragmatic breathing: reflux, anxiety and other conditions	¹⁵
Immune System	Biological association	Very low certainty	Studied for: Fast breathing with breath holds and cold exposure (Wim Hof style)	^{14 12}

E. Health conditions

Connected to	Kind of connection	Evidence status	Context	Studies
Epilepsy		Expert opinion	A 2026 review says people with epilepsy are more vulnerable and should avoid high-ventilation practices. Preparation or compound: Fast breathing (hyperventilation) practices	²⁵
Shallow water blackout	Adverse effect or risk	Case series	16 drownings reviewed in New York; two healthy young men died after hyperventilating before submerging. Preparation or compound: Hyperventilation before breath-holding	^{4 18}
High blood pressure		Low certainty	Modest falls in pooled trials; blinded device trials found none. Preparation or compound: Slow paced breathing	^{6 13 17}
Asthma		Moderate certainty	Probably better quality of life; unclear on control and lung function. Preparation or compound: Breathing exercises (yoga, retraining, Buteyko)	^{23 28}
Stress and anxiety		Low certainty	Small effects in pooled trials. Preparation or compound: Breathwork	^{10 1}

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
Systolic blood pressure (the upper number)	Biological association	Low certainty	Measured in trials: modest fall with slow breathing; no clear fall in blinded device trials. A lab change is not the same as a health benefit.	^{6 13 17}
Self-rated stress	Biological association	Low certainty	Measured in trials: small fall compared with non-breathwork controls. A lab change is not the same as a health benefit.	¹⁰
Self-rated sleep quality and duration	Biological association	Low certainty	Measured in trials: improved in 7 studies; objective measures inconclusive. A lab change is not the same as a health benefit.	⁹
Panic disorder severity	Biological association	Low certainty	Measured in trials: fall in the treated group compared with a waiting list. A lab change is not the same as a health benefit.	²⁰
Vagally mediated heart rate variability	Biological association	Moderate certainty	Measured in trials: rises during and after slow breathing. A lab change is not the same as a health benefit.	¹⁶
Breathlessness (modified Medical Research Council scale)	Biological association	Low certainty	Measured in trials: slight fall with pursed-lip or diaphragmatic breathing. A lab change is not the same as a health benefit.	⁵
Asthma Quality of Life Questionnaire (AQLQ)	Biological association	Moderate certainty	Measured in trials: higher at 3 months than inactive control. A lab change is not the same as a health benefit.	²³
Pain intensity in chronic low back pain	Biological association	Low certainty	Measured in trials: lower with breathing exercises. A lab change is not the same as a health benefit.	⁷

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Slow paced breathing	Biological association	Human	The most studied style; used in the blood pressure, sleep, stress and heart rate variability reviews.	^{6 9 25 16}
Diaphragmatic (belly) breathing	Biological association	Human	Reflux, anxiety and other conditions; evidence is varied.	¹⁵
Pursed-lip breathing	Biological association	Human	Used in COPD and asthma care for breathlessness.	⁵
Device-guided breathing	Biological association	Human	Blood pressure trials; blinded trials found no effect.	^{19 17}
Capnometry-guided breathing training	Biological association	Human	Panic disorder trial and uncontrolled study.	^{20 26}
Pranayama (yogic breathing, including alternate nostril and bhramari breathing)	Biological association	Human	Heart rate and blood pressure trials in hypertension.	^{13 8}
Box breathing, cyclic sighing and cyclic hyperventilation with retention	Biological association	Human	Compared with mindfulness meditation over 1 month; cyclic sighing gave the largest mood gain.	¹
Buteyko breathing technique	Biological association	Human	Small improvement in asthma control scores in the 2026 review.	^{28 23}
Papworth method	Biological association	Human	Asthma breathing retraining; no separate results in the abstract.	²³
Sudarshan Kriya yoga	Biological association	Human	Post-traumatic stress symptoms in veterans.	^{24 2}
Wim Hof Method	Biological association	Human	Laboratory chemistry and short-term self-rated energy; risks listed on the Safety tab.	^{14 12}
Holotropic breathwork	Biological association	Hypothesis	No controlled trial found; hypothesis only.	²²
Breath-holding (static apnoea, freediving)	Biological association	Human	Not a health practice; the sources read describe blackout and drowning.	^{4 18 27}

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 31, 2026).

Evidence at a glance: what the research found for 15 outcomes

2Moderate certainty

9Low certainty

2Very low certainty

1Mixed findings

1Not enough evidence

Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.

Blood pressure: slow breathing practices 4 studies Low certainty Blood pressure: device-guided breathing 2 studies Mixed findings Stress, anxiety and low mood 3 studies Low certainty Sleep 1 study Low certainty Panic disorder: breathing training guided by carbon dioxide feedback 2 studies Low certainty Post-traumatic stress symptoms: breathing-based meditation 2 studies Very low certainty Asthma: quality of life and breathing symptoms 1 study Moderate certainty Asthma control with the Buteyko breathing technique 2 studies Low certainty Breathlessness and quality of life in COPD and other serious lung illness 2 studies Low certainty Dysfunctional breathing (over-breathing without a lung cause) 1 study Low certainty Chronic low back pain and other long-term pain 2 studies Low certainty Diaphragmatic breathing: reflux, anxiety and other conditions 1 study Low certainty Heart rate variability (a body measure, not a health outcome) 1 study Moderate certainty Fast breathing with breath holds and cold exposure (Wim Hof style) 2 studies Very low certainty Holotropic breathwork (prolonged fast breathing) 2 studies Not enough evidence

The evidence

The research centre for Breathwork and Breathing Exercises. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, re-read the abstract of every review and trial cited, read the full text of the 2026 safety review through Europe PMC, and read the NCCIH, MedlinePlus and Healthline pages through a tool that summarises pages. Certainty ratings are the compiler's own reading, except where a review gives its own GRADE (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.

