Breathing Exercises for Lung Resilience
By: Martha Theirl, Doctor of Physical Therapy, Jackie Shakar, Doctor of Physical Therapy, Michael Christoforo, Wim Hof practitioner
This month I’m excited to collaborate with Dr. Jackie Shakar, Physical Therapist at Central Mass Physical Therapy, and Michael Christoforo, a practitioner of the Wim Hof breathing method to discuss breathing techniques and how their implementation can facilitate lung and immune system function while potentially preventing and treating mild COVID-19 respiratory symptoms. The techniques that will be discussed and demonstrated in this blog can be easily implemented into one’s daily routine to optimize respiratory and immune system function.
SARS-CoV-2, commonly known as COVID-19 has become a household word these days. The new virus has stretched us to our limits both locally and globally. On the upside, the virus has also brought a wealth of collaboration and novel inventions. MIT is working on an open-source ventilator, new ways to decontaminate N95 respirators, and novel treatments for this virus and its many complications. Professionals in the healthcare and wellness fields are working tirelessly to develop and offer virtual telehealth sessions, educational webinars, and blogs for all interested parties. Group and individual exercise instructional classes are merely a click away!
One of the hallmark symptoms associated with COVID-19 is respiratory dysfunction. Symptoms of the virus may start out as a tightness in the chest or dry cough, and can progress to severe shortness of breath (dyspnea) and something called Acute Respiratory Distress Syndrome (ARDS). ARDS typically requires mechanical ventilation from 5-28 days and is a major reason why we may see a ventilator shortage associated with a spike in cases as the impact of COVID-19 continues to be experienced.
In the health and wellness worlds, we often speak about breathing and why it’s so important for our overall health and wellbeing. Functional breathing is a core foundation for any rehabilitation or fitness routine. Functional breathing consists of two phases, inspiration, and expiration. Inspiration is how our body takes in new oxygen to be distributed in our bodies, and expiration is how we get rid of waste products and deoxygenated air. The major muscle of breathing is the diaphragm and this magnificent and amazing muscle is assisted by the abdominal muscles (transverse abdominis, external and internal obliques).
In terms of a suggested “how-to”, functional breathing should incorporate the following:
Nasal Breathing: our noses were made for inspiration and our mouths were not! Our nasal passages are lined with cilia (small hairs) to clean and warm the air that we breathe.They also act as a filter to purify the air as it passes through. In addition, when we breathe through our noses, a gas, nitric oxide is released that improves our ability to take in oxygen. These important effects do not occur when we breathe through our mouths.
Resting Position of the mouth: We suggest resting the tip of your tongue in the roof of your mouth toward the back of the front teeth at all times unless you are speaking or eating. This tongue position optimally opens your airway and facilitates nasal breathing. The lips should be closed with teeth not touching when you are not speaking or eating to encourage a nasal breathing pattern.
Inspiration should not be forced and we should not use our neck or low back muscles to inhale. If you experience chronic tension in your neck and/or low back, dysfunctional breathing may be a root cause. The breathing techniques demonstrated in this blog may be helpful for you!
Pattern: We suggest a shorter 2-second inhalation followed by a 4-second exhalation. A pause between breaths is ideal. A longer exhalation removes deoxygenated air ridding the body of the waste products that are formed during respiration AND it facilitates activation of the abdominals. Just think, you can get the effects of doing situps simply by developing a longer and more effective exhalation!
Humming/Low Toned Vowel Sound: During the exhalation phase, create a low-toned vowel sound (or hum). Try to maintain this tone as long as you can to help remove all air from your lungs and activate your abdominals. The vibration that is created from this low tone humming stimulates your immune and parasympathetic nervous systems.
The benefits of functional breathing have been identified in the literature for healthy individuals, for a number of patient populations, and, even for performance athletes. Breathing techniques can help control anxiety and calm us down by activating our parasympathetic (restful) nervous system.
The breathing techniques discussed and demonstrated in this blog are suggestions to maintain and improve lung resilience. If you have mild respiratory issues, these techniques may also help to control and mitigate them. As a disclaimer, the following is not meant as medical advice. If you are experiencing symptoms, be sure to call your doctor and follow their advice. We have not done an evaluation for your specific case. COVID-19 is a novel virus and we don’t yet know the best treatments. While we are uncertain exactly how these techniques may impact COVID-19, we know they will not hurt you when done properly. As always, you should consult your healthcare practitioner for proper techniques and questions.
