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COPD and Breathlessness

Breathing Practice and Gentle Yoga for Living With COPD

Breathlessness has a loop in it. Being short of breath makes you breathe faster, faster breathing empties the lungs less completely, and lungs that are already full leave less room for the next breath in. That loop is trainable, and it is what this guide is about.

What the breathing techniques actually do, why they matter more here than the poses, what happened when yoga was put up against pulmonary rehabilitation, and how to use all of it on a flight of stairs rather than only on a cushion.

Who this guide is for

Signs this guide was written for you

This is for the settled version of COPD. Things have been stable for a while, you get about under your own steam, and what you want is something to do about the breathlessness.

  • ·Your COPD has been stable for a month or more, with no recent flare up.
  • ·You can walk on your own, even if you have to stop and rest.
  • ·You do not need oxygen while sitting still.
  • ·Stairs, slopes and carrying things are where you notice it most.
  • ·You can find ten minutes on most days.

Research based yoga sequences for COPD and Breathlessness

12-Week Breathing and Yoga Program for COPD

Our yoga teachers built this twelve-week program around the finding that surprised everyone in this field: the breathing does most of the work. Twelve weeks to breathe out more completely, walk further before you stop, and have something to do when the breathlessness starts.

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What causes COPD and Breathlessness

The problem is not getting air in. It is getting the last of it out.

In COPD the small airways tend to collapse early on the way out, so a breath ends before the lungs are properly empty. What stays behind takes up room, and the next breath in has less space to arrive in. That is why breathlessness builds on itself, and it is why almost every technique that helps works on the exhalation.

Which is also why this program is built the way it is. In the pooled evidence, the benefit tracked with the breathing-focused interventions rather than the pose-heavy ones, and one trial tested a breathing technique with no poses at all and still moved the walking distance.

  • ·A trial of breathing practice with no poses at all produced a 65 metre advantage in six-minute walking distance after twelve weeks, on about twelve minutes of daily practice.
  • ·Across 11 trials with 586 patients, yoga improved six-minute walking distance by 25.5 metres and improved FEV1, and the authors attributed the benefit to the breathing rather than the postures.
  • ·An earlier meta-analysis found 38.8 metres on the walking test and 123 mL on FEV1, both past the threshold for a difference people notice.
  • ·Supervised yoga by video call matched pulmonary rehabilitation by video call across walking distance, breathlessness, symptoms, quality of life, anxiety and depression in a trial of 150 people.
  • ·The trials reporting on safety found no increase in adverse events in stable COPD.

Safety

When to practise and when to get it looked at

Three things decide whether this is useful, and all three come from how the studies behind it were run.

How to practise so it works

  • ·This sits alongside your medical care and any pulmonary rehabilitation, not instead of either. Everything here was studied as an addition to ordinary treatment.
  • ·The breathing goes first in every session, while you are freshest. It is the part carrying the effect, so it does not get pushed to the end.
  • ·Never hold your breath, and nothing forced. No Kapalabhati, no Bhastrika, and no deep forward folds that press the belly into the diaphragm.
  • ·Breathe out on the effort. Standing up, reaching, stepping up. That habit is worth more than any single pose here.
  • ·Stop and rest for breathlessness at rest, dizziness or chest tightness. If you use a pulse oximeter, agree a floor with your clinician and treat it as a floor.

The asanas

The yoga poses that matter for COPD and Breathlessness

Grouped by what each one asks the body to do. Tap any pose to see how it is done, what it works on and who should leave it out.

