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Research Matters Several studies on breathing exercises demonstrate that techniques such as diaphragmatic breathing (see page 101) can help a diverse group of clients meet health-care goals, as long as the technique is practiced regularly. In one study, asthmatic adults who practiced diaphragmatic breathing exercises experienced a significant reduction in the amount of medication they needed and a lower intensity of their symptoms. This reduction in symptoms led to increased physical activity, which improved overall health. Unfortunately, most participants decreased their practice of diaphragmatic breathing after the study concluded, and relapsed into sedentary habits, returning their medication needs to previous levels.1 Another study showed that diaphragmatic breathing Photos courtesy of Lippincott Williams & Wilkins. Pursed-Lip Breathing Pursed-lip breathing tones and strengthens the diaphragm and helps to reeducate the client's kinesthetic sense of breath. When the client exhales with taut lips (imagine the lips closing around a straw), this creates resistance for the diaphragm. The diaphragm contracts on the inhalation and relaxes on the exhalation. Pursed- lip breathing keeps the diaphragm working at the same time that it is relaxing. Use this technique at the opening or closing of the massage session with the client in a supine position or sitting up in a chair. As with diaphragmatic breathing, communication skills are important as you coach the client through pursed-lip breathing. After obtaining permission, place your hand on your client's abdomen, and instruct the client to raise your hand with each inhalation by breathing in through the nose on a slow 2–4 second count. Demonstrate the pursed-lip position of the mouth for the client, and instruct the client to exhale through the lips on a slow 4–8 second count. The client should exhale through the lips as slowly as possible. Practice the technique a few times. Clients can practice pursed-lip breathing 20–40 times, twice a day, at home. lowered blood pressure as long as it was practiced regularly.2 Patients with anxiety disorders and panic attacks found that the diaphragmatic breathing exercise helped them experience less fear, fewer cognitive symptoms, and fewer catastrophic thoughts during an attack, and the technique sometimes served as an intervention to prevent an attack.3 Finally, patients suffering from chronic low-back pain improved significantly with breath therapy (a variety of techniques were taught, including pursed-lip breathing and diaphragmatic breathing). This study reports that "changes in standard low-back pain measures for pain and disability were comparable to those resulting from high-quality, extended physical therapy." Again, the regular practice of these methods was important for continued benefit.4 Notes 1. M. Girodo, K.A. Ekstrand, G.J. Metivier, "Deep Diaphragmatic Breathing: Rehabilitation Exercises for the Asthmatic Patient," Archives of Physical Medicine and Rehabilitation 73, no. 8 (August 1992): 717–20. 2. J.S. Lee et al., "Effects of Diaphragmatic Breathing on Ambulatory Blood Pressure and Heart Rate," Biomedicine & Pharmacotherapy 57, no. 1 (October 2003): 87–91. 3. G.H. Eifert, M. Heffner, "The Effects of Acceptance Versus Control Contexts on Avoidance of Panic-Related Symptoms," Journal of Behavior Therapy and Experimental Psychiatry 34 (September–December 2003): 293–312. 4. W.E. Mehling et al., "Randomized, Controlled Trial of Breath Therapy for Patients with Chronic Low-Back Pain," Alternative Therapies in Health and Medicine 11, no. 4 (July–August 2005): 44–52. 102 massage & bodywork july/august 2012