But first, some self assessment tools:
Hi-Lo Breathing
Hi-Lo Breathing is an assessment technique to help you to identify whether your breathing mechanics are less than ideal which can then transition into a drill that can help you to develop a more functional breathing pattern. We suggest that you try it first while lying down with your head, neck, and shoulders supported on a pillow and with your knees and legs supported as well. The purpose of this drill is to help you to identify whether your current breathing pattern utilizes upper chest mechanics (not preferred) vs. a diaphragmatic breathing pattern. Once you have mastered diaphragmatic breathing, we suggest that you try this drill daily as it is helpful in reducing stress/anxiety and it induces relaxation. It is often effectively done at night and right before bedtime.
Pinch Test
The pinch test helps identify places you may not be getting fully into. Once identified, it allows us to target those areas we find more difficult to breathe into during our exercise. Begin by placing your thumb on the bottom of your ribs on your back. Then place your middle finger of the same hand on your hip bone in front. Now take a deep breath in, and see if your thumb moves. Ideally, your thumb should expand outward showing that you have breathed into the back body, and all four points of contact should expand against your fingers simultaneously. The following video shows both a moving and nonmoving thumb.
Diaphragmatic Breathing
Often we think of this as “belly breathing” however it’s a bit more nuanced. Think of the lungs as a balloon. When you blow up the balloon it’s not just one side that expands, it’s all sides together. Your lungs work in a similar way but often we have a hard time breathing into the back of our lungs. So how do we test to see if we’re breathing into the back body?
To perform the diaphragmatic breathing, in either sitting or lying down do the following:
Place one hand over your belly button, the other hand over your chest
Breathe in deeply through your nose, trying to fill the entirety of the lower hand (this includes feeling the back press against the floor as you inhale to expand the backside of the lungs)
As you continue to inhale, feel the top hand rise evenly with the bottom hand
Breathe out through your mouth.
Expiration (breathing out) should be twice as long as inhalation (breathing in)
Perform 5-10 breaths then breathe normally for 5 breaths. Repeat 3-4 times.
Wim Hof
The Wim Hof breathing technique is deep rhythmic breathing that focuses on optimizing the energy systems of the body and is linked to decreased stress, improved breathing efficiency, and decreased inflammation. Typically done in groups of 15-30 rhythmic breaths followed by breath holding with some regular breathing in between bouts. Mike Christoforo, a Wim Hof practitioner is in the video below explaining how this works. You can find Mike’s website here where he has classes available to learn this process.
Stacked Breathing
This technique is used commonly in those who are unable to take a deep breath. It is helpful by allowing our lungs to take in oxygen and gives our lungs more time to get that oxygen into the bloodstream. It’s also been shown to increase cough effectiveness and oxygen capacity.
To perform, take a small to moderate amount of air in through the nose, then “sip” in 2-3 more breaths. Hold for 3s, then breath out through the mouth. Repeat 3-4 times, then resume normal breathing. You can repeat this a few times per day when you’re feeling a tightness in your chest or feel like you’re unable to get a deep breath.
Seated Alternating Reach, Breathe and Tone Technique
The following breathing drill is inspired by the Postural Restoration Institute.
Seated Alternating Reach, Breathe and Tone facilitates diaphragmatic breathing and chest expansion through the breath in all dimensions. The longer exhalation phase with humming facilitates immune system pumping while also stimulating the Vagus Nerve which is the driver for the parasympathetic (think rest and digest) nervous system. It is easy to perform yet helps with both respiratory, immune and parasympathetic nervous system function.
To perform, begin seated with knees higher than your waist. If sitting on the floor with knees up is difficult for you, you can sit on a chair and stack some books or an ottoman to raise your feet! On the inhale, stretch one hand behind you, thumb facing toward the floor. During your exhale, reach the opposite arm forward, with your thumb facing the ceiling. You may also add a vowel hum tone to the exhale to further build nitrous oxide and help to clear the mucous membranes.
Repeat 3-4 times before switching sides, taking 5 regular breaths between sides.
Pursed Lip Breathing
Do you find sometimes that your anxiety gets the better of you? That you’re having a hard time slowing your breathing or find your thoughts racing? Pursed lip breathing is a great technique to calm anxiety, improve gas exchange in the lungs, improve overall exercise tolerance, and decrease the use of accessory muscles (such as our neck muscles) while breathing.
This may be done in seated, standing, or lying down on your back. Take a deep breath into the bottom of your lungs through your nose. During exhalation, push air out of the mouth as if you’re blowing through a straw. Your exhalation should be twice as long as your inhalation. Repeat 5-8 times, then return to breathing normally.
Our breath is connected to our mental state, immune function, and general health. Optimizing our breathing and creating resilience in the lungs is a small but fundamental simple step toward our larger goals of fitness and health. We hope that by using these techniques you’re able to have a simple, daily check in with your own lung health and some ways to help improve it.
Be well. Be resilient to the finish.
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