Objective To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients.
Methods Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively.
Results Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p<0.001), inspiratory time (p=0.007), and total respiratory time (p<0.001). VF plus exercise significantly improved inspiratory capacity (p<0.001), and singing significantly improved the physical component of QoL, than did the control groups (p<0.001). All BEs did not significantly improve dyspnea, compared to the controls (p>0.05).
Conclusion PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).
Citations
Citations to this article as recorded by
Effects of breathing exercises performed with virtual reality on dyspnea, anxiety and quality of life in COPD patients: A randomized controlled trial Derya Şimşekli, Mehtap Tan Heart & Lung.2025; 71: 7. CrossRef
BREATHLEssness in INDIA (BREATHE-INDIA): realist review to develop explanatory programme theory about breathlessness self-management in India Joseph Clark, Naveen Salins, Mithili Sherigar, Siân Williams, Mark Pearson, Seema Rajesh Rao, Anna Spathis, Rajani Bhat, David C. Currow, Kirsty Fraser, Srinagesh Simha, Miriam J. Johnson npj Primary Care Respiratory Medicine.2025;[Epub] CrossRef
Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: A Network Meta-analysis Yingying Cai, Xiaohe Ren, Jingyi Wang, Bin Ma, Ou Chen Archives of Physical Medicine and Rehabilitation.2024; 105(3): 558. CrossRef
Effectiveness of mind–body exercises in chronic respiratory diseases: an overview of systematic reviews with meta-analyses Alberto Marcos Heredia-Rizo, Javier Martinez-Calderon, Fernando Piña-Pozo, Paula González-García, Cristina García-Muñoz Disability and Rehabilitation.2024; 46(12): 2496. CrossRef
Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs Emily Johnson, Shaina Corrick, Serena Isley, Ben Vandermeer, Naomi Dolgoy, Jack Bates, Elana Godfrey, Cassidy Soltys, Conall Muir, Sunita Vohra, Puneeta Tandon, Haleh Ayatollahi PLOS Digital Health.2024; 3(1): e0000435. CrossRef
The Effectiveness of Combined Resistance and Breathing Exercise Education in Alleviating Dyspnea and Anxiety Among COVID-19 Patients: A Randomized Controlled Trial Tahereh Ramezani, Zahra Saboohi, Majid Hamoongard, Zahra Taheri-Kharameh Middle East Journal of Rehabilitation and Health Studies.2024;[Epub] CrossRef
Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review Helga Rafael Henriques, Andreia Correia, Tatiana Santos, José Faria, Diana Sousa, Joana Portela, Joana Teixeira International Journal of Nursing Sciences.2024; 11(2): 241. CrossRef
The effect of manual therapy on diaphragm function in adults with asthma: Protocol for a randomized controlled trial Dimitrios Tsimouris, Eirini Grammatopoulou, Maria Papandreou, George Gioftsos, George Koumantakis F1000Research.2024; 12: 1361. CrossRef
Effect of breathing exercises on patients with interstitial lung disease: A systematic review and meta-analysis Jia Fan, Yuyang Chang, Siming Cheng, Bing Liang, Danhua Qu Quality of Life Research.2024; 33(9): 2335. CrossRef
The Effect of Breathing Exercise on Self-Care Management in Chronic Obstructive Pulmonary Patients Mehtap Tan, Derya Şimşekli, Gönül Gökçay Clinical and Experimental Health Sciences.2024; 14(3): 719. CrossRef
Comparing Guided and Non-guided Deep Breathing Impact on Disability Well-Being: A Systematic Review Eng-Keat Kwa, Soon-Keng Cheong, Lin-Kooi Ong, Poh-Foong Lee Journal of Medical and Biological Engineering.2024; 44(5): 635. CrossRef
