The Science Behind Breathwork
Updated: Oct 13
Breathing is more than an automatic reflex, it is one of the most accessible clinical tools we have for influencing physiology in real time. Because respiration can be both involuntary and voluntary, it provides a direct gateway into autonomic regulation.
Slow diaphragmatic breathing, particularly with an extended exhale, shifts the balance away from sympathetic dominance and toward parasympathetic activity via vagal pathways, improving cardiovascular adaptability and emotional regulation (3,5). This is reflected clinically by reduced anxiety, improved sleep, and enhanced stress tolerance, outcomes strongly associated with improved autonomic flexibility and heart rate variability (11, 13).
Breathwork also modulates the endocrine stress response. Slow controlled breathing reduces hypothalamic-pituitary-adrenal (HPA) axis activation and is associated with decreased cortisol, supporting recovery, immune regulation, and improved resilience (8, 10). When practiced at approximately six breaths per minute, paced breathing increases respiratory sinus arrhythmia and HRV, both important markers of stress adaptability and cardiometabolic health (6).
Nasal breathing further improves oxygen uptake efficiency through nitric oxide delivery from the sinuses, while contributing to vascular regulation and antimicrobial defence (4, 6, 12). Finally, breath-based interventions are linked to reduced inflammatory signalling and improved immune regulation, including effects on pro-inflammatory cytokines and immune cell activity (1). In practical terms, breathwork is not simply relaxation training, it is autonomic, endocrine, vascular, and immune modulation delivered through a single behavioural lever.
As a practical introduction, I have included a link to a Box Breathing (4–4–4–4) video, which demonstrates one of the foundational techniques we frequently recommend in clinical practice. This method can be helpful for improving emotional regulation, reducing stress reactivity, and supporting sleep when practiced consistently.
That said, effective breathwork rarely relies on a single technique. In practice, multiple breathing procedures are often combined and progressed over time, guided by how each individual responds physiologically and functionally. Selection is based on factors such as symptom profile, autonomic balance, activity level, and recovery capacity.
Ultimately, when prescribed with precision and applied consistently, breathwork becomes one of the most powerful and accessible interventions in modern healthcare, capable of shaping nervous system balance, stress physiology, vascular health, and immune regulation through a simple, intentional daily practice.
References
Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: A systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373(1), 13–24.
Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in Psychiatry, 9, 44.
Critchley, H. D., & Garfinkel, S. N. (2018). The influence of physiological signals on cognition. Current Opinion in Behavioral Sciences, 19, 13–18.
Ignarro, L. J., Buga, G. M., Wood, K. S., Byrns, R. E., & Chaudhuri, G. (1987). Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proceedings of the National Academy of Sciences of the United States of America, 84(24), 9265–9269.
Jerath, R., Crawford, M. W., Barnes, V. A., & Harden, K. (2015). Self-regulation of breathing as a primary treatment for anxiety. Applied Psychophysiology and Biofeedback, 40(2), 107–115.
Lehrer, P. M., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129.
Lundberg, J. O., Weitzberg, E., & Lundberg, J. M. (1994). Alveolar nitric oxide in man: Role of nasal nitric oxide in pulmonary gas exchange. European Respiratory Journal, 7(8), 1501–1505.
Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. Journal of Psychiatric Research, 95, 156–178.
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
Sapolsky, R. M. (2015). Why zebras don’t get ulcers (3rd ed.). Henry Holt and Company.
Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in Public Health, 5, 258.
Weitzberg, E., & Lundberg, J. O. (2002). Humming greatly increases nasal nitric oxide. American Journal of Respiratory and Critical Care Medicine, 166(2), 144–145.
Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.
DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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