Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
Original Research

Acute effects of breathing exercises on diaphragmatic mobility and respiratory muscles activity in healthy adults

Maryne Ramos da Siva; Catherine Correa Peruzzolo; Jéssica Canizelli; Dayane Montemezzo; Elaine Paulin

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Objective: To investigate the differences between the breathing exercises sniff inspiration (SI), diaphragmatic breathing (DB), fractionated breaths (FB) and breathing from functional residual capacity (BFRC) in terms of their effect on diaphragmatic mobility and electrical activity of the sternocleidomastoid (SCM) and anterior scalene muscles in healthy adults in two positions: sitting and supported 30° trunk inclination. Methods: In a cross-sectional observational research, healthy adults of both sexes were recruited. Participants underwent anthropometric and spirometric assessment and their vital signs were measured. Diaphragmatic mobility (DM) was analyzed by ultrasound (US). Electrical activity of the sternocleidomastoid and anterior scalene muscles was assessed by electromyography (EM), in two positions: sitting and supported 30° trunk inclination. Results: A total of 30 individuals were assessed, 14 women and 16 men. Among the exercises studied, respiratory muscles were least used in DB for both positions and most used in BFRC. In regard to DM, the exercise that mobilized the diaphragm the most was BFRC in both studied positions, while DB caused the least mobilization of this muscle. Diaphragmatic mobility declined during trunk inclination at 30° and respiratory muscle electrical activity was lower when compared to the sitting position. Conclusion: In clinical practice, diaphragmatic breathing proved to be the exercise that least used the respiratory muscles. However, the BFRC with a 30° trunk inclination is the most recommended exercise when the objective is the mobilization of the diaphragm. It is important to know the muscle action during breathing exercises for a better prescription.


Breathing Exercises; Diaphragm; Electromyography


1. Holland AE, Hill CJ, Jones AY, McDonald CF. Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;10:CD008250. pub2. PMid:23076942.

2. Vieira DSR, Mendes LPS, Elmiro NS, Velloso M, Britto RR, Parreira VF. Breathing exercises: influence on breathing pattern and thoracoabdominal motion in healthy subjects. Braz J Phys Ther. 2014;18(6):544-52. PMid:25590447.

3. Cuello GA, Masciantonio L, Cuello AF. Patrones respiratorios en distintas afecciones. Corde. 1982;3(3):48-60.

4. Kang J, Jeong I, Choi H. The effects of breathing exercise types on respiratory muscle activity and body function in patients with mild chronic obstructive pulmonary disease. J Phys Ther Sci. 2016;28(2):500-5. PMid:27064889.

5. Morrow B, Brink J, Grace S, Pritchard L, Lupton-Smith A. The effect of positioning and diaphragmatic breathing exercises on respiratory muscle activity in people with chronic obstructive pulmonary disease. South African Journal of Physiotherapy. 2016;72(1):315. http://dx.doi. org/10.4102/sajp.v72i1.315. PMid:30135892.

6. Santos TV, Ruas G, Souza LAPS, Volpe MS. Influence of forward leaning and incentive spirometry on inspired volumes and inspiratory electromyographic activity during breathing exercises in healthy subjects. J Electromyogr Kinesiol. 2012;22(6):961-7. http://dx.doi. org/10.1016/j.jelekin.2012.05.001. PMid:22682605.

7. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by M-Mode ultrasonography: methods, reproducibility, and normal values. Chest. 2009;135(2):391-400. PMid:19017880.

8. Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N. Ultrasound M-Mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol. 2011;37(1):44-52. ultrasmedbio.2010.10.004. PMid:21144957.

9. Yamaguti WP, Claudino RC, Neto AP, Chammas MC, Gomes AC, Salge JM, et al. Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(4):571-7. apmr.2011.11.026. PMid:22464088.

10. Azeredo CAC. Fisioterapia respiratória moderna. 4. ed. Barueri: Editora Malone; 2002.

11. Chinali C, Busatto HG, Mortari DM, Rockenbach CWF, Leguisamo CP. Inspirometria de incentivo orientada a fluxo e padrões ventilatórios em pacientes submetidos a cirurgia abdominal alta. ConScientiae Saúde. 2009;8(2):203-10.

