Practicing breathwork isn’t exactly groundbreaking or new to ourselves as physical therapists. For years we have instructed patients in “box breathing” to induce relaxation, control pain, and improve physical performance.

For many people mouth breathing is instinctual. As carbon dioxide (CO2) builds up in the body during exertion, it makes us hungry for air. Breathing through the mouth offloads more carbon dioxide than breathing through the nose, quieting the alarm bells going off in the brain. Studies have shown however significant fitness benefits to having the body tolerate higher levels of carbon dioxide in the blood, through nasal breathing. While breathing through the nose does increase carbon dioxide in the blood, it has also been shown to release nitric oxide, which helps deliver more oxygen to the cells. This heightened oxygenation is a natural performance enhancer, whereas mouth breathing produces poor sleep and lower stamina. Evidence of this fact can be found at the finish line of any distance running races where the front runners appear as nasal breathers, and the later finishers display mouth breathing with tongues dragging.

In these pandemic times where the issues of respiratory distress and need for ventilators are in the news every day, I offer the following “box breathing” exercise. Doing this daily will not only help relieve stress, and improve focus, but also build carbon dioxide tolerance.

  1. Sit upright in a supported position
  2. Breathe in through your nose for four seconds
  3. Hold for four seconds
  4. Exhale for four seconds
  5. Hold with your lungs empty for four seconds

Repeat at least five times. Work slowly to increase the duration of each step, with a goal of eight-ten seconds.