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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 69 Breathing Rehabilitation Exercises A foundational focus on full exhalation characterizes successful breathing retraining.1 It is not possible or desirable to focus on "how to inhale," unless and until the ability to exhale fully is achieved. (Note: be mindful of scope of practice in your state as it relates to initiating these exercises.) Antiarousal Pursed-Lip Breathing Pursed-lip breathing, combined with diaphragmatic breathing, helps to achieve a "full exhale," and also enhances pulmonary efficiency. 2 • The client is asked to sit or recline and to exhale slowly, and as fully as is comfortably possible, through pursed lips. • While exhaling, a candle flame about 6 inches from the mouth may be visualized with the exhalation sufficient to flicker the flame but not blow it out. • Exhalation should continue until the first sign of a need to inhale. • During exhalation, a slow, silent count is suggested to establish the length of the out breath. • At the end of the pursed-lip exhalation, without strain, a 1-second pause is suggested, followed by inhalation through the nose. • Without pausing to hold the breath, the next slow and full exhalation follows, through pursed lips, blowing the air in a thin stream, followed by a pause for a count of one, and then nasal inhalation. • The inhalation and exhalation sequence should be repeated approximately 30 times, morning and evening. • After some weeks of daily practice, the inhalation phase should be found to comfortably last 2–3 seconds, and the exhalation phase 4–5 seconds, without strain. • Exhalation should always be slow and continuous; there is little value in breathing the air out rapidly and then simply waiting before inhaling again! • Over a period of weeks, feelings of anxiety should diminish and other fibromyalgia symptoms will lessen. NOTE: When beginning to practice slow, pursed-lip breathing, carbon dioxide (CO2) tolerance might be very low, and can result in: a. Feelings of increased anxiety/panic after just a few cycles of inhalation- pause-slow-pursed-lip-exhalation. If this happens, the exercise should stop and be briefly tried again later that day. Over time (perhaps after weeks of repetition), as CO2 tolerance increases, this sensation will disappear. b. After the breathing exercise, a feeling of light-headedness may be experienced due to increased oxygen reaching the brain. If this happens, the advice is to sit quietly for a few minutes until it passes. Breath-Holding Test At least once a week, test the breath- holding time.3 As the weeks pass, and CO2 tolerance increases, the comfortable breath-holding period should gradually increase. Notes 1. G. Fregonezi, V. R. Resqueti, and R. Güell Rous, "Pursed Lip Breathing," Archivos de Bronconeumología (English Edition) 40, no. 6 (2004): 279–82. 2. V. Busch et al., "The Effect of Deep and Slow Breathing on Pain Perception, Autonomic Activity, and Mood Processing—An Experimental Study," Pain Medicine 13, no. 2 (February 2012): 215–28; L. McLaughlin, C. H. Goldsmith, and K. Coleman, "Breathing Evaluation and Retraining as an Adjunct to Manual Therapy," Manual Therapy 16, no. 1 (February 2011): 51–2. 3. R. Courteney, "The Buteyko Method— An Osteopathic Approach to Asthma?" Osteopathy Today (August 2002): 16–19.