When we work out, we obviously sweat, breathe deeply, and increase our heartrate. But, did you know that you can actually do exercises for breathing, rather than the other way around? Well, one of the best known types of breathing exercise is found in yoga. Yoga in the west is often seen as simply a series of postures. However, classical yoga usually involves a mixture of postures (asana), breathing (pranayama) and mindfulness of various forms (pratyahara and dharana). In this blog we take a look at yoga breathing exercises or Pranayama and see what they can do for us.

How we breath
Essentially, to breath we have two balloon like lungs encased in the drum shaped ribcage. To get air into and out of the lungs, we go through a sequence of movements called breathing mechanics. The drum which forms the chest consists of the backbone (spine) with curved, ‘U’ shaped ribs attached to it at the back and linked to the breastbone (sternum) at the front. The ribcage is smaller in its upper portion where the ribs get shorter towards the collarbones (clavicles) and larger at its lower portion. At the lower part of the chest, the floor of the drum is formed by a sheet of muscle (diaphragm) which essentially cuts through the middle of the body dividing it into the chest above and abdomen below.
When we breath, both the rib cage and abdominal wall move. As we breath in (inspiration) the diaphragm and ribcage muscles (intercostals) contract to expand the rib cage outward and draw the diaphragm down increasing the volume of the chest cavity – literally making the drum bigger. To breath out (expiration) the intercostal muscles relax, and the ribcage gets smaller again. If we force this breath out as in blowing up a balloon for example the diaphragm works harder, and additional chest muscles are used.


Breathing has several effects. Firstly, it provides us with oxygen which acts as a fuel for our muscles and brain. As the oxygen is used, waste carbon dioxide is produced which is released from the body as we breath out. The amount of carbon dioxide in the body is important because it has an effect on body acidity through a mechanism called the acid-base balance. Essentially, to adjust this balance and keep the chemical reactions of the body working well, we use the rate and depth of our breathing. Breathing is also linked to our autonomic nervous system (ANS) this is an extra part of our nervous system which controls our inner organs and the workings our body. Breathing can speed up or slow down these mechanisms, and hence breathing can have an effect on anxiety and relaxation.

breathing can have an effect on anxiety and relaxation.

The science of breathing
Three categories of breathing are commonly recognised, tummy (abdominal) breathing, costal (ribcage) breathing, and upper chest (apical) breathing. With abdominal breathing the diaphragm alone is active with little chest movement occurring during gentle breathing. This is generally thought to be the most efficient form of breathing with the diaphragm creating up to 80% of the work of inspiration at a cost of less than 5% of the body’s energy. Costal breathing occurs as the lower ribs flare out, the so-called bucket handle movement of the rib cage. Apical breathing sees the ribs moving upwards and forwards in the so-called pump handle movement of the rib cage. Apical breathing is the least efficient mechanism and is seen when people breath excessively (hyperventilation) and this can use as much as 30% of body energy, while taking in less air that the other methods.
Several factors are involved in breathing, and so pranayama can have a variety of effects. It can be used for medical conditions effecting the lungs (respiratory conditions) such as asthma, and COPD (chronic obstructive pulmonary disease) or simply to clear the air passages (sinuses and bronchi) after a bout of flu. Because of the effect of breathing on the autonomic nervous system, pranayama can also be used to relax the body and help relax the mind in conditions such as anxiety and depression. Several scientific studies support its use. For example, looking at asthmatic patients, pranayama practiced for 15 minutes twice daily for a two week period has been shown to improve respiratory measures (forced expiratory volume, peak flow rate, and inhaler usage) compared to a control group (Singh et al 1990). Favourable respiratory changes (oxygen saturation) have also been shown in patients with COPD during a 30-minute yoga breathing session (Pomidori et al 2009). Both yoga poses (asana) and yoga breathing (pranayama) have been shown to reduce stress levels by increasing the effect of the autonomic nervous system (Sengupta 2012). In addition, yoga breathing exercises have been shown to be as effective as mechanical inspiratory threshold training (a type of training where you take deep breaths in against resistance) when training seniors (Iranzo et al 2014).