Study library: every study we checked 32

Design Research type Year from Search

Study	Design	People	Product, dose, length	Result
Balban 2023 Brief structured respiration practices enhance mood and reduce physiological arousal Cell Rep Med · PMID 36630953 · DOI	Randomised controlled trial	Remote randomised trial (NCT05304000) comparing three breathing exercises with mindfulness meditation; participant number not in the abstract	Cyclic sighing, box breathing, and cyclic hyperventilation with retention 5 minutes daily 1 month · vs Mindfulness meditation for the same time	Breathwork, especially exhale-focused cyclic sighing, gave greater mood improvement and a larger fall in breathing rate than mindfulness meditation (p < 0.05). Mood and respiratory rate improved more with cyclic sighing than with mindfulness, p < 0.05 (Not given in the abstract) Methods, limits and funding Outcomes: Mood, anxiety, respiratory rate, heart rate, heart rate variability Limitations: Remote, unblinded; control was another active practice; abstract gives no numbers. Funding and conflicts: Record lists US National Eye Institute support; no conflict statement read. Read: abstract
Bayley 2022 Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of post-traumatic stress disorder in military veterans BMJ Open · PMID 36008059 · DOI	Randomised controlled trial	85 85 veterans with PTSD symptoms (59 finished); mean age 56.9, 75 men; NCT02366403	Sudarshan Kriya yoga: breathing routines in a group format 15-hour workshop then two 1-hour sessions a week 5 weeks (workshop plus sessions); follow-up to 1 year · vs Cognitive processing therapy, two 1-hour sessions a week for 6 weeks	Both groups improved; the breathing programme was not inferior to cognitive processing therapy on PTSD score at 6 weeks, 1 month and 1 year, but was inferior on depression and mood scores at 1 year. PTSD checklist change -5.6 (programme) vs -6.8 (CPT); difference -1.2 (-5.7 to 3.3) Methods, limits and funding Outcomes: PTSD Checklist score; depression; mood Limitations: Only 59 of 85 finished; modest improvements in both groups; veterans only. Funding and conflicts: Record lists US Department of Veterans Affairs support; no conflict statement read. Read: abstract
Bondarenko 2025 Nonpharmacological Interventions for Dysfunctional Breathing in Adults: A Systematic Review J Allergy Clin Immunol Pract · PMID 40345332 · DOI	Systematic review	2119 68 studies (26 cohort, 20 case series, 19 randomised, 3 non-randomised) in adults with dysfunctional breathing	Breathing retraining with or without biofeedback, psychological therapy, acupoint, manual and exercise therapy Highly variable Not given in the abstract · vs Varied	Breathing retraining showed positive effects in most studies, with low-quality evidence. Positive in 29 of 34 (biochemical), 10 of 10 (biomechanical), 15 of 19 (psychophysiological) (Not given) Methods, limits and funding Outcomes: Biochemical, biomechanical and psychophysiological measures Limitations: High or unclear risk of bias in most studies; interventions inadequately reported. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Boyd 2015 Fatal and nonfatal drowning outcomes related to dangerous underwater breath-holding behaviors - New York State, 1988-2011 MMWR Morb Mortal Wkly Rep · PMID 25996093	Case series	16 drowning cases in New York State	Hyperventilation before underwater breath-holding	Two healthy young men died after hyperventilating before submerging; practising more than one dangerous underwater breath-holding behaviour raised the risk of death. 16 cases (None) Methods, limits and funding Outcomes: Fatal and nonfatal drowning Limitations: Small sample; case review. Funding and conflicts: Public-health agency report; no conflict statement read. Read: abstract
Burge 2024 Breathing techniques to reduce symptoms in people with serious respiratory illness: a systematic review Eur Respir Rev · PMID 39477355 · DOI	Systematic review	5479 73 randomised trials, mostly in COPD or asthma	Breathing techniques that alter breathing pattern (pursed-lip, diaphragmatic, yoga breathing); respiratory muscle training excluded Not given in the abstract Not given in the abstract · vs Usual care	Pursed-lip and/or diaphragmatic breathing lowered breathlessness slightly, below the minimal important difference; quality of life consistently improved; no adverse events related to the techniques. mMRC MD -0.40 (pursed-lip/diaphragmatic); -1.05 (yoga breathing) (-0.70 to -0.11; -2.45 to 0.35) Methods, limits and funding Outcomes: Breathlessness (primary), quality of life, adverse events Limitations: Heterogeneous trials; no GRADE in the abstract. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Chaddha 2019 Device and non-device-guided slow breathing to reduce blood pressure: A systematic review and meta-analysis Complement Ther Med · PMID 31331557 · DOI	Systematic review meta analysis	17 randomised trials in adults with hypertension, prehypertension or on blood pressure medicines	Slow breathing at 10 breaths a minute or fewer, with or without a device (including pranayama) At least 5 minutes on at least 3 days a week (entry rule of the review) At least 4 weeks · vs Control group	Slow breathing lowered systolic and diastolic blood pressure modestly; heterogeneity was high. Systolic -5.62 mmHg; diastolic -2.97 mmHg (Systolic -7.86 to -3.38; diastolic -4.28 to -1.66) Methods, limits and funding Outcomes: Systolic and diastolic blood pressure, heart rate, medicine use Limitations: High heterogeneity; risk of bias assessed but not summarised in the abstract; participant number not given. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Chen 2026 Can breathing exercises effectively treat people with chronic non-specific low back pain? A systemic review with meta-analysis J Back Musculoskelet Rehabil · PMID 40965964 · DOI	Systematic review meta analysis	633 17 randomised trials in chronic non-specific low back pain (PROSPERO CRD42024567159)	Diaphragmatic, slow or deep breathing and forced exhalation exercises Not given in the abstract 2 to 12 weeks · vs Interventions without breathing exercises	Lower pain and better function, lung function, core activity and fear-avoidance; larger pain effect in athletes; GRADE low to very low. Pain SMD -1.11; ODI SMD -0.56; FVC SMD 0.46; FABQ SMD -0.56 (Pain -1.71 to -0.51; ODI -0.88 to -0.25; FVC 0.18 to 0.74; FABQ -0.97 to -0.15) Methods, limits and funding Outcomes: Pain, function, lung function, core muscle activity, fear-avoidance Limitations: High heterogeneity; five studies at high risk of bias; low to very low certainty. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Chidambaram 2026 The effect of yogic breathing (Pranayama) on heart rate and blood pressure in patients with hypertension: A systematic review and meta-analysis Indian Heart J · PMID 41580026 · DOI	Systematic review meta analysis	683 7 randomised trials in patients with hypertension (PROSPERO CRD42024597502)	Pranayama (yogic breathing) Not given in the abstract Not given in the abstract · vs Control groups	Heart rate fell; systolic pressure fell under a fixed-effects model, while diastolic pressure and heart rate variability changed modestly. Heart rate SMD -0.43; systolic SMD -0.72 (fixed-effects) (Heart rate -0.52 to -0.34) Methods, limits and funding Outcomes: Heart rate (primary), systolic and diastolic blood pressure, heart rate variability Limitations: Only 7 trials; small; the abstract gives no certainty rating; results depend on the model used. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Eide 2026 Slow breathing techniques before bedtime and the effects on sleep: A systematic review Sleep Med Rev · PMID 41886931 · DOI	Systematic review meta analysis	457 9 studies of slow breathing (10 breaths a minute or fewer) before bedtime	Slow breathing before bed Not given in the abstract One-day protocols (objective studies) or 28 to 30 days (self-report studies) · vs Varied	Self-reported sleep duration and quality improved (7 studies); objective results (2 actigraphy, 3 polysomnography) were inconclusive. Not given as numbers in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Self-reported sleep duration and quality; actigraphy; polysomnography; heart rate variability Limitations: Small studies, short interventions; GRADE used but ratings not in the abstract. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Fincham 2023 Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials Sci Rep · PMID 36624160 · DOI	Systematic review meta analysis	785 12 randomised trials in adults for stress (20 for anxiety, 18 for depressive symptoms)	Breathwork of many kinds Not given in the abstract Not given in the abstract · vs Non-breathwork controls	Breathwork was linked to lower stress, anxiety and depressive symptoms than controls; the authors urge caution about hype. Stress g -0.35; anxiety g -0.32; depression g -0.40 (Stress -0.55 to -0.14) Methods, limits and funding Outcomes: Self-rated stress (primary), anxiety, depressive symptoms Limitations: Most studies at moderate risk of bias; moderate heterogeneity for anxiety and depression. Funding and conflicts: Record lists non-US government support; no conflict statement read. Read: abstract
