Diaphragmatic Breathing Helps Reduce GERD Symptoms, Improves QOL

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A team of researchers analyzed the effects of using diaphragmatic breathing exercises in patients with GERD, specifically whether their symptoms and QOL improved.

Diaphragmatic breathing exercises decreased the severity and frequency of gastroesophageal reflux disease (GERD) symptoms and improved patient quality of life (QOL), according to study findings published in Advances in Integrative Medicine.

Researchers conducted a randomized controlled trial at Tehran University of Medical Sciences in Iran between October 2020 and March 2021, randomly assigning 96 patients with GERD to either an experimental group (n=47) or a control group (n=49). Participants in the experimental group underwent 4 weeks of diaphragmatic breathing training in addition to routine care, while those in the control group received routine care alone for GERD, including a nutritional diet plan and medications.

The diaphragmatic breathing training program consisted of a 30-minute training session, during which patients received instructions on proper exercise technique in 3 positions: supine, sitting, and standing. The patients learned to feel the diaphragm contracting through their hands placed on the abdomen, while their other hands placed on their chests remained stationary during inhalation. This tactile biofeedback ensured that the patient could monitor correct performance of the exercise.

After confirmation of patient understanding and correct performance, the researchers provided patients with a home exercise program consisting of 30 diaphragmatic breaths within 5 minutes 3 times per day. During the remaining 4 weeks, text messages reminded the patients to complete their exercises.

The investigators determined treatment efficacy using the Reflux Disease Questionnaire (RDQ) and the Gastroesophageal Reflux Syndrome Health-Related Quality of Life Questionnaire (GERD-HRQL), collecting questionnaire results before and after 4 weeks of treatment.

Although symptom frequency and intensity significantly decreased in both treatment groups, according to RDQ mean scores, the experimental group compared with the control group experienced a more significant decrease in symptom frequency (-10.63±6.77 vs -5.91±9.33; P =.006) and symptom intensity (-11.65±7.03 vs -5.77±9.92; P =.001). Similarly, per GERD-HRQL mean scores, QOL improved in the experimental group compared with the control group (-16.67±10.45 vs -8.41±16.19; P =.004).

“The results of the present study indicated that teaching these patients to do diaphragmatic breathing exercises could reduce their gastric reflux symptoms and increase their [QOL] over time,” the study authors wrote. “Thus, diaphragmatic breathing exercises are recommended to be used as a part of these patients’ treatment programs, and the patients should be provided with the required explanations in this regard in health care environments.”

The study was limited by COVID-19 restrictions, which necessitated home exercise programs, making it impossible for the researchers to monitor adherence to the exercises or confirm correct performance. Similarly, the researchers did not monitor patient adherence to nutritional and medical regimens.


Hosseini A, Shorofi SA, Jackson AC, et al. The effects of diaphragmatic breathing training on the quality of life and clinical symptoms of patients with gastroesophageal reflux disease: A randomized controlled trial. Adv Integr Med. Published online April 6, 2022. doi:10.1016/j.aimed.2022.03.002