The health effects of diaphragmatic breathing: A systematic review

Diaphragmatic breathing (DB) is widely used clinically, but a comprehensive synthesis of randomized controlled trial (RCT) evidence on its health effects is lacking. This systematic review evaluated the health effects of DB interventions in adults based on RCT evidence.

Six electronic databases were searched through January 2025 for RCTs comparing DB to control conditions in adults. Two reviewers independently selected studies, extracted data, and assessed risk of bias (Cochrane RoB 2). A narrative synthesis was performed due to substantial heterogeneity across studies.

We included 48 RCTs. DB protocols were highly heterogeneous, with parameters varying widely in breathing frequency (2-10 breaths/min), session duration (3-45 min), and total duration (single session to 12 weeks). Methodological quality was a significant concern (only 2.12 % of outcomes low risk of bias). Consistent benefits were found for gastroesophageal reflux disease (GERD) (including reduced medication use), anxiety, post-COVID-19 syndrome, and gestational diabetes). In healthy adults, DB showed acute cardiovascular benefits. However, evidence was inconsistent for chronic obstructive pulmonary disease, and DB was less effective than standard care after cardiac surgery. Safety was underreported (18.75 % of studies), but no serious adverse events were noted.

DB is a promising complementary therapy for specific conditions, including GERD, but the evidence base is constrained by methodologically weak and heterogeneous primary studies. Future research requires rigorous, standardized trial designs to establish its clinical value. Despite these limitations, DB is a low-cost, accessible, and apparently safe intervention for select conditions.