Fincham 2023 High ventilation breathwork practices: An overview of their effects, mechanisms, and considerations for clinical applications Neurosci Biobehav Rev · PMID 37923236 · DOI	Narrative review	Review of fast-breathing practices	High ventilation breathwork	Reports unusual subjective and physiological effects and putative benefits; calls for rigorous testing. The abstract gives no specific safety rates. None (None) Methods, limits and funding Outcomes: Experience, physiology, safety profile, clinical potential Limitations: Abstract only; safety detail not read. Funding and conflicts: Record lists non-US government support; no conflict statement read. Read: abstract
Fox 2025 A semi-randomised control trial assessing psychophysiological effects of breathwork and cold immersion Sci Rep · PMID 41388053 · DOI	Randomised controlled trial	404 404 healthy adults, mean age 37 (226 female)	Wim Hof Method (cyclic hyperventilation and cold exposure), in person or remote Daily protocol 29 days · vs Mindfulness meditation	Larger daily gains in energy, clarity and handling stress than meditation; smaller early stress reduction; minimal trait change over 29 days. Not given as numbers in the abstract (Not given) Methods, limits and funding Outcomes: Self-rated energy, mental clarity, stress; executive function; sleep Limitations: Semi-randomised; multi-part method; self-rated outcomes. Funding and conflicts: Record lists no funder; no conflict statement read; the method is branded, so commercial interest is possible but not stated. Read: abstract
Garg 2024 Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis Int J Cardiol Cardiovasc Risk Prev · PMID 38179185 · DOI	Systematic review meta analysis	15 randomised trials of breathing exercises on blood pressure (PROSPERO CRD42022316413)	Breathing exercises incl. pranayama, bhramari, alternate nostril, deep and slow breathing Not given in the abstract Not given in the abstract · vs Control groups	Modest but significant falls in blood pressure and heart rate; the authors say the studies are not free of bias. Systolic -7.06 mmHg; diastolic -3.43 mmHg; heart rate -2.41 beats a minute (Systolic -10.20 to -3.92; diastolic -4.89 to -1.97; heart rate -4.53 to -0.30) Methods, limits and funding Outcomes: Systolic and diastolic blood pressure; heart rate Limitations: Not free of bias; participant number not in the abstract; searches covered January 2017 to September 2022 only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Kox 2014 Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans Proc Natl Acad Sci U S A · PMID 24799686 · DOI	Randomised controlled trial	24 24 healthy volunteers (12 trained, 12 untrained)	Training in meditation, cyclic hyperventilation followed by breath retention, and cold exposure (the Wim Hof Method) Not given in the abstract 10 days of training before endotoxin · vs Untrained control	Trained group had short respiratory alkalosis and low oxygen with a large adrenaline rise, higher IL-10, lower TNF-alpha, IL-6 and IL-8, and fewer flu-like symptoms. Not given as numbers in the abstract (Not given) Methods, limits and funding Outcomes: Adrenaline, cytokines, flu-like symptoms after endotoxin Limitations: Small; multi-part method; lab markers, not a treatment trial. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Kwon 2026 The health effects of diaphragmatic breathing: A systematic review Complement Ther Med · PMID 41482169 · DOI	Systematic review	48 randomised trials in adults	Diaphragmatic breathing 2 to 10 breaths a minute, 3 to 45 minute sessions Single session to 12 weeks · vs Control conditions	Consistent benefits in reflux, anxiety, post-COVID-19 syndrome and gestational diabetes; acute cardiovascular benefits in healthy adults; inconsistent in COPD; less effective than standard care after heart surgery; no serious adverse events but safety under-reported. No pooled numbers (Not given) Methods, limits and funding Outcomes: Many outcomes Limitations: Only 2.12 percent of outcomes low risk of bias; safety reported in 18.75 percent of studies. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Laborde 2022 Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis Neurosci Biobehav Rev · PMID 35623448 · DOI	Systematic review meta analysis	223 studies (172 during breathing, 16 right after one session, 49 after multi-session programmes)	Voluntary slow breathing Not given in the abstract Single session to multi-session programmes · vs Varied	Variability rose during slow breathing, right after a session and after multi-session programmes. No numbers in the abstract (Not given) Methods, limits and funding Outcomes: Vagally mediated heart rate variability Limitations: Quality ratings not in the abstract; a marker, not a health outcome. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Landman 2014 Efficacy of device-guided breathing for hypertension in blinded, randomized, active-controlled trials: a meta-analysis of individual patient data JAMA Intern Med · PMID 25222103 · DOI	Systematic review meta analysis	5 blinded randomised trials of at least 4 weeks with an active control; individual patient data missing for 2 of the 5	Device-guided breathing Not given in the abstract At least 4 weeks · vs Music therapy or a sham device	Device-guided breathing did not significantly lower office blood pressure compared with a sham procedure or music therapy; follow-up was short so no treatment recommendation could be made. Systolic +2.2 mmHg in favour of control; diastolic 0.2 mmHg in favour of device (both not significant) (Systolic -2.7 to 7.0; diastolic -2.8 to 3.1) Methods, limits and funding Outcomes: Office blood pressure Limitations: Short follow-up; data from 2 of 5 trials not provided; participant total not in the abstract. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Lindholm 2009 The physiology and pathophysiology of human breath-hold diving J Appl Physiol (1985) · PMID 18974367 · DOI	Narrative review	Review of breath-hold diving physiology	Breath-hold diving	Mortality is concentrated in less well-trained recreational divers; hyperventilation is among mechanisms of hypoxia and loss of consciousness. None (None) Methods, limits and funding Outcomes: Physiology and risks Limitations: Review of diving, not of breathing exercises on land. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Mahtani 2012 Device-guided breathing exercises in the control of human blood pressure: systematic review and meta-analysis J Hypertens · PMID 22495126 · DOI	Systematic review meta analysis	494 8 randomised trials in adults using one commercial breathing-guide device	Device-guided breathing (one commercial device) Not given in the abstract Maximum trial length 9 weeks · vs Control groups	Short-term use reduced blood pressure, but with the 5 manufacturer-linked trials excluded no overall effect remained; no effect on heart rate or quality of life. Systolic -3.67 mmHg; diastolic -2.51 mmHg (Systolic -5.99 to -1.39; diastolic -4.15 to -0.87) Methods, limits and funding Outcomes: Systolic and diastolic blood pressure; heart rate; quality of life; side effects Limitations: Five of the eight trials were sponsored by or involved the device maker; short trials. Funding and conflicts: Industry involvement in 5 of 8 included trials (stated in the abstract); the review itself lists non-US government support. Read: abstract
Meuret 2008 Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder J Psychiatr Res · PMID 17681544 · DOI	Randomised controlled trial	37 37 people with panic disorder with or without agoraphobia	Capnometry-assisted breathing therapy Not given in the abstract Follow-up at 2 and 12 months · vs Delayed-treatment control	Treated patients improved with moderate to large effect sizes and held the gains at follow-up; untreated patients did not. Moderate to large effect sizes (no numbers in the abstract) (Not given in the abstract) Methods, limits and funding Outcomes: Panic severity, agoraphobic avoidance, anxiety sensitivity, disability, breathing rate and end-tidal carbon dioxide Limitations: Small trial; the authors call the evidence preliminary and ask for replication. Funding and conflicts: Record lists US National Institute of Mental Health support; no conflict statement read. Read: abstract
