Question explored with the scientific record
Which is the best way to breath diaphragm or chest or a combination of both
The short version: for a healthy person at rest, diaphragmatic breathing is the most efficient default, but the best technique depends on what you are trying to accomplish.
The evidence here is not about which breathing style is "best" in general. It is about specific techniques for specific problems. Diaphragmatic breathing consistently improves lung function in people with asthma [1, 3], reduces pain and improves balance in people with chronic low back pain [8], and helps with dyspnea in heart failure patients [4]. Chest wall vibration, by contrast, triggers an inhibitory reflex that actually reduces tidal volume and inspiratory time [15]—the opposite of what you want for efficient breathing.
The real question is what you are trying to do. For resting ventilation and stress reduction, slow diaphragmatic breathing raises end-tidal CO2 and lowers respiratory rate [19, 20]. For exercise, the body naturally shifts to a combination: tidal volume increases, end-expiratory lung volume drops, and breathing rate rises [12]. For people with chronic neck pain, breathing retraining that includes chest wall mobilization reduces accessory muscle overuse and improves respiratory reserve [21]. For asthma patients with dysfunctional breathing, physiotherapy-based retraining improves quality of life [16, 17].
The evidence is thin on head-to-head comparisons of pure diaphragmatic versus pure chest breathing in healthy people. One 2025 study in healthy young adults found that game-based breathing exercises improved chest expansion and respiratory frequency more than traditional pursed-lip breathing [11], but both groups improved. No study here compares "diaphragm only" to "chest only" to "combination" in a general population and declares a winner.
My call: for daily resting breathing, lead with the diaphragm—it is the body's primary breathing muscle and the evidence supports it for most clinical contexts. For exercise or when you need maximum ventilation, let the chest muscles assist naturally. The combination is not a compromise; it is what your body does on its own when you do not interfere. Confidence: moderate—the evidence supports diaphragmatic breathing for specific conditions but does not settle the general "best" question.
Sources used 12
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Role of diaphragmatic breathing and aerobic exercise in improving pulmonary function and maximal oxygen consumption in asthmatics
This study investigates the effects of eight weeks of supervised aerobic exercise, diaphragmatic breathing, and a combination of both on pulmonary function and maximal oxygen consumption in moderate-persistent asthmatics, finding significant improvements in forced vital capacity…
DOI: 10.1016/j.scispo.2009.10.003 -
Effect of diaphragmatic breathing exercise on quality of life in subjects with asthma: A systematic review
This systematic review evaluates the impact of diaphragmatic breathing exercises on the quality of life in asthma patients, finding moderate evidence of improvement in both short-term and long-term outcomes based on three randomized controlled trials.
DOI: 10.3109/09593985.2012.731626 -
Studi Kasus: Penerapan Pursed Lip Breathing dan Diaphragmatic Breathing Exercise pada Pasien Congestive Heart Failure dengan Sesak Napas di Instalasi Gawat Darurat
Five CHF patients with dyspnea in the ED experienced reduced respiratory rate and dyspnea with a slight rise in oxygen saturation after a five-cycle combination of pursed lip breathing and diaphragmatic breathing exercise, suggesting potential non-pharmacological relief in acute…
DOI: 10.14710/hnhs.6.2.2023.86-95 -
Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial
Adding diaphragmatic training to Transcutaneous Electrical Nerve Stimulation (TENS) in amateur athletes with nonspecific chronic low back pain reduces pain, and yields greater improvements in static stability and dynamic balance than TENS alone, with a non-significant trend towa…
DOI: 10.1186/s13102-021-00250-y -
Comparison of Game-Based Breathing Exercise and Traditional Pursed Lip Breathing Exercise in Young Adults
In healthy young adults, four weeks of game-based breathing exercise (Breathing+) improved respiratory frequency and chest expansion more than traditional pursed lip breathing, with similar heart-rate reductions.
DOI: 10.30934/kusbed.1658296 -
Lung volumes during low-intensity steady-state cycling
This study directly measured total lung capacity (TLC) and end-expiratory lung volume (EELV) in eight healthy men during rest and two low-intensity cycling conditions, finding TLC remained essentially constant while EELV decreased with exercise and inspiratory capacity (IC) incr…
DOI: 10.1152/jappl.1991.70.2.934 -
Inspiratory inhibitory reflex caused by the chest wall vibration in man
This study shows that inspiratory phase-locked vibration of the lower chest wall depresses tidal volume and inspiratory time, with reduced diaphragmatic activity, indicating a supraspinal inspiratory inhibitory reflex contributing to the off-switch of the inspiratory phase in he…
DOI: 10.1016/0034-5687(80)90065-1 -
Breathing retraining for dysfunctional breathing in asthma: a randomised controlled trial
This study investigates the effectiveness of physiotherapy-based breathing retraining in improving quality of life for asthma patients with dysfunctional breathing symptoms, demonstrating significant improvements in health status after one month and sustained benefits for over 2…
DOI: 10.1136/thorax.58.2.110 -
Breathing pattern recordings using respiratory inductive plethysmography, before and after a physiotherapy breathing retraining program for asthma: A case report
This case report investigates the effects of a physiotherapy breathing retraining program on a 57-year-old female asthma patient, demonstrating improvements in symptoms and some physiological parameters, although objective changes in breathing patterns were not fully realized.
DOI: 10.1080/09593985.2017.1400139 -
Preliminary investigations into the effects of breathing retraining techniques on end-tidal carbon dioxide measures in patients with asthma and healthy volunteers during a single treatment session
Two small, exploratory studies tested whether a single session of breathing retraining (slow breathing with and without breath holds, with and without visual biofeedback) can raise end-tidal CO2 in adults with asthma and in healthy volunteers, finding ETCO2 increases with reduce…
DOI: 10.1016/j.physio.2006.07.006 -
Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders
This study evaluates the effects of breathing therapy on patients with hyperventilation syndrome and anxiety disorders, demonstrating significant improvements in complaints and breathing patterns, particularly linked to a reduction in breathing frequency.
DOI: 10.1016/s0022-3999(96)00220-6 -
Breathing retraining with chest wall mobilization improves respiratory reserve and decreases hyperactivity of accessory breathing muscles during respiratory excursions: A randomized controlled trial
This randomized controlled trial evaluates the effects of breathing retraining with chest wall mobilization on respiratory reserve and accessory breathing muscle activity in individuals with chronic neck pain, finding significant improvements in respiratory function and pain red…
DOI: 10.37190/abb-01641-2020-03