Types Of Breathing Exercises In Physiotherapy

Breathing is nothing but the movement of air into and outside the lungs. Apart from simply moving in and out of the air, breathing involves gaseous exchange, which is the transport of oxygen and carbon dioxide which takes place within small sac-like structures present in the lungs called the Alveoli. In this article, you can know the different types of breathing exercises in physiotherapy and can also know the procedure to the breathing exercises.

What Is Breathing Exercise?

Breathing exercises can be defined in the following ways;

• Breathing exercises can be defined as those which enhance the respiratory system function by improving ventilation, strengthening respiratory muscles, and increasing endurance.
• It is an exercise that is intended to promote healthy and effective breathing and control of breathing.

Breathing exercises are often employed in yoga and physiotherapy since they are known to improve blood flow and circulation and calm the nerves. In physiotherapy, breathing exercises are frequently combined with postural drainage, medications, and graded exercise programs based on each patient’s clinical presentation.

Breathing exercises in physiotherapy are utilized in the following cases;

• Acute respiratory illnesses like bronchitis, pneumonia
• Chronic respiratory illnesses such as Chronic Obstructive Pulmonary Diseases (COPD), interstitial lung diseases, bronchial asthma, etc.
• Pain in the abdomen or thoracic region due to recent injury or surgery
• Central nervous system deficits leading to muscular weakness
• Severe structural or orthopedic abnormalities
• Stress management and relaxation

Benefits of Breathing Exercises In physiotherapy

• Improves ventilation and circulation
• Improves the effectiveness of cough
• Prevents complications related to the respiratory system
• Maintains or improves the mobility of the thoracic spine
• Improves the strength and coordination of respiratory muscles
• Promotes Bronchial Hygiene – Mobilization of secretions and prevents the accumulation of secretions
• Corrects abnormal breathing patterns and reduces the work of breathing
• Promotes relaxation, improves concentration, and relieves stress

Types Of Breathing Exercises In Physiotherapy

The following are the three types of breathing exercises in physiotherapy where you can also know the procedure of breathing exercises;

1. Diaphragmatic Breathing Exercises

• The diaphragm is the primary muscle for breathing in (inspiration). The diaphragm also controls breathing at the subconscious level.
• Patients suffering from chronic lung infections such as chronic obstructive pulmonary disease (COPD) can be trained to control their breathing by using the diaphragm optimally and minimize the use of accessory muscles of respiration.
• Diaphragmatic breathing exercises can also be used for mobilization of pulmonary secretions.

The Procedure Of Diaphragmatic Breathing Exercises

• The therapist will let the patient rest in a semi-Fowler's position that is head and trunk raised to 15-45 degrees angle.
• The therapist may ask the patient to stop any accessory muscle movements if he/she notices any.
• The therapist will then place his hands over the abdomen and will ask the patient to breathe slow and deep through the nose keeping the shoulders relaxed and allowing the upper abdomen to rise. The patient will then be asked to exhale through the mouth (controlled expiration).
• The patient will be instructed to follow this technique at least 2-4 times a day.
• For the purpose of self-monitoring, the patient should place his/her hand over the upper abdomen to feel the rise and fall movement or contraction of abdominal muscles which occurs during controlled expiration or coughing.
• Once the patient understands this technique, he/she will be able to carry out controlled breathing in various other positions such as standing, sitting, or even during activities.

Resisted Diaphragmatic Breathing

• The physiotherapist uses a sandbag or a small weight to strengthen the diaphragm.
• The patient is asked to lie down in a semi-Fowler's position and a small weight is placed over the epigastric region of the abdomen.
• The patient is asked to breathe deep without moving the chest. The weight is gradually increased as the patient breathes against the resistance of that weight.

2. Segmental Breathing Exercises

This type of breathing is performed on a segment of a lung or a particular section of the chest wall which needs enhanced movement or ventilation. This type of breathing exercise is particularly effective in cases where there is hypoventilation in a section of the lung due to pain after some surgery, pneumonia, or injury or trauma to that particular section of the chest wall.

Advantages Of This Type Of Breathing Include

Helps to prevent the accumulation of pulmonary secretions or pleural fluids

Improves chest mobility

Reduces panic

Types of Segmental Breathing Exercises

a) Lateral Coastal Expansion

The patient is asked to be seated in a relaxed and comfortable position. This breathing exercise can be performed in a seated or a lying down position.

The patient is asked to breathe in and out and also asked to feel the rib cage move downward and inward.

Slight resistance is applied to the lower ribs as the patient breathes in and deep and as the chest expands.

This maneuver can be performed by the patient himself with the help of a towel around the rib cage when breathing in and out by gently squeezing the ribs downward and inward.

b) Posterior Basal Expansion

This type of breathing exercise is performed in patients post-surgery or those who have been bedridden for a long period of time due to which pleural secretions tend to accumulate in the posterior side of the lower lobes of the lungs.

The patient is asked to sit and lean forward on a pillow.

A similar procedure is done as in lateral coastal expansion, except in this, the physiotherapist applies resistance on the posterior part of the lower ribs.

3. Pursed Lip Breathing Exercises

This method involves tightly closed lips during controlled exhalation. Advantages of pursed-lip breathing exercises for patients with chronic obstructive pulmonary diseases (COPD) are;

• It helps them to deal with episodes of breathlessness.
• These exercises help in releasing trapped air from the lungs and improve ventilation.
• This breathing exercise keeps the airway open for a longer time and prolonged exhalation slows down the respiratory rate.
• This method also allows old or trapped air to move out of the lungs and allows new air to enter into the lungs.
• This method can be used as a “rescue exercise” to deal with and also effectively manage acute episodes of breathlessness as in bronchial asthma or COPD.

Procedure For Pursed Lip Breathing Exercise

The patient is asked to be seated in a comfortable and relaxed position and the method is explained to the patient beforehand (relaxed and passive expiration phase).

Throughout the exercise training, the physiotherapist will place the hand over the patient’s abdomen to check for any abdominal contractions. Abdominal contractions must not be present during the entire exercise.

The patient is asked to breathe in slow and deep through the nose.

This is followed by gently breathing out through tightly pursed lips. A candle is placed in front and the air breathed out must be blown on and should be able to bend the candle’s flame.

When a little more resistance is provided, a positive pressure will be created which will open up smaller bronchioles that otherwise remain in a collapsed position in patients with COPD.

4. Glossopharyngeal Breathing Exercises

This type of breathing pattern increases the patient’s inspiratory capacity when the muscles of inspiration have become severely weak. This type of breathing is taught to patients who face difficulty in deep breathing.

Procedure For Diaphragmatic Breathing Exercises

• The patient is supposed to gulp air, closing the mouth pushing the air into the throat, and into the lungs.