Mikkelsen 2026 Breathing therapy as a supplement to opioid management for complex chronic non-cancer pain conditions - a systematic review Scand J Pain · PMID 42104567 · DOI	Systematic review	638 10 randomised trials in adults with chronic neck pain, low back pain, fibromyalgia or tension-type headache (PROSPERO CRD42023460181)	Breathing therapy Two low-risk-of-bias trials used daily slow diaphragmatic breathing for 15 minutes Not given in the abstract · vs Varied	Breathing therapy improved pain and/or quality of life in six studies; the two best trials reported pain reductions up to 37 percent; evidence sparse. Pain reduction up to 37 percent in the two best trials (Not given) Methods, limits and funding Outcomes: Pain, quality of life, physical function, sleep Limitations: Quality from high to critically low; too varied to pool. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Rhinewine 2007 Holotropic Breathwork: the potential role of a prolonged, voluntary hyperventilation procedure as an adjunct to psychotherapy J Altern Complement Med · PMID 17931070 · DOI	Hypothesis paper	No participants; hypothesis and literature review	Holotropic breathwork (prolonged voluntary hyperventilation) Not given Not given	Poses the hypothesis that holotropic breathwork may help psychiatric conditions; says more rigorous research is needed. None (None) Methods, limits and funding Outcomes: None Limitations: Hypothesis paper; no trial data. Funding and conflicts: Record lists non-US government support; no conflict statement read. Read: abstract
Santino 2020 Breathing exercises for adults with asthma Cochrane Database Syst Rev · PMID 32212422 · DOI	Systematic review meta analysis	2880 22 randomised trials in adults with mild to moderate asthma (outpatients); 14 yoga, 4 breathing retraining, 2 Buteyko, 1 Papworth, 1 deep diaphragmatic	Breathing exercises (yoga, breathing retraining, Buteyko, Papworth, diaphragmatic) Not given in the abstract Follow-up from under 3 months to 6 months · vs Inactive control (20 trials) or asthma education (2 trials)	Probably better asthma quality of life at 3 months; fewer hyperventilation symptoms at 4 to 6 months in two trials (not at 6 months in two others); asthma control inconclusive; FEV1 in litres inconclusive. AQLQ MD 0.42; Nijmegen MD -3.22; ACQ MD -0.15; FEV1 MD -0.10 L; FEV1 percent predicted MD 6.88 (AQLQ 0.17 to 0.68; Nijmegen -6.31 to -0.13; ACQ -2.32 to 2.02; FEV1 -0.32 to 0.12; FEV1 percent 5.03 to 8.73) Methods, limits and funding Outcomes: Quality of life (primary), asthma control, hyperventilation symptoms, lung function Limitations: Different methods, incomplete reporting; adverse effects not an outcome; moderate to very low GRADE. Funding and conflicts: Record lists non-US government/university support; no conflict statement read. Read: abstract
Seppälä 2014 Breathing-based meditation decreases posttraumatic stress disorder symptoms in U.S. military veterans: a randomized controlled longitudinal study J Trauma Stress · PMID 25158633 · DOI	Randomised controlled trial	21 21 male US veterans of the Iraq or Afghanistan wars	Sudarshan Kriya yoga (breathing-based meditation) Not given in the abstract Follow-up at 1 month and 1 year · vs Waiting list	The programme group had lower PTSD scores, anxiety and breathing rate; the waiting list group did not. Reduction in startle matched reduction in hyperarousal. PTSD score d = 1.16 (0.20 to 2.04) Methods, limits and funding Outcomes: PTSD score, eye-blink startle, respiration rate, anxiety Limitations: Very small trial; waiting-list control; men only. Funding and conflicts: Record lists a US National Institute of Child Health and Human Development grant; no conflict statement read. Read: abstract
Sharma 2026 Neurophysiological mechanisms of breathing-based well-being practices: a narrative review for clinical application Front Psychiatry · PMID 42487760 · DOI	Narrative review	Narrative review of breathing practices and their safety	Breathing-based practices (slow-paced, high-ventilation, breath-hold)	Identifies populations needing caution (panic symptoms, significant heart or lung disease, pregnancy); lists dizziness, anxiety, intrusive memories and rare hallucinations as adverse effects. None (None) Methods, limits and funding Outcomes: Physiology, adverse effects, contraindications Limitations: Narrative review, not systematic; reasons come from other papers it cites. Funding and conflicts: No funding or conflict statement in the record read. Read: full-text
Tolin 2017 A Multisite Benchmarking Trial of Capnometry Guided Respiratory Intervention for Panic Disorder in Naturalistic Treatment Settings Appl Psychophysiol Biofeedback · PMID 28194546 · DOI	Uncontrolled trial	69 69 adults with panic disorder in four non-academic clinics	Capnometry-guided respiratory intervention with a commercial home device, clinician-supervised remotely Home use after clinician training 4 weeks, followed to 12 months	83 percent responded and 54 percent reached remission (intent-to-treat); end-tidal carbon dioxide moved from slightly low to normal; gains mostly held at follow-up. Response 83 percent; remission 54 percent (Not given in the abstract) Methods, limits and funding Outcomes: Panic severity, functional impairment, end-tidal carbon dioxide Limitations: No control group; uses a commercial device programme; commercial interest not stated in the abstract. Funding and conflicts: Record lists a US National Center for Advancing Translational Sciences grant; no conflict statement read. Read: abstract
Valdivia-Valdivia 2021 Prolonged syncope with multifactorial pulmonary oedema related to dry apnoea training: Safety concerns in unsupervised dry static apnoea Diving Hyperb Med · PMID 34157738 · DOI	Case report	1 One unsupervised diver	Dry static apnoea after hyperventilation	Loss of consciousness after hyperventilation and breath-hold, prolonged low oxygen and lung fluid; the authors warn against unsupervised exhalatory breath-holding after hyperventilation. One case (None) Methods, limits and funding Outcomes: Clinical course Limitations: Single case. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Wu 2026 The effect of the Buteyko breathing technique on asthma control and quality of life: a systematic review and meta-analysis of Randomized Controlled Trials Explore (NY) · PMID 41930853 · DOI	Systematic review meta analysis	7 randomised trials in adults and children or teenagers with asthma	Buteyko breathing technique plus standard care Not given in the abstract Not given in the abstract · vs Standard care alone	Better asthma control overall; quality of life improved only in children and teenagers; no adverse events reported. Control SMD -0.33; quality of life SMD 0.13 overall, 0.44 in children and teenagers (Control -0.54 to -0.13; quality of life -0.23 to 0.49; children 0.03 to 0.84) Methods, limits and funding Outcomes: Asthma control scores; quality of life Limitations: Few trials; the authors call the evidence limited. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Zaccaro 2018 How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing Front Hum Neurosci · PMID 30245619 · DOI	Systematic review	15 studies in healthy people	Slow breathing techniques (under 10 breaths a minute) Not given in the abstract Not given in the abstract · vs Varied	Slow breathing increased heart rate variability and respiratory sinus arrhythmia, raised EEG alpha and lowered theta power, and went with more comfort and relaxation and less anxiety, depression, anger and confusion in healthy people. Not given as numbers in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Heart rate variability, brain activity (EEG, fMRI), mood and arousal Limitations: Healthy volunteers only; 15 of 2,461 abstracts met the criteria; mechanisms are a hypothesis. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
s-healthline-holotropic Healthline: Holotropic Breathwork: Usage, Safety, and More (updated 18 September 2018; medically reviewed 6 October 2017) · Source	Consumer health page n/a			Methods, limits and funding Read: full-text
s-medlineplus-hyperventilation MedlinePlus: Hyperventilation (reviewed 23 July 2024) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-nccih-relaxation NCCIH: Relaxation Techniques: What You Need To Know (page marked Last Updated June 2021) · Source	Health agency n/a			Methods, limits and funding Read: full-text