From Norris, C.M. (2015) Complete guide to Back Rehabilitation. Bloomsbury

Beginning practice
Several factors can be worked on during Pranayama to have an effect. Firstly, the mechanics of breathing can be affected by practicing yoga postures to help expand the ribcage, loosen off the shoulders, and enable the upper spine (thoracic region) to move fore freely. Secondly, the sequence of breathing can be affected by changing the breath in (inspiration), breath out (expiration) and the amount of time air is held in the lungs (retention). Finally, the air passages can be affected by closing one nostril, altering the position of the windpipe using head position, or making a sound to change the orientation of the throat.
The first stage is to become aware of the breath, and typically Pranayama is taught initially in lying and then in sitting. When lying you can either lie on a mat on the floor, or with a bolster or thick folded blanket placed lengthways along the spine to open the chest. Sitting is typically performed cross legged and sitting on one or two yoga blocks will allow your lower back to be upright, or you can sit with your back against a wall for support.
Breath awareness
Initially it is important to simply become aware of your own breathing, feeling the movement of the abdomen and chest, and the passage of air through the nose. Breathing awareness is traditionally practiced at the end of a yoga session in the lying position (corpse pose). Placing the hands on the abdomen helps to feel the abdominal wall move as you breath in, and then locating movement in the sides of the rib cage, and then the upper rib cage can also be practiced either on your own, or often with a partner. The sequence represents the yoga ‘three-part breath’ sometimes called the complete breath (Deergha Swasam). Once you are aware of these movements you are ready to move on and modify them. Initially begin by changing your posture. Raise your chest on a folded blanket or yoga bolster to expand the ribcage and allow the abdomen to move unhindered. Now, gradually start to lengthen your breath in and out, perhaps counting 3 or 4 with each breath. Perform 5 repetitions of this sequence and then breath normally. It is important when practicing Pranayama to stop and allow your normal breathing to recover. This prevents over-breathing (hyper ventilation) which can lead to dizziness. Typically, in pranayama the focus is on extending the outbreath, so the ratio of a count of 1 to breath in and 2 to breath out is often used.

Expansive breath
Expansive breath (Ujjayi) follows on from breath awareness. Breath in through your nose and out through your mouth, gradually increasing the volume of the breath. It is important to breath in through the nose to warm and moisten the air rather than breathing in through the mouth which can result in a sore throat or a gagging sensation. The in breath (inhalation) should be performed slowly and gradually without forcing or gulping air into the lungs. The tummy (abdomen) is relaxed but not bloated, to allow the diaphragm to move unhindered. Aim to fill the lower (basal) part of the lungs by expanding the lower ribs, before the middle ribs, and finally the upper ribs. Chest expansion should include lifting of the sternum (pump handle action), sideways and backwards expansion of the ribcage (bucket handle movement). Finally, the top portion of the ribcage lifts (apical breathing), to represent the third part of the breath sequence.
In the second part of the breath, constrict your throat slightly, to make a ‘haaa’ sound, initially out loud (to learn) and then quietly just to yourself with your mouth closed. As air passes over the roof of your palate it makes a gentle rushing sound said to resemble an ocean, hence the alternative name of this pranayama is ‘ocean breath’ or victorious breath. If air is forced in rapidly it will rush over the palate causing throat irritation and coughing, so the action must be deliberate and controlled. The focus should be on a prolonged smooth breath rather than panting.

Abdominal breath
Once you can identify and control movement of your abdomen with expansive breath, it is time to use the action of the abdomen to perform diagrammatic breathing (Kapapabhathi). This is traditionally done in sitting and involves an inhalation followed by exhalation where the abdominal wall is gently tightened to force air out of the lungs, drawing the lower belly (between the tummy button and pubis) inwards and back towards the spine. If you find controlling this action difficult, place the flat on one hand over the lower belly to feel the movement occurring. Three or four cycles are completed before practising normal breathing to recover. This recovery period is important to prevent dizziness as mentioned above. Abdominal breath can progress to Bellows breath (Bhastrika) where the diaphragm contraction is more forceful and repeated (like a bellows). Both techniques are helpful to clear the air tubes which travel from the nose to the lungs (airways), and bellows breath is often described as a yoga cleansing technique.

