Breathing Exercises and Strategies for OT Professionals
This four-page breathwork guide is for OT practitioners who use breathing strategies with clients. The first three pages are a reference for you. They cover how to teach diaphragmatic and nasal breathing, ways to add tactile feedback, apps and breathing patterns, ideas for building lung capacity, and what to do when focusing on the breath makes a client more uncomfortable. The last page has step-by-step breathing exercises written for clients to print and take home.
Use it when you’re adding slow, controlled breathing to a client’s plan. That might be to support relaxation, functional movement, or orthostatic tolerance (the ability to stay upright without symptoms like dizziness or a racing heart). It works as a quick refresher before a session and as a home-program sheet afterward.
The handout was created with Emily Rich, PhD, OTR/L, a researcher and clinical specialist in postural orthostatic tachycardia syndrome (POTS).
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The handout’s framing is “breathing is a tool, not a rule.” The clinician pages help you match the approach to the person. For example, you can adjust hand placement, use imagery cues like a balloon filling and emptying, or change position. Some clients feel the diaphragm better lying prone (face down) and then carry that feedback into supine (face up). Upright sitting or standing tends to work well when the client tolerates it. Clients with orthostatic intolerance may need modified positions.
Page 4 covers seven patterns, including five-finger, figure-8, box, and 4-7-8 breathing, so you can teach one in session and send it home for practice. The handout suggests teaching both proactive use (practicing regularly) and reactive use (in the moment), with an emphasis on proactive practice. It also suggests starting in a calm setting like home before trying it somewhere stressful.
Supporting Evidence
The handout cites three sources. Russo, Santarelli, and O’Rourke (2017) reviewed the physiological effects of slow breathing in healthy people, including changes in heart rate variability and the autonomic nervous system. Bradley and Esformes (2014) reviewed how breathing pattern disorders relate to functional movement. Ruth (2015), a nursing practice article, outlines the benefits of nasal breathing, such as filtering and humidifying air.
Together, these support teaching slow, nasal, diaphragmatic breathing as part of a broader plan. The evidence is mostly review articles, and much of the physiology comes from healthy adults rather than clinical populations. Treat these strategies as one tool, watch how each client responds, and adjust.
Instructions and Tips
When you introduce breathing work, cue a “slow” breath rather than a “deep” one. The handout notes that “slow” can engage the diaphragm and abdominals better. Emphasize the exhale. The handout suggests about a 2–4 second inhale and a 4–6 second exhale, because heart rate drops on the exhale. For patterns with a hold, like box or 4-7-8 breathing, teach clients to relax through the hold instead of bracing. Offer sensory options for comfort, and tell clients their breathing may feel different in different places, such as a doctor’s office versus home.
Some clients feel more anxious or uncomfortable when they focus on their breath. That doesn’t mean breathwork is wrong for them. Switch to an external focus instead: blowing a pinwheel or bubbles, straw “races” with pom-poms or cotton balls, whistling, or a harmonica. These activities work on the same breathing skills while drawing attention away from body sensations.
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