What we do not know yet

No trial read compared slow breathing with a sham breathing exercise matched for time and attention.
Many trials were unblinded and used self-rated scales; the blinded blood pressure device trials were null.
Follow-up beyond about a year, and outcomes such as heart attack or stroke, were not found.
Reviews pool many styles, so which method, how long or how often is not established.
No controlled trial of holotropic breathwork was found.
Rates of harm from fast-breathing practices were not found.
The history and origins of the named methods were not read from a source.

How new research is added

New studies are found by a saved PubMed search and placed in a review queue before the page changes.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 8

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Systolic blood pressure (the upper number)

Modest fall with slow breathing; no clear fall in blinded device trials in trials

The pressure in the arteries when the heart beats, in millimetres of mercury (mmHg).

Low certainty

Results and what it means

Why it was measured

High blood pressure raises the risk of heart attack and stroke.

Statistical vs. clinical meaning

A modest average change in a stand-in measure; no review followed people to heart attack or stroke.

Safety implication

Anyone on blood pressure medicines should not change them because of breathing practice.

Study	Result	People	Product
⁶	Systolic pressure fell by 5.62 mmHg (95% CI 3.38 to 7.86), with high heterogeneity.	17 studies; hypertension or prehypertension	Slow breathing at 10 breaths a minute or fewer
¹³	Systolic pressure fell by 7.06 mmHg (95% CI 3.92 to 10.20).	15 randomised trials	Breathing exercises incl. pranayama styles
¹⁷	Office systolic pressure was 2.2 mmHg higher with the device than with a sham device or music (95% CI -2.7 to 7.0), not significant.	5 blinded, active-controlled trials	Device-guided breathing

^{6 13 17}

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Self-rated stress

Small fall compared with non-breathwork controls in trials

A questionnaire score in which people rate how stressed they feel; lower is better.