12. Andrade AD, Silva TNS, Vasconcelos H, Marcelino M, Rodrigues MG, Filho VCG, et al. Inspiratory muscular activation during threshold therapy in elderly healthy and patients with COPD. J Electromyogr Kinesiol. 2005;15(6):631-9. jelekin.2005.06.002. PMid:16051499.

13. Chiti L, Biondi G, Morelot-panzini C, Raux M, Similowski T, Hug F. Scalene muscle activity during progressive inspiratory loading under pressure support ventilation in normal humans. Respir Physiol Neurobiol. 2008;164(3):441-8. resp.2008.09.010. PMid:18952011.

14. Lunardi AC, Porras DC, Barbosa RC, Paisani DM, Silva CCM, Tanaka C, et al. Effect of volume-oriented versus flow-oriented incentive spirometry on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly. Respir Care. 2014;59(3):420-6. PMid:23983269.

15. Jung J, Kim N. Relative activity of respiratory muscles during prescribed inspiratory muscle training in healthy people. J Phys Ther Sci. 2016;28(3):1046-9. PMid:27134409.

16. Fernandes M, Cukier A, Feltrim MIZ. Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2011;8(4):237-44. PMid:22094449.

17. Yong MS, Lee H, Lee Y. Effects of diaphragm breathing exercise and feedback breathing exercise on pulmonary function in healthy adults. J Phys Ther Sci. 2017;29(1):85-7. PMid:28210046.

18. Ishii N, Tomita K, Suetake S, Okuno Y, Kawamura K, Takeshima R, et al. Oxygen cost of thoracic and diaphragmatic breathing during hyperventilation in healthy males. J Phys Ther Sci. 2018;30(2):238-41. PMid:29545685.

19. Legrand A, Schneider E, Gevenois P, De Troyer A. Respiratory effects of the scalene and sternomastoid muscles in humans. J Appl Physiol. 2003;94(4):1467-72. japplphysiol.00869.2002. PMid:12626472.

20. Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, et al. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. J Appl Physiol. 2017;122(5):1267-75. japplphysiol.00046.2017. PMid:28255085

21. Tomich GM, França DC, Diório ACM, Sampaio RF, Parreira VF. Breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises. Braz J Med Biol Res. 2007;40(10):1409-17. 879X2006005000165. PMid:17713643.

22. Paulin E, Yamaguti WPS, Chammas MC, Shibao S, Stelmach R, Cukier A, et al. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med. 2007;101(10):2113-8. PMid:17644365.

23. Cavalcanti AG, Lima CS, Sá RB, Reinaux CM, Braz DS Jr, Teixeira AL, et al. Influence of posture on the ventilatory pattern and the thoraco-abdominal kinematics of patients with chronic obstructive pulmonary disease (COPD). Physiother Theory Pract. 2014;30(7):490-

4. PMid:24678754.

24. Contesini AM, Garcia A Jr, Caromano FA. Influência das variações da postura sentada na função respiratória: revisão de literatura. Fisioter Mov. 2011;24(4):757-67. 51502011000400021.

25. Yamaguti WPS, Paulin E, Shibao S, Kodaira S, Chammas MC, Carvalho CRF. Avaliação ultra-sonográfica da mobilidade do diafragma em diferentes posturas em sujeitos saudáveis. J Bras Pneumol. 2007;33(4):407-13.

37132007000400009. PMid:17982532.

26. Romei M, Mauro AL, D’Angelo MG, Turconi AC, Bresolin N, Pedotti A, et al. Effects of gender and posture on thoraco-abdominal kinematics during quiet breathing in healthy adults. Respir Physiol Neurobiol. 2010;172(3):184-91. PMid:20510388.

27. Mesquita A, Tam C, Crasto C, Argel C, Melo D, Carvalho P, et al. Forward trunk lean with arm support affects the activity of accessory respiratory muscles and thoracoabdominal movement in healthy individuals. Hum Mov Sci. 2018;61(11):167-76. http://dx.doi. org/10.1016/j.humov.2018.07.011. PMid:30107366.

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