Pranayama and breathing exercises: how to practise them safely

This review describes pranayama, what official sources say about slow breathing exercises, and how to practise them safely.

1. Introduction

Pranayama is the breathing part of yoga. The Ministry of Ayush lists it as one of the eight limbs of yoga, the one that regulates the breath ^[1]. The US NIH centre NCCIH notes that yoga as usually taught in the United States emphasises postures, breathing techniques and meditation ^[3].

Official pages do not give detailed instructions for specific pranayama methods. The Ayush page on yoga gives no further detail on pranayama or precautions ^[1]. For this reason, this article focuses on slow, gentle breathing, which NCCIH and the NHS describe, and on safety.

2. What a simple breathing exercise looks like

NCCIH describes breathing exercises as slow, deep breaths, also called diaphragmatic breathing, meant to trigger the body's relaxation response, which is the opposite of the stress response ^[2]. The NHS describes a simple method for stress, anxiety and panic that takes only a few minutes ^[4]:

1. Sit supported in a chair, stand, or lie down, and loosen tight clothing.
2. Let the breath move deep into the belly without forcing it.
3. Breathe in gently and steadily through the nose, and out through the mouth.
4. Counting from 1 to 5 may help, though you may not reach 5 at first.
5. Carry on for at least 5 minutes.

The NHS suggests doing it regularly as part of your daily routine ^[4].

3. What research suggests

NCCIH summarises the findings with clear cautions ^[2]:

• Blood pressure: A 2019 review of 17 studies found a modest drop with slow breathing exercises. The studies varied, had short follow-up and a high risk of bias, and none measured outcomes such as stroke or heart attack.
• Stress: A 2019 review of 3 studies found preliminary evidence that diaphragmatic breathing may reduce stress.
• Hot flashes: A 2019 review of 4 studies suggested paced breathing may improve hot flashes in menopause.
• Irritable bowel syndrome: One small study combined breathing with muscle relaxation. A single small study gives limited evidence.

These findings do not show that breathing exercises treat any disease.

4. Safety and side effects

NCCIH says relaxation techniques are generally considered safe for healthy people, and most studies reported no negative effects ^[2]. Occasionally people report increased anxiety, intrusive thoughts or fear of losing control ^[2]. Rare reports suggest some relaxation techniques may cause or worsen symptoms in people with epilepsy, certain psychiatric conditions or a history of abuse or trauma ^[2].

For yoga breathing, NCCIH advises beginners to avoid forceful breathing ^[3]. It also lists severe high blood pressure and glaucoma among conditions that may need changes to yoga practice ^[3]. If a breathing exercise makes you feel more anxious or distressed, stop and return to normal breathing, and talk with your doctor.

5. Using breathing exercises with medical care

NCCIH advises people with high blood pressure to keep following their prescribed treatment plan and to discuss breathing exercises with their provider first ^[2]. People with severe or long-lasting symptoms should see a provider ^[2]. People with persistent depression or anxiety should seek help from a qualified health professional ^[2]. Discuss any complementary approach you use with your doctors ^[2].

6. Getting started sensibly

The NHS says a simple breathing exercise can be done anywhere, in a few minutes, and that regular practice as part of a daily routine gives the most benefit. It suggests standing, sitting in a supportive chair, or lying on a bed or yoga mat with arms slightly away from the sides and palms up ^[4]. Keep the feet about hip-width apart and loosen tight clothing ^[4]. The NHS tells readers not to force the breath and to let it move deep into the belly ^[4].

NCCIH says one 2019 review found a modest blood pressure reduction with slow breathing and that it may be a reasonable first treatment for prehypertension or low-risk high blood pressure, but the studies varied, had short follow-up and had a high risk of bias ^[2]. NCCIH adds that people with high blood pressure should follow their prescribed treatment plan, because this prevents or delays serious complications ^[2]. Only a doctor can decide whether slow breathing is suitable for you.

The Ayush yoga page does not describe individual breathing methods, so if you want to learn traditional pranayama, find a qualified teacher who can explain each method, teach it step by step and adapt it to your health ^[1]. Beginners should avoid forceful breathing, because NCCIH advises against it ^[3]. Ask a qualified teacher and your doctor whether any method is suitable for you.

7. When to see a doctor

Get emergency help straight away if you have severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to the arms, back, neck or jaw, lips or skin turning very pale, blue or grey, or sudden confusion ^[5]. Get emergency help too if you have heart palpitations that do not go away, or palpitations with chest pain, shortness of breath or feeling faint or fainting ^[6]. Seek urgent advice if you are more short of breath than usual or have palpitations ^[5].

Seek advice before practising if you have high blood pressure, epilepsy, a psychiatric condition or a history of abuse or trauma ^[2]. Do not delay care for a medical problem in order to practise yoga ^[3].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Pranayama is the breathing limb of yoga. Slow, gentle breathing is generally safe for healthy people and may help with stress, but the research is limited and these exercises are not a treatment for disease. Beginners should avoid forceful breathing, and people with health conditions should first speak to their doctor and a qualified teacher.