Low certainty

Results and what it means

Why it was measured

To see whether breathing practice changes how stressed people feel.

Statistical vs. clinical meaning

A small average change on a self-rated scale, with moderate risk of bias in most trials.

Safety implication

None beyond the cautions on the Safety tab.

Study	Result	People	Product
¹⁰	Stress was lower with breathwork: g -0.35 (95% CI -0.55 to -0.14).	12 trials, 785 adults	Breathwork of many kinds

¹⁰

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Self-rated sleep quality and duration

Improved in 7 studies; objective measures inconclusive in trials

How well and how long people say they slept, from diaries or questionnaires.

Low certainty

Results and what it means

Why it was measured

To see whether slow breathing before bed changes the sleep people report.

Statistical vs. clinical meaning

Self-rated gains without clear support from sleep-lab or wrist-monitor data.

Safety implication

None beyond the Safety tab.

Study	Result	People	Product
⁹	Self-reported sleep duration and quality improved after slow breathing before bed; actigraphy (2 studies) and polysomnography (3) were inconclusive.	9 studies, 457 participants	Slow breathing at 10 breaths a minute or fewer, before bedtime

⁹

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Panic disorder severity

Fall in the treated group compared with a waiting list in trials

A clinician-rated score of how often and how strongly panic symptoms occur.

Low certainty

Results and what it means

Why it was measured

To see whether breathing training reduces panic.

Statistical vs. clinical meaning

One small trial; preliminary according to its authors.

Safety implication

Fast breathing can sometimes trigger panic; see the Safety tab.

Study	Result	People	Product
²⁰	Significant improvement in panic disorder severity in the treated group but not the untreated group, with moderate to large effect sizes, maintained at 12 months.	37 people with panic disorder	Capnometry-assisted breathing therapy

²⁰

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Vagally mediated heart rate variability

Rises during and after slow breathing in trials

A measure of the small changes in time between heartbeats; higher values usually mean the nervous system's resting branch is more active.

Moderate certainty

Results and what it means

Why it was measured

To see whether slow breathing shifts the nervous system toward rest.

Statistical vs. clinical meaning

Consistent in direction, but a stand-in measure, not a health outcome.

Safety implication

None beyond the Safety tab.

Study	Result	People	Product
¹⁶	Vagally mediated variability increased during slow breathing, immediately after one session and after multi-session programmes.	223 studies	Voluntary slow breathing

¹⁶

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Breathlessness (modified Medical Research Council scale)

Slight fall with pursed-lip or diaphragmatic breathing in trials

A scale on which people rate how much breathlessness limits their activities; lower is better.

Low certainty

Results and what it means

Why it was measured

To see whether breathing techniques reduce breathlessness.

Statistical vs. clinical meaning

A real but small change, below the size patients notice.

Safety implication

People with lung disease should keep to their prescribed treatment.

Study	Result	People	Product
⁵	MD -0.40 points (95% CI -0.70 to -0.11); did not exceed the minimal important difference.	8 studies, 323 people	Pursed-lip and/or diaphragmatic breathing

⁵

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Asthma Quality of Life Questionnaire (AQLQ)

Higher at 3 months than inactive control in trials

A questionnaire on how asthma affects daily life; higher is better.

Moderate certainty

Results and what it means

Why it was measured

To see whether breathing exercises improve daily life with asthma.

Statistical vs. clinical meaning

A moderate-certainty gain per the Cochrane reviewers.

Safety implication

The review did not look at side effects.

Study	Result	People	Product
²³	MD 0.42 (95% CI 0.17 to 0.68) at 3 months; moderate certainty.	4 studies, 974 people	Breathing exercises (mostly yoga and breathing retraining)

²³

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Pain intensity in chronic low back pain

Lower with breathing exercises in trials

A self-rated pain score; lower is better.

Low certainty

Results and what it means

Why it was measured

To see whether breathing exercises lower back pain.

Statistical vs. clinical meaning

A large pooled effect, but low to very low certainty.

Safety implication

None beyond the Safety tab.

Study	Result	People	Product
⁷	SMD -1.11 (95% CI -1.71 to -0.51), high heterogeneity.	17 studies, 633 people	Diaphragmatic, slow or deep breathing and forced exhalation exercises, 2 to 12 weeks

⁷

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 4

Fast breathing can cause dizziness, tingling and fainting. Over-breathing washes carbon dioxide out of the blood. MedlinePlus lists lightheadedness, dizziness, weakness, trouble thinking clearly, and numbness or tingling in the arms or around the mouth among the signs of hyperventilation, and says rapid breathing for the first time may be a medical emergency. A 2026 narrative review says even slow, deep breathing can cause acute dizziness and lightheadedness through lower carbon dioxide and reduced blood flow to the brain; these effects are usually brief but can be upsetting for people with anxiety. The same review lists feeling about to faint, chest pain, palpitations and new neurological symptoms as red flags for stopping at once. Health agency guidance and narrative review ^{31 25}
Never practise breath-holding or fast breathing in or near water, or while driving. A CDC report reviewed 16 drownings in New York State (1988 to 2011) linked to dangerous underwater breath-holding behaviours. It was prompted by two healthy young men who lost consciousness underwater after deliberately hyperventilating before submerging and died in a regulated swimming facility. A review of breath-hold diving says hyperventilation is one of the mechanisms of low oxygen and loss of consciousness, and that deaths are concentrated in less well-trained recreational divers. A case report describes a diver who lost consciousness during unsupervised dry breath-holding after hyperventilation and then had severe low oxygen and lung fluid. Breathing practices that cause dizziness or faintness also make it unsafe to drive or operate machinery; no source read tests driving directly, so that last point is the compiler's inference from the reports of dizziness and fainting. Public health case review, narrative review, case report ^{4 18 27}
Fast breathing with breath holds (Wim Hof, holotropic and similar styles) carries real risks for some people. A 2026 narrative review says people with epilepsy, panic disorder or psychotic disorder are more vulnerable to breathing manipulation, that high-ventilation practices should be avoided in epilepsy, panic disorder and significant heart or lung disease, that pregnant people and people with pheochromocytoma should avoid high-ventilation and breath-hold protocols, and that pheochromocytoma is an absolute contraindication because of the risk of a blood pressure crisis. It adds that fast breathing can bring back traumatic memories in people with acute stress, and rarely causes hallucinations. A consumer health page on holotropic breathwork also lists high blood pressure, heart disease, glaucoma, retinal detachment, osteoporosis and seizure disorders. No controlled study read measured how often these harms happen. Narrative review and consumer health page ^{25 30 11}
Gentle, slow breathing is described as low risk for most people. The 2026 narrative review calls gentle slow breathing at about six breaths a minute, with natural breath size, low risk for most healthy adults. The heart rate variability review expects few adverse effects, and the 73-trial lung review found no breathing-technique adverse events. But safety was reported in only 18.75 percent of diaphragmatic-breathing trials, and NCCIH notes that relaxation techniques occasionally bring more anxiety, intrusive thoughts or fear of losing control, and rare reports of worsening in people with epilepsy, certain psychiatric conditions or a history of abuse or trauma. Narrative review, systematic reviews and health agency guidance ^{25 16 5 15 32}