Where the breath gets more room

Bridge Pose

Bridge Pose

Setu Bandha Sarvangasana

Fish Pose

Fish Pose

Matsyasana

High Cobra Pose

High Cobra Pose

Bhujangasana

Upward Salute

Upward Salute

Urdhva Hastasana

Legs Up the Wall

Legs Up the Wall

Viparita Karani

Keeping the ribcage mobile

Cow Pose

Cow Pose

Bitilasana

Mountain Pose with Side Bend

Mountain Pose with Side Bend

Parshva Tadasana

Revolved Easy Pose

Revolved Easy Pose

Parivrtta Sukhasana

Half Lord of the Fishes

Half Lord of the Fishes

Ardha Matsyendrasana

Half Standing Forward Bend

Half Standing Forward Bend

Ardha Uttanasana

Positions that let the diaphragm work

Easy Pose

Easy Pose

Sukhasana

Staff Pose

Staff Pose

Dandasana

Thunderbolt Pose

Thunderbolt Pose

Vajrasana

Mountain Pose

Mountain Pose

Tadasana

Cow Face Pose

Cow Face Pose

Gomukhasana

For yoga teachers

Teaching a class for COPD and Breathlessness

A class for people with COPD is a breathing class with movement attached, and getting that proportion right is most of the job. The pooled evidence attributes the benefit to the breathing-focused work rather than the pose-heavy work, and one trial got a clinically meaningful improvement in walking distance from a seated breathing technique with no poses at all. Give the breathing the first third of the class, while everyone is freshest.

Teach pursed lip breathing early and cue it constantly. In through the nose for two, out through gently pursed lips for four, like cooling soup rather than blowing out a candle. Then cue the out breath on every effort: standing up, reaching, stepping. Breathing out on exertion is the single habit most worth leaving the room with.

Leave out the forced techniques and the deep forward folds. Kapalabhati and Bhastrika use rapid forced exhalation in lungs that are already over-inflated, with no evidence that this is safe. Deep folds press the abdomen into the diaphragm. Neither omission costs the class anything.

Three things to have in the room before anyone asks:

  • ·Chairs, and permission to use them for any part of the class. Getting up and down off the floor repeatedly is often the most breathless part of the hour.
  • ·Pillows or a bolster for lying down. Many people breathe more easily propped up than flat, and being able to say so should not require an announcement.
  • ·A wall to stand near for the upright work, offered to everyone rather than to whoever looks unsteady.

Hand made yoga sequences for COPD and Breathlessness

Full sequences you can teach or practise today

Our yoga teachers built each of these around the same trials the guide above is based on. The order of the poses, the length of the holds and the props are not a stylistic choice. They follow what the studied programmes actually did.

If you teach, take one of them straight into your class. Every pose comes with its timing, the cue that matters and the reason it sits where it sits.

10-Minute Yoga Sequence for Easier Breathing With COPD

10 min · Beginner

10-Minute Yoga Sequence for Easier Breathing With COPD

The daily one. In the study behind this program, people managed about twelve minutes a day and it was enough to matter.

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15-Minute Yoga Sequence for Breathing Under Exertion

15 min · Beginner

15-Minute Yoga Sequence for Breathing Under Exertion

The last three weeks and the one to keep. Short, mostly upright, and built around using the breathing rather than practising it.

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20-Minute Yoga Sequence for Breathing With COPD

20 min · Beginner

20-Minute Yoga Sequence for Breathing With COPD

The first three weeks. Two breathing techniques, learned properly, and four gentle positions that give the ribs room.

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25-Minute Yoga Sequence for Breath and Gentle Movement

25 min · Beginner

25-Minute Yoga Sequence for Breath and Gentle Movement

Weeks four to nine. Two more breathing techniques, a little standing, and everything still at the speed of the breath.

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Build your own

Put together your own class for COPD and Breathlessness

The sequence builder gives you all 108 asanas and lets you arrange them yourself. While you build, it watches the shape of the class: whether the intensity rises and falls the way a practice should, whether every strong pose gets its counterpose, and whether the order makes anatomical sense.

Save what you build, come back to it, and teach it. It is the fastest way to turn what you just read into a class of your own.

The research

What the studies actually found

The most striking result in this field came from a trial where people did nothing but sit and breathe. No poses, four short teaching sessions, about twelve minutes of practice a day, and after twelve weeks a 65 metre advantage in walking distance over the control group. Two meta-analyses covering 586 and 233 patients point the same way on walking distance and lung function, and both attribute the benefit to the breathing work. And when supervised yoga was put head to head against pulmonary rehabilitation in 150 people, both groups improved substantially and neither came out ahead.