Immediate and Long-Term Effects of Breathing Exercises on Reaction Time Burçin Akçay, Ozan Bahadır Türkmen, Ebru Kaya Mutlu, Canan Demir, Ahmet Kurtoğlu, Kopzhassar Bayetov, Madawi H. Alotaibi, Safaa M. Elkholi Medicina.2024; 60(11): 1890. CrossRef
Immediate effects of structured and natural deep breathing on heart rate variability and blood pressure in community-dwelling older adults Ting-Ting Yeh, Yi-Chieh Ho Experimental Gerontology.2024; 198: 112644. CrossRef
Effects of physical therapy via telerehabilitation on cardiopulmonary, physical and psychological function in patients with coronavirus disease 2019: A randomised controlled trial Benyada Suthanawarakul, Noppawan Promma, Pacharaporn Iampinyo, Chanatsupang Saraboon, Jatupat Wattanaprateep, Pooriput Waongenngarm Journal of Telemedicine and Telecare.2024;[Epub] CrossRef
Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials Guy William Fincham, Clara Strauss, Jesus Montero-Marin, Kate Cavanagh Scientific Reports.2023;[Epub] CrossRef
Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals Camilla R. Illidi, Lee M. Romer, Michael A. Johnson, Neil C. Williams, Harry B. Rossiter, Richard Casaburi, Nicholas B. Tiller European Journal of Applied Physiology.2023; 123(8): 1599. CrossRef
Pulmonary rehabilitation care: Current perspective Ankit Kumar, Surya Kant IP Indian Journal of Immunology and Respiratory Medicine.2023; 8(1): 6. CrossRef
Effect of physiotherapy and its frequency on the outcome of COVID-19 patients regarding acute care setting at isolation unit of Ain Shams University Mona M El-Bably, Ahmed M M Galal, Riham Hazem Rafat, Samia M Abd El Rehem The Egyptian Journal of Chest Diseases and Tuberculosis.2023; 72(3): 433. CrossRef
Development of Personalized Respiratory Training Device with Real-time Feedback for Respiratory Muscle Strengthening Merve Nur Uygun, Yeong-geol Bae, Yejin Choi, Dae-Sung Park Physical Therapy Rehabilitation Science.2023; 12(3): 251. CrossRef
The effect of manual therapy on diaphragm function in adults with asthma: Protocol for a randomized controlled trial Dimitrios Tsimouris, Eirini Grammatopoulou, Maria Papandreou, George Gioftsos, George Koumantakis F1000Research.2023; 12: 1361. CrossRef
Cognitive Improvement through Breathing Exercises in Post-Stroke Respiratory Sarcopenia: A Review Jeong-Gon Lee, Jae-Hoon Lee, Min-Seong Ha Exercise Science.2023; 32(4): 358. CrossRef
Effect of pulmonary rehabilitation on dyspnea and exercise tolerance in patients with interstitial lung disease: a systematic review Nicholas DePietro, Jennifer Rinaldi, Courtney Nieschwitz, Heather Robinson, Alysha Walter Physical Therapy Reviews.2022; 27(3): 214. CrossRef
Effects of breathing control using visual feedback of thoracoabdominal movement on aerobic exercise Nobuhisa Ishii, Kazuhide Tomita, Kenta Kawamura, Yukako Setaka, Ryo Yoshida, Reiko Takeshima Respiratory Physiology & Neurobiology.2022; 301: 103887. CrossRef
Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review Yu Fu, Emma J Chapman, Alison C Boland, Michael I Bennett Palliative Medicine.2022; 36(5): 770. CrossRef
Effects of Farinelli Breating Exercise on Respiratory Function and Symptoms in Patients with Chronic Obstructive Pulmonary Disease Supawit Ittinirundorn, Naiyana Wongsaita, Dujrath Somboonviboon, Wannaporn Tongtako Tuberculosis and Respiratory Diseases.2022; 85(2): 137. CrossRef