Side effects 6

Effect	How often	Severity and recovery	Evidence
Dizziness, lightheadedness, tingling and numbness Caused by low carbon dioxide and reduced blood flow to the brain.	Frequency not reported in the sources read.	Usually mild and brief Usually settles when normal breathing returns	Narrative review and health agency page ^{25 31}
More anxiety, panic-like sensations or fear of losing control Palpitations and tingling from breathing can feel like the start of a panic attack.	Occasional, according to NCCIH; no rate given.	Can be distressing Not stated	Health agency guidance and narrative review ^{32 25}
Intrusive traumatic memories, detachment, altered states and (rarely) hallucinations during fast breathing Higher concern with a trauma history or psychotic illness.	Described as rare; no rate given.	Not graded Not stated	Narrative review ^{25 11}
Loss of consciousness and drowning after hyperventilating before breath-holding Practising more than one of these behaviours raised the risk of death in that small sample.	16 cases in a New York review of 1988 to 2011, including two deaths of healthy young men in one incident.	Can be fatal Not reversible if drowning occurs	Public health case review ^{4 18}
Severe low oxygen and lung fluid after unsupervised dry breath-holding with hyperventilation A nose clip was thought to have interfered with resuming breathing after fainting.	One case report.	Serious Recovery described after hospital care	Case report ²⁷
Short spells of low carbon dioxide and low oxygen with a large adrenaline surge in cyclic hyperventilation with breath retention This is the body response the Wim Hof style of breathing produces; it is the reason sources advise caution with heart disease, epilepsy and pregnancy.	Seen in the trained group of a 24-person trial.	Not graded; healthy volunteers only Temporary	Randomised trial (laboratory findings) ¹⁴

Medicines and supplements 3

With	Why it matters	Importance	Evidence	What to do
Blood pressure medicines prescription	No mechanism found.	No interaction study was found. Slow breathing lowered blood pressure a little in pooled trials, so people on medicines might see their readings change; the trials did not test this. NCCIH says people with high blood pressure should follow their prescribed plan and discuss complementary approaches with their provider.	Absence of evidence and health agency guidance Not enough evidence ^{32 6}	Absence of a study is not proof of safety. Tell your doctor or pharmacist about any breathing practice if you take blood pressure medicines, and do not change medicines because of it.
Asthma and COPD medicines prescription	No mechanism found.	The asthma Cochrane review studied breathing exercises alongside usual care and did not look at side effects. No source read says breathing exercises can replace inhalers or other lung medicines.	Absence of evidence Not enough evidence ^{23 5}	Keep taking prescribed lung medicines and ask your care team before starting a breathing practice.
Other medical treatment other-treatments		NCCIH advises anyone with severe or long-lasting symptoms to see a health care provider and says relaxation techniques should not replace care.	Health agency guidance Not enough evidence ³²	Tell your doctor or pharmacist about all treatments you use.

Who should check first 10

Situation	Advice	Evidence
Epilepsy or a seizure history	The 2026 review says people with epilepsy are more vulnerable to breathing manipulation and that high-ventilation practices should be avoided. NCCIH reports rare worsening of symptoms in people with epilepsy. A consumer holotropic breathwork page lists seizure disorders. Ask a neurologist before any fast breathing.	Narrative review and health agency guidance ^{25 32 30}
Panic disorder, or fear of breathing sensations	The review says people with panic disorder are more vulnerable to breathing manipulation and should avoid high-ventilation practices. Slow breathing can still be taught in clinics, as the capnometry trials show, but under a clinician.	Narrative review ^{25 20}
Psychosis, severe mental illness, or trauma and abuse history	The review says people with psychotic disorder are more vulnerable and that people with acute stress may relive traumatic memories during hyperventilation. NCCIH reports rare worsening in certain psychiatric conditions and in people with a history of abuse or trauma. The holotropic page lists psychosis and severe mental illness. A clinician should be involved.	Narrative review, health agency guidance and consumer health page ^{25 32 30}
Heart disease, high blood pressure, aneurysm or stroke history	The review says people with significant cardiovascular disease (including malignant high blood pressure, arrhythmias, ischaemic heart disease, aneurysms and heart failure) or cerebrovascular disease should practise only under close medical supervision, and approach breath holds with caution. The consumer page lists angina, heart attack, high blood pressure and a family history of aneurysms.	Narrative review and consumer health page ^{25 30}
Lung disease (COPD, asthma)	The review says people with respiratory conditions such as COPD should practise only under close medical supervision. Pursed-lip and diaphragmatic breathing are used in lung rehabilitation, and the lung review found no adverse events from them, but ask your care team.	Narrative review and systematic review ^{25 5}
Pregnancy and breastfeeding	The review says pregnant people should avoid high-ventilation and breath-hold protocols, while gentle slow-paced breathing may be appropriate under medical guidance. The holotropic page says it is not recommended in pregnancy or breastfeeding.	Narrative review and consumer health page ^{25 30}
Pheochromocytoma (an adrenal gland tumour)	The review calls pheochromocytoma an absolute contraindication for high-ventilation and breath-hold practices, because of the risk of a blood pressure crisis.	Narrative review ²⁵
Glaucoma, retinal detachment, osteoporosis, or recent injury or surgery	These come only from a consumer health page on holotropic breathwork, which says to talk to a doctor first. No research source read explains the reasons, so none is offered here.	Consumer health page ³⁰
Pacemaker or conditions causing acidosis, with biofeedback-guided slow breathing	The review says resonance-frequency biofeedback needs caution in people with pacemakers or conditions that cause metabolic acidosis.	Narrative review ²⁵
Water, driving, heights and machinery	Breath-holding and fast breathing near or in water have caused deaths. Sources describe dizziness and fainting from over-breathing, so any practice that causes them is unsafe at the wheel, at heights or around machinery (the last point is the compiler's inference).	Public health case review and compiler's inference ^{4 18 27}

