Key takeaways
- The diaphragm is the large, dome-shaped muscle at the base of the lungs; diaphragmatic breathing makes it do the work, so the belly rises on the inhale.
- The classic check: one hand on the chest and one on the belly; the belly hand should move while the chest hand stays still.
- Cleveland Clinic suggests starting lying down, then progressing to sitting, for five to ten minutes three or four times a day.
- A small 2017 trial linked eight weeks of training with lower negative affect and cortisol; a 2019 review found only three eligible studies.
- Cleveland Clinic advises people with COPD, asthma or anxiety to ask their healthcare provider whether the technique is right for them.
Diaphragmatic breathing, also called belly breathing, means breathing so that the diaphragm does the work: one hand on your chest and one on your belly, the belly rises as you breathe in while the chest stays as still as possible. This guide explains how to practise it, using guidance from Cleveland Clinic and NHS inform, and what research has found.
What the diaphragm does
Cleveland Clinic describes the diaphragm as a large, dome-shaped muscle at the base of the lungs, and calls it the most efficient muscle for breathing; the abdominal muscles help move it and give you more power to empty the lungs. Diaphragmatic breathing is about using that muscle deliberately, which, Cleveland Clinic explains, decreases the work of breathing by slowing your breathing rate.
How to practise lying down
Cleveland Clinic suggests learning lying down, because it is easier:
- Lie on your back on a flat surface or in bed, with your knees bent and your head supported. A pillow under the knees can help.
- Place one hand on your upper chest and the other just below your rib cage, so you can feel the diaphragm move.
- Breathe in slowly through your nose, so your stomach moves out against your hand. The hand on your chest should stay as still as possible.
- Tighten your stomach muscles as you breathe out through pursed lips, so your stomach moves back in. Again, the chest hand stays still.
How to practise sitting
With practice, the same exercise works in a chair. Sit comfortably with your knees bent and your shoulders, head and neck relaxed, put your hands in the same places, and repeat the steps. NHS inform's version for stress, anxiety and panic is similar: one hand on the tummy and one on the chest, a slow, deep breath in through the nose, then a slow, gentle breath out through pursed lips. When you breathe in, you want your tummy to get bigger, moving your tummy but not your chest. It suggests counting steadily from 1 to 5 on each breath in and out if that helps, adding that you may not reach 5 at first.
Session length and frequency for belly breathing
The two sources suggest different starting doses:
| Source | Session length | How often |
|---|---|---|
| Cleveland Clinic | 5 to 10 minutes | About 3 to 4 times a day at first |
| NHS inform | 3 to 5 minutes | Build up the length over time |
A worked example. Cleveland Clinic's starting range works out at 15 minutes a day at the low end (three sessions of five minutes) and 40 at the high end (four sessions of ten). A single NHS-style session of three to five minutes is a gentler way in. Cleveland Clinic warns that using the diaphragm correctly takes effort at first and that you will probably tire, but that with continued practice it becomes automatic.
What a 2017 trial and a 2019 review found
The evidence is limited. In a 2017 trial in Frontiers in Psychology, 40 healthy adults were randomly assigned to either diaphragmatic-breathing training or a control group. The training group did 20 sessions over eight weeks, using a real-time feedback device and breathing at an average of four breaths a minute. Compared with their own baseline, the training group showed a significant decrease in negative affect and increase in sustained attention, and had lower cortisol, a stress hormone, after training, while the control group's cortisol did not change significantly. The authors concluded that diaphragmatic breathing "could improve" sustained attention, affect and cortisol levels in healthy adults.
A 2019 systematic review of diaphragmatic breathing for stress in adults found only three studies that met its criteria: one randomised controlled trial and two quasi-experimental studies. All three reported reduced stress, but the reviewers could not pool the results because the studies differed too much, and they noted limitations such as small sample sizes. The reviewers concluded that the evidence suggests diaphragmatic breathing may decrease stress, and that ongoing research is needed to establish the evidence base. Slow breathing and relaxation puts this in the wider context of breathing research.
COPD, asthma and checking with a provider
Cleveland Clinic notes that conditions such as chronic obstructive pulmonary disease (COPD) may prevent the diaphragm from working effectively, and advises people with COPD, asthma or anxiety to talk to their healthcare provider about whether diaphragmatic breathing is right for them. It adds that the technique should not be the only treatment for any condition and should sit alongside whatever your healthcare provider recommends. This guide describes a relaxation practice, not a treatment. Stop and breathe normally if you feel dizzy or uncomfortable.
Belly breathing with a guide
For counted patterns with breath holds, see box breathing and 4-7-8 breathing. Kawaii Cute Breathe Relax Care, one of our health and nutrition apps, paces each breath with an animated guide, such as a cloud that grows as you inhale and shrinks as you exhale, and its store screenshots show equal breathing among its routines; the app guide explains them.
Good to know
Frequently asked questions
How do you do diaphragmatic breathing?
How can you tell if you are breathing from your diaphragm?
How often should you practise belly breathing?
Does diaphragmatic breathing reduce stress?
Sources
- Diaphragmatic Breathing Exercises & Benefits (opens in a new tab)Cleveland Clinic — accessed
- Belly breathing exercise (opens in a new tab)NHS inform — accessed
- The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults (Ma et al., Frontiers in Psychology, 2017) (opens in a new tab)PubMed — accessed
- Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review (Hopper et al., 2019) (opens in a new tab)PubMed — accessed
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