PubMed Central2017

Effect of Yoga Breathing (Pranayama) on Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized, Controlled Trial

40 people with moderate to severe COPD, twelve weeks, a single seated breathing technique and no poses at all. Taught in four short sessions, practised at home for about twelve minutes a day. The group difference in six-minute walking distance at twelve weeks was 65 metres, and quality of life improved in the breathing group only. This is the clearest evidence that the breathing is the active part.

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Clinical Rehabilitation2019

The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

11 randomised trials with 586 patients. Six-minute walking distance improved by 25.5 metres and FEV1 improved as well, both robust to how well the individual trials were run. The authors were specific that the benefit tracked with the breathing-focused interventions rather than the pose-heavy ones, which is the finding this whole program is built around.

Read the source →
PubMed Central2024

Effectiveness of Telemedicine Interventions in Chronic Obstructive Pulmonary Disease: yoga versus pulmonary rehabilitation

150 people randomised to supervised yoga or pulmonary rehabilitation, both by video call, 45 minutes five times a week for three months. Walking distance improved by a median of 165 metres with yoga and 120 with rehabilitation, with no significant difference between them, and breathlessness, symptoms, quality of life, anxiety and depression all improved in both groups.

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Journal of Thoracic Disease2014

Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Five randomised trials with 233 patients. FEV1 improved by 123 mL and by 3.9 percent of predicted, and six-minute walking distance by 38.8 metres. Both of those are past the point where a person would notice the difference in daily life.

Read the source →
PubMed Central2016

Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease

72 people with moderate to severe COPD over twelve weeks. Walking distance improved by 59 metres against 16 in the control group, with breathlessness down 24 percent, fatigue down 26 percent and oxygen saturation up. The most intensive protocol in this set, and the one that documents every component it used.

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Frequently Asked Questions

Can yoga help with COPD?

The breathing side of it clearly can. Two independent meta-analyses found improvements in six-minute walking distance of 25.5 and 38.8 metres and improvements in FEV1, and one of them was explicit that the benefit tracked with the breathing-focused programmes rather than the pose-heavy ones.

What is the single most useful technique?

Pursed lip breathing. Breathing out through gently pursed lips keeps a small back pressure in the airways so they do not collapse early, which lets the lungs empty more completely and leaves room for the next breath in.

How much do I have to do?

Less than you would expect. In the trial that tested breathing alone, people were asked for thirty minutes a day, managed about twelve, and still ended up 65 metres ahead on the walking test after twelve weeks. Ten minutes most days is a real dose here, not a compromise.

Is this instead of pulmonary rehabilitation?

Alongside it. In a trial of 150 people, supervised yoga by video call and pulmonary rehabilitation by video call produced similar improvements across walking distance, breathlessness, symptoms and quality of life, with no significant difference. That makes yoga a reasonable thing to add, not a substitute for a supervised programme.

I get breathless lying flat. Can I still do this?

Yes, propped up. Being more comfortable with the head and shoulders raised is common, and every lying position in this program has a propped version. Legs up the wall is the one to simply skip if it does not suit you.

Should I be watching my oxygen saturation?

If you already use a pulse oximeter, agree a floor with your clinician and rest when you reach it. And let symptoms count as much as the number: breathlessness at rest, dizziness or chest tightness mean stop regardless of the reading.

Ready to practice COPD and Breathlessness12-Week Breathing and Yoga Program for COPDStart the practice →

Related Practices

Breathing CapacityChest OpeningInner Calm

Creator of this guide

Manish Rana

Manish Rana

Founder of Asanaverse.de. Manish writes about yoga, Ayurveda and meditation, and owes his deep connection to yoga to his Indian roots. With over 1,000 hours of Yoga Alliance Teacher Training, he shares his knowledge with the community.

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Registered Experienced Yoga Teacher, E-RYT 500VEAT

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