Overdose, product quality and regulators

Body	Action	Date
National Center for Complementary and Integrative Health (NCCIH, part of the US National Institutes of Health) (United States)	Says relaxation techniques, including slow deep (diaphragmatic) breathing, are generally considered safe for healthy people, that most studies report no negative effects, that occasional people report more anxiety, intrusive thoughts or fear of losing control, and that there are rare reports of worsening in people with epilepsy, certain psychiatric conditions or a history of abuse or trauma. Advises people with high blood pressure to follow their treatment plan and discuss complementary approaches with their provider. source	2021-06
MedlinePlus (US National Library of Medicine) (United States)	Lists lightheadedness, dizziness, weakness, trouble thinking, and numbness or tingling in the arms or around the mouth as signs of hyperventilation; says rapid breathing for the first time may be a medical emergency requiring the emergency room. source	2024-07-23
US Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report) with New York health departments (United States)	Reports that hyperventilating before breath-holding underwater is linked to unconsciousness and drowning, names these behaviours 'dangerous underwater breath-holding behaviors', and says New York City enacted education and regulations to discourage them. source	2015-05-22

When to get medical help

Anyone who passes out, has a seizure, or cannot be woken after a breathing practice: call emergency services.
Anyone who loses consciousness in or under water: get them out and call emergency services at once.
Chest pain, palpitations, feeling about to faint, or new weakness, numbness, speech or vision changes during practice: stop and seek medical help (the review's red flags).
Rapid breathing for the first time with no clear cause: MedlinePlus says this may be a medical emergency.
Dizziness or tingling that does not settle quickly after returning to normal breathing, or panic that keeps rising: stop the practice and speak with a doctor.

Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What is breathwork?

It means deliberately changing the pace, depth or pattern of breathing. Reviews use it for slow paced breathing, diaphragmatic (belly) breathing, pranayama and faster styles such as holotropic or Wim Hof breathing.

^{25 15}

Can slow breathing lower blood pressure?

Three pooled analyses found modest falls in blood pressure, but trials were small and varied. Blinded trials of a guiding device found no significant effect against a sham device or music. It has not been shown to replace blood pressure medicines; ask a doctor.

^{6 13 8 19 17}

Does breathwork help with stress and anxiety?

A pooled analysis of 12 trials found a small fall in self-rated stress, with small effects on anxiety and low mood, mostly in healthy or mildly stressed adults. The authors warn that hype may be ahead of the evidence.

^{10 1}

Does breathing before bed help sleep?

A 2026 review of 9 studies found better self-rated sleep after slow breathing before bed, but wrist-monitor and sleep-lab results were inconclusive.

⁹

Do breathing exercises help asthma?

The Cochrane review of 22 trials found probably better quality of life and fewer over-breathing symptoms, with unclear effects on asthma control and lung function. A 2026 analysis found a small control gain with the Buteyko technique. They are an addition to prescribed treatment, not a replacement.

^{23 28}

Do they help COPD?

A review of 73 trials found pursed-lip and diaphragmatic breathing slightly eased breathlessness, below the size patients notice, and consistently improved quality of life. A separate review found diaphragmatic breathing inconsistent in COPD. Ask your care team.

^{5 15}

Can breathwork treat panic or post-traumatic stress?

Not proven. One 37-person trial and one uncontrolled study of a clinic-supervised, carbon dioxide-guided programme reported big drops in panic severity, and two small veteran trials of a breathing-based group programme reported lower trauma scores. Certainty is low to very low. Fast breathing can itself trigger panic or bring back traumatic memories.

^{20 26 24 2 25}

Is breathwork safe?

Gentle slow breathing is described as low risk for most healthy adults. Fast breathing, long breath holds and breath-hold diving are a different matter: sources describe dizziness, tingling, fainting, and in water, blackout and drowning.

^{25 4 31}

Who should avoid fast breathing styles?

A 2026 review says people with epilepsy, panic disorder or psychotic disorder are more vulnerable, that those with significant heart, brain-vessel or lung disease should only practise under close medical supervision, and that pregnant people and people with pheochromocytoma should avoid high-ventilation and breath-hold protocols. Ask a doctor first.

^{25 30}

Is it safe to practise near water or while driving?

No. Hyperventilating before holding the breath has caused loss of consciousness and drowning, including two healthy young men in one New York incident. Breathing that causes dizziness or faintness is also unsafe at the wheel; no source read tests driving, so that is the compiler's inference.

^{4 18 27}

When should I stop?

The 2026 review lists feeling about to faint, chest pain, palpitations and new neurological symptoms as red flags. MedlinePlus says rapid breathing for the first time may be an emergency. Anyone who passes out or has a seizure needs emergency help.

^{25 31}

Can breathwork replace medical treatment?

No. NCCIH says relaxation techniques are generally safe for healthy people but that people with severe or long-lasting symptoms should see a provider, and that people with high blood pressure should follow their treatment plan and discuss complementary approaches with their provider.

³²

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-31
Last substantive update: 2026-10-31
How we research: We searched PubMed, re-read the abstract of every review and trial cited, read the full text of the 2026 safety review through Europe PMC, and read the NCCIH, MedlinePlus and Healthline pages through a tool that summarises pages. Certainty ratings are the compiler's own reading, except where a review gives its own GRADE (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown.

Sources 32

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

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Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.