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BREATHING IS A MOVEMENT Are you moving well?


Are you moving well?

SAMANTHA HOLTZHAUSEN | MSc.Cardiopulmonary Rehabilitation

The Covid-19 pandemic has been a part of our lives for almost a year now – that’s a long time. Many of us have lost loved ones, contacted the virus ourselves or been indirectly affected by strict isolation and lockdown rules.  Whether we are aware of it or not, our breathing changes to match our “state”.  In other words, if we are relaxed, we tend to breathe slowly and more efficiently.  In contrast, if we are anxious, we breathe quickly and shallowly.  We breathe in the same way when our bodies have to shift metabolic gears in order to fight a virus. But until we encounter these moments that challenge our ability to breathe with ease, we don’t really give our inhale and exhale much thought – do we?

So, let’s zoom in on breathing for a moment.

Did you know that breathing influences your training (e.g., walking, running, cycling, track etc.) more than training influences your breathing? Breathing efficiency and physical fitness are both independent and complimentary; while physical fitness does not always translate into breathing efficiency, breathing efficiency is the gateway to attaining physical fitness (on all levels – novice / elite).  But yet, it is the last thing we think of to train or pay attention to, isn’t it? I suppose it’s because breathing is one of our body’s autonomic functions, occurring on a subconscious level without any input from us, so it’s easy to assume we’re pretty good at it. But this is not always the case and by improving the way you breathe, both at rest and during movement, it will positively impact your sporting performance as well as your general health and wellbeing.


Normal breathing at rest should be:

  • Quiet and relaxed
  • Through the nose and not the mouth (which should stay closed)
  • Shoulders and upper chest should stay still with no accessory muscle use
  • Abdominal ribcage movements using the lower intercostal muscles and the diaphragm
  • Expiration passive and relaxed
  • Rate of 8–14 breaths per minute
  • Inspiration to expiration ratio approximately 1:2
  • Smooth and rhythmical

How many of the above points can you say that you do?  Now don’t change the way you breathe, be honest in your answers, because then you can identify where improvement can be made. Let me guess, the “breathe through your nose” part got you, right?  And that’s using the nose on the inhale and the exhale!


Remember, your nose was designed to be the channel you breathe through—your mouth was not. Taking air in through your nasal passages warms it, filters it like a vacuum cleaner, regulates the amount of oxygen that reaches your lungs and activates your diaphragm.  Breathing through your nose also stimulates the release of a gas called nitric oxide, which is a potent vasodilator stored in your para-nasal sinuses.  This gas also sterilizes the air that passes through the nasal passages, a win-win in times of a pandemic.  Breathing through the mouth unfortunately has none of these benefits.  If you are a mouth breather, changing to nasal breathing is one of the most valuable health investments you will ever make.  Try it at rest first, as changing the way you breathe is a big deal.  Once you are comfortable at rest, try it with movement.   It may be challenging at first but stick to it and practice.


The diaphragm is located just below the lungs and is the primary muscle used for breathing. It plays a role in everything, from oxygen utilization to the removal of waste to core stabilization when moving about. But due to the nature of our everyday tasks, with most of us spent hunched over a desk, we place the diaphragm at a mechanical disadvantage. We therefore don’t use this powerhouse of a muscle nearly as much as we should. Instead, we use the mouth to do the nose’s job, gulp large volumes of air into the upper chest and use the neck and shoulder muscles (accessory muscles) to do so.  Let’s change that.

Place your right hand to the side of your bottom left ribs.  Relax the shoulders.   Take a slow breath in through the nose and feel the lungs expand (THINK: NOSE, LOW AND SLOW). Are you using your chest to do the work or your diaphragm? As you breathe in, you should feel your left hand expand sideways, slightly to the front and slightly to the back – in a full 360° breath.

EXERCISE 1: Perform 1 – 2 times per day, for at least 5 minutes.

Lie on your back, bend up both knees. Place one hand on your upper chest and

 one hand just below your bottom ribs (SEE PICTURE). The diaphragm should contract as you inhale, so you should feel your bottom hand move UP on the INHALE and down on the exhale. Ideally, your bottom hand should be moving more than your top hand. Breathe in and out slowly, using the nose and without forcing the breath in or out.


EXERCISE 2: If your top hand was moving more

Stay in the same position, but clasp your hands and place them behind your head

 (SEE PICTURE). This should slightly reduce the movement of the upper chest. Breathe in and out slowly, using the nose. Stay in this position for 5 – 10 minutes, if



If you are struggling to improve your breathing on your own, there is help available.   Physiotherapists with a special interest in the field of cardiorespiratory are equipped to assess and treat altered breathing patterns and respiratory muscle weakness.  By improving breathing efficiency through supervised breathing re-training sessions, strengthening the breathing muscles and sufficiently downregulating the sympathetic nervous system (the state most of us are in when we are anxious and worried) when appropriate, one could dramatically enhance performance and quality of life. Another advantage of learning to breathe more efficiently is the positive effect it has on post-training recovery, performance during training, improved sleep, and improved stress management.

SAMANTHA HOLTZHAUSEN | MSc.Cardiopulmonary Rehabilitation
Director: Nel, Housego, Holtzhausen Physiotherapists Inc.
Department: Cardiopulmonary Rehabilitation, Critical Care
Cell: 084 324 0249