 

Interrupted breath
In this technique, the inbreath and outbreath are extended by performing a series of slow breath actions which build up. There are two stages to this technique. Firstly, interrupted inhalation is used. The sequence is to inhale-pause-inhale-pause with each inbreath with the pause lasting approximately 2 seconds. The breath is held at full inhalation for 3-5 seconds. Exhale slowly but continuously and then breath normally for 2-3 breaths to recover. For interrupted exhalation, the sequence is reversed. Take a single deep breath and hold it briefly before the interrupted exhalation cycle begins with the rhythm exhale-pause-exhale-pause with each period again lasting for 2 seconds. Interrupted breath (Viloma) translates to vi (against) loma (hair) meaning against the natural flow, and gradually expands the breath to increase the amount of air which can be moved during breathing (lung capacity). The interrupted breath technique can also be used to target different regions of the lungs for example focussing on the lower chest rather than upper portion.

interrupted breath technique can also be used to target different regions of the lungs

Alternate nostril breathing
Many individuals have blocked sinuses, and it is typical for people to favour one nostril when they breathe normally throughout the day. Alternate nostril breathing (Nadi Sodhana or Anuloma Viloma) helps to clear the sinuses and provide symmetry of breathing through all the nasal passages. In addition, research has shown that there is alteration between right and left-brain activity during this pranayama technique (Naveen et al 1997). In the sitting position take your right hand and place the thumb against the side of one nostril and the fourth and fifth fingers against the other, bending the middle and index fingers into the palm to allow room for the nose. The right nostril is blocked with the thumb as you client breath in. Pause whilst opening the right nostril and closing the left with the fourth and fifth fingers to exhale. Pause and then reverse the technique. Eight to ten breath should be taken using this alternate nostril method before resting and breathing normally to recover. Commonly the breath is retained, and exhalation increased, using a ratio of one to inhale, four to retain, and two to exhale. Rather than alternating the closed nostril (right then left), both inbreath and outbreath may be taken through one nostril for five repetitions, then alternate and perform 5 repetitions with closing the other nostril.
We have seen that a ratio of 1 (inhale) to 2 (exhale) is encouraged to slow the breath and aid relaxation. Once used to this type of breath control, air retention (keeping the air in the lungs) is extended to a count of 4. A full single pranayama cycle would therefore be inhale, retain, exhale to a ratio of 1:4:2. Gradually with practice the breaths get longer but the ratio is maintained for example 3 second inbreath, 12 seconds retain, 6 seconds outbreath. Like any form of training, its takes time to build up Pranayama. The body must adapt gradually, and the specific Pranayama practice is performed in parallel with yoga poses to expand the ribcage, free the abdomen, and control the breath during movement.

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References
Iranzo, C et al (2014) Effects of Inspiratory Muscle Training and Yoga Breathing Exercises on Respiratory Muscle Function in Institutionalized Frail Older Adults: A Randomized Controlled Trial, Journal of Geriatric Physical Therapy 37(2): 65-75
Naveen K, Nagarathna, R., Nagendra, H., and Telles S (1997) Yoga breathing through a particular nostril increases spatial memory scores without lateralized effects. Psychological Reports 81: 555-561.
Pomidori, L. Campigotto, F, Amatya, T, Bernardi, L (2009) Efficacy and Tolerability of Yoga Breathing in Patients With Chronic Obstructive Pulmonary Disease. Journal of Cardiopulmonary Rehabilitation & Prevention: 29(2) 133-137
Sengupta, P (2012) Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. International Journal of Preventive Medicine. 3(7): 444–458.
Singh V, Wisniewski A, Britton J, and Tattersfield A (1990) Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma The Lancet 335 (9) 1381-1383