Resistance Breath Training Can Lower Blood Pressure — Here's How to Do It

Hypertension is common: about half of all Americans have it, according to the National Heart, Lung, and Blood Institute. If you don't control it, you're at risk for serious health problems, such as stroke and heart attack.

A heart-healthy diet, medications, and exercise can all help bring blood pressure numbers down. Now, there's another simple strategy the health-conscious can add to their toolkits: a type of breathing exercise called inspiratory muscle strength training.

The training involves inhaling through a special device that makes each breath more challenging. This not only strengthens breathing muscles, it appears to have effects throughout the whole body, lowering systolic blood pressure (the top number) by an average of 9 mmHg, and diastolic (the bottom number) by 4 mmHg, according to an October 2022 study in the ‌Journal of Applied Physiology.‌

And all it takes is about 5 to 10 minutes per day, says lead study author Daniel Craighead, PhD, assistant research professor in the Integrative Physiology of Aging Lab at the University of Colorado Boulder.

"You can do [these exercises] while you're watching TV at home; you don't have to deal with weather or transportation or anything," he says. "The effectiveness and the potential for actually getting people to do it was something that made it exciting."

The new study builds upon work in Craighead's lab and by researchers at the University of Arizona College of Medicine. Several previous, smaller studies, including a September 2020 pilot trial of 25 older adults in the ‌Journal of Applied Physiology‌ and a June 2021 study of 36 midlife and older participants in the ‌Journal of the American Heart Association,‌ found the training was beneficial for blood pressure.

"It seems to work pretty effectively, in general, regardless of age, sex, blood pressure, BMI, whether you're taking blood pressure medications or not," Craighead says. "We didn't identify anything obvious that's going to strongly impact the effects people will see."

The average degree of improvement (reducing blood pressure by 9/4 mmHg) is similar to what can be achieved with medications: A May 2014 review in the ‌Cochrane Database of Systematic Reviews‌ found the highest dose of drugs called thiazides caused a 8/3 mmHg to 11/5 mmHg drop, and an older October 2008 review in the same publication cited a reduction of 8/5 mmHg for commonly used medicines called ACE inhibitors.

That doesn't mean you should do these exercises instead of taking medicines prescribed by your doctor, or that you can skip any other kind of exercise. Moving your whole body is still important for your health, for lots of reasons. But it does suggest this type of training could serve as an another effective way to protect your heart health, Craighead says.

First, check in with your doctor, Craighead recommends. Across the trials, there were minimal side effects or adverse events. A few people reported minor neck soreness and lightheadedness, but that's similar to what anyone starting a new exercise program might experience, he notes.

Still, you'll want to ask your health care team about any precautions before beginning this type of breath training, especially if you already have a chronic health condition.

You'll need to purchase a device that adds resistance to your inhalations. Craighead's studies have used one called a POWERbreathe K3, which retails for $600, in part because it has a digital storage system that helps researchers track whether study participants are doing their exercises.

But you can find similar devices for far less, including several made by the same company. Craighead recommends searching for one that allows you to adjust the resistance, and can go up to at least 100 cmH2O of resistance (such as the POWERbreathe Plus Medium Resistance, available for $70 on Amazon). That will make the exercises challenging enough to produce similar results.

Your first day, start with the device on a lower setting. Begin by fully exhaling, as you normally would. Then, "inhale as quickly and powerfully as possible against resistance," Craighead says. Most of the devices have a valve that opens and closes — your goal is to produce enough force with your breath to get it open and keep it open as long as you can.

Exhale slowly, without the device, for at least 2 to 4 seconds. This helps you avoid hyperventilation and dizziness, he says. Repeat for six breaths in a row. Rest for one minute, then repeat for four more sets, for a total of 30 breaths.

If those 30 breaths felt easy, increase the resistance a little bit until the routine feels hard but doable. "You should get to the end of the 30 breaths in a session and basically not feel like you could do more than a couple more at that intensity," Craighead says. Once you reach that point, keep the resistance steady for a week or two, then see if you can increase it again as you gain strength.

Most studies have asked participants to do the exercises at least five days a week. Craighead recommends doing them daily, so you get into routine. But don't stress too much if you miss a day or two — you'll likely still see benefits, he says.

Though the exercises will make your diaphragm and other breathing muscles stronger, scientists don't believe that's how this training produces its effects on blood pressure. Instead, Craighead cites the effects on the sympathetic nervous system, which controls the body's fight or flight system. The deep, hard inhalations seem to flip a switch that reduces sympathetic nervous system activity, allowing your blood pressure to drop.

According to the June 2021 study in ‌JAHA,‌ inspiratory muscle strength training appears to improve the health of blood vessels, enabling them to better expand and contract to shuttle blood where it's needed in the body.

While the results are compelling, experts have more to learn about the benefits and potential risks of inspiratory muscle strength training, Craighead says. He and his colleagues are currently doing longer and larger studies to see if the results hold up or even add up over time. They're also planning to move the technique out of the lab and into the real world, making sure participants can stick to this plan without researchers peeking over their shoulders or checking on their progress.

Craighead is optimistic enough about the benefits that he does inspiratory muscle strength training regularly himself. In addition to the blood-pressure benefits, the exercises also may improve athletic performance: A January 2021 study in the journal ‌Medicina‌ found twice-daily breathing training increased the speed of 800-meter runners, and that appeals to Craighead, a runner himself.

And if enough other people tried it too, more hearts would be healthier, he believes.

"I think if this is something that's shown, in larger follow-up studies with longer treatment durations, to be as effective as we've seen so far, it really could have a profound impact on the prevalence of cardiovascular disease, if it's widely adopted," he says.

People with high blood pressure could use inspiratory muscle strength training as another tool to bring their numbers down — and those who currently have regular readings could use it to keep them that way.