Evaluating the Efficiency of Breathing Exercises via Telemedicine in Post-Covid-19 Patients: Randomized Controlled Study Fatih Okan, Sevil Okan, Fadime Duran Yücesoy Clinical Nursing Research.2022; 31(5): 771. CrossRef
The Effect of Progressive Muscle Relaxation and Deep Breathing Exercises on Dyspnea and Fatigue Symptoms of COPD Patients Adile Neşe, Sevgin Samancıoğlu Bağlama Holistic Nursing Practice.2022; 36(4): E18. CrossRef
A Retrospective Study of Diaphragmatic Breathing Training Combined with Discharge Care Bundles in Patients with Chronic Obstructive Pulmonary Disease Shuhui Yu, Chen Lu, Lingling Qin, Weiguo Li Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
“I Felt Grounded and Clear-Headed”: Qualitative Exploration of a Mind-Body Physical Activity Intervention on Stress Among College Students During COVID-19 Ildiko Strehli, Donna H. Ziegenfuss, Martin E. Block, Ryan D. Burns, Yang Bai, Timothy A. Brusseau INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2022;[Epub] CrossRef
Validity and Reliability of Korean Version of Self-Care Chronic Obstructive Pulmonary Disease Inventory (SC-COPD) and Self-Care Self-Efficacy Scale (SCES-COPD) Ja Yun Choi, So Young Yun Journal of Korean Academy of Nursing.2022; 52(5): 522. CrossRef
Elementary Pulmonary Rehabilitation Protocol to Ameliorate Functionality Level in Case of Pneumothorax Following Emphysema: A Case Report Ritika S Bhagwani, Vaishnavi Yadav, Shubhada R Dhait, Samruddhi M Karanjkar, Roshni R Nandanwar Cureus.2022;[Epub] CrossRef
Effect of Singing on Symptoms in Stable COPD: A Systematic Review and Meta-Analysis Xuejie Fang, Zhengtong Qiao, Xinjuan Yu, Rujin Tian, Kai Liu, Wei Han International Journal of Chronic Obstructive Pulmonary Disease.2022; Volume 17: 2893. CrossRef
Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews Yiting Li, Zile Ji, Yan Wang, Xuanlin Li, Yang Xie International Journal of Chronic Obstructive Pulmonary Disease.2022; Volume 17: 3075. CrossRef
Community-Based Pulmonary Rehabilitation Programs in Individuals With COPD Marisela Barbosa, Renato Andrade, Cristina Argel de Melo, Rui Torres Respiratory Care.2022; 67(5): 579. CrossRef
Breathing exercises in people with COPD: A realist review Jing Li, Wei Liu, Xinxin Ding, Wenjing Wang, Kun Li Journal of Advanced Nursing.2021; 77(4): 1698. CrossRef
The effects of yoga on dyspnea, sleep and fatigue in chronic respiratory diseases Zülfünaz Özer, Gülcan Bahçecioğlu Turan, Meyreme Aksoy Complementary Therapies in Clinical Practice.2021; 43: 101306. CrossRef
Rehabilitation, a necessity in hospitalized and discharged people infected with COVID-19: a narrative review Najmeh Sedighimehr, Javad Fathi, Nahal Hadi, Zahra Sadat Rezaeian Physical Therapy Reviews.2021; 26(3): 202. CrossRef
Prediction of COVID-19 Hospital Length of Stay and Risk of Death Using Artificial Intelligence-Based Modeling Bassam Mahboub, Mohammad T. Al Bataineh, Hussam Alshraideh, Rifat Hamoudi, Laila Salameh, Abdulrahim Shamayleh Frontiers in Medicine.2021;[Epub] CrossRef
Effects of visual feedback of thoracoabdominal motion on oxygen consumption during hyperventilation - Pilot study Nobuhisa Ishii, Kazuhide Tomita, Reiko Takeshima, Kenta Kawamura, Yukako Setaka, Ryo Yoshida, Shigeyuki Imura Journal of Bodywork and Movement Therapies.2021; 28: 317. CrossRef
Development of a smartphone application for Korean patients with chronic obstructive pulmonary disease: Self-monitoring based action plans Ja Yun Choi, Maureen George, So Young Yun Applied Nursing Research.2021; 61: 151475. CrossRef
Development of an educational intervention to reduce the burden of adult chronic lung disease in rural India: Inputs from a qualitative study Biswajit Paul, Rita Isaac, Hemalatha R., Paul Jebaraj, Muthathal S., Deepa Das, John Norrie, Liz Grant, Hilary Pinnock, Harish Nair, Aziz Sheikh, David Weller, Vijayaprasad Gopichandran PLOS ONE.2021; 16(7): e0254534. CrossRef
The physiology of singing and implications for ‘Singing for Lung Health’ as a therapy for individuals with chronic obstructive pulmonary disease Adam Lewis, Keir Elmslie James Philip, Adam Lound, Phoene Cave, Juliet Russell, Nicholas S Hopkinson BMJ Open Respiratory Research.2021; 8(1): e000996. CrossRef
Evaluate Breathing Exercises on Improvement in Respiratory Status among Patients with Respiratory Diseases Gitima Kalita, Nabajani Dutta Asian Journal of Nursing Education and Research.2021; : 495. CrossRef
Effect of Inspiratory Muscle Training on Anxiety and Depression in Patient with COPD that Received Pursed Lip Breathing Yeanita, Rahmi Isma Asmara Putri Indonesian Journal of Physical Medicine and Rehabilitation.2021; 9(02): 87. CrossRef
Simulation-based learning to enhance students’ knowledge and skills in educating older patients Goodarz Torkshavand, Mahnaz Khatiban, Ali Reza Soltanian Nurse Education in Practice.2020; 42: 102678. CrossRef
Interventions to Improve the Quality of Life of Patients with Chronic Obstructive Pulmonary Disease: A Global Mapping During 1990–2018 Giap Van Vu, Giang Hai Ha, Cuong Tat Nguyen, Giang Thu Vu, Hai Quang Pham, Carl A. Latkin, Bach Xuan Tran, Roger C. M. Ho, Cyrus S. H. Ho International Journal of Environmental Research and Public Health.2020; 17(9): 3089. CrossRef
Effects of Diaphragmatic Breathing on Health: A Narrative Review Hidetaka Hamasaki Medicines.2020; 7(10): 65. CrossRef
The Use of Diaphragm Ultrasonography in Pulmonary Physiotherapy of COPD Patients: A Literature Review Agnieszka Lewińska, Karen Shahnazaryan Journal of Clinical Medicine.2020; 9(11): 3525. CrossRef
Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease Nicola Marotta, Andrea Demeco, Lucrezia Moggio, Cinzia Marinaro, Ilaria Pino, Marianna Barletta, Annalisa Petraroli, Davide Pepe, Francesco Lavano, Antonio Ammendolia Complementary Therapies in Clinical Practice.2020; 41: 101260. CrossRef
Effects of pursed-lip breathing and forward trunk lean postures on total and compartmental lung volumes and ventilation in patients with mild to moderate chronic obstructive pulmonary disease Nutsupa Ubolnuar, Anong Tantisuwat, Premtip Thaveeratitham, Somrat Lertmaharit, Chathipat Kruapanich, Jaturong Chimpalee, Witaya Mathiyakom Medicine.2020; 99(51): e23646. CrossRef
Training of Respiratory Muscles in Motion in the Physical Rehabilitation of Patients with Chronic Cerebral Ischem V.V. Ezhov, V.I. Mizin, A.Yu. Tsarev, T.E. Platunova Bulletin of Restorative Medicine.2020; 100(6): 19. CrossRef
The Effect of Controlled Breathing Exercises on Anxiety and Arterial Oxygen Saturation in Chronic Obstructive Pulmonary Disease the Military Specialist Hospitals Abdi Alvar. D, Kalroozi. F, Nezamzadeh. M, Pishgooie. SAH Military Caring Sciences.2020; 7(2): 96. CrossRef
First
Prev
