Breathing therapy for patients with medically unexplained physical symptoms and dysfunctional breathing: A pilot and feasibility trial 2025 Karlsen+

[Andy]

Abstract
Medically unexplained physical symptoms (MUPS) are symptoms without an identifiable organic cause that lead to functional impairment. MUPS is highly prevalent in general practice consultations. This pilot trial aimed to investigate the effectiveness and feasibility of a 5-week breathing retraining program focusing on basic anatomy and physiology, breathing awareness, nasal breathing and resonance (coherent) breathing for patients meeting the criteria for MUPS.

The trial used a quantitative design with pre- and post-intervention measurements. Fifteen participants with MUPS and dysfunctional breathing (assessed by the Nijmegen Questionnaire) were recruited from two general practitioner offices. The intervention consisted of 5 weekly sessions including education on breathing physiology and weekly breathing exercises focused on nasal breathing and resonance breathing techniques. One week post intervention, improvements were observed in dysfunctional breathing scores, lower symptom severity, higher general well-being, and reduced musculoskeletal pain complaints. At 3 months post-intervention, sustained improvements were seen in dysfunctional breathing, general well-being, musculoskeletal pain, and additionally lower pseudoneurological, gastrointestinal, and allergy complaints, as well as lower overall symptom burden and improved end-tidal CO2 levels.

The trial concluded that the 5-week breathing program showed promising results for improving multiple patient-reported outcomes in MUPS. Recruitment, adherence, and acceptability of the program were satisfactory. A randomized controlled trial is recommended to further evaluate the efficacy of this breathing intervention for MUPS patients.

Trial registration: ClinicalTrials.gov NCT06575920

Open access

 

[Andy]

"According to the scientific literature, DB patterns might be harmful, self-perpetuating patterns [14,20] and may partially explain some MUPS [18,21,22]. There are indications that its correction after breathing therapy combined with stress reduction and lifestyle management is associated with reduced symptoms and improved quality of life [23–25]. Breathing therapy may also be beneficial for somatic syndromes, such as irritable bowel syndrome [26], fibromyalgia and ME/CFS [27] and post-traumatic stress disorder [20]."

Ref 27 is to A Cognitive Behavioral Model Proposing That Clinical Burnout May Maintain Itself, a review article that only ever talks about "chronic fatigue".

 

[Hutan]

Fifteen participants with MUPS and dysfunctional breathing (assessed by the Nijmegen Questionnaire)

This is even worse than I imagined. Here's the Nijmegen Questionnaire:

It's very circular. There's no actual assessment of whether the breathing is disordered.

16 questions, scored from 0 to 4.
12 of the questions don't necessarily have much to do with the quality of breathing.
So, you could score 'sometimes' on the non-breathing questions and 0 on the breathing questions and still qualify for a disordered breathing diagnosis.

 

[Utsikt]

Ugh. This is an add for Svenningsen. From her website (auto translated):

I am a specialist in general medicine and have over 20 years of experience as a doctor, 15 of which as a GP at Hisøy Medical Center. There I also had Mediyoga for patients for many years.

Strengthening and preserving the healthy has always been important to me. In my search for good tools, I took further training as a Unit Therapist with Audun Myskja, where I discovered how incredibly powerful the breath is as a tool and medicine.

Since 2018, breathing has been my great passion, simply because it works! Functional breathing is absolutely essential for good health. I have seen time and time again how well breathing exercises work on conditions such as anxiety, stress-related ailments, respiratory ailments, aches, fatigue, irritable bowel syndrome, joint pain and headaches/migraines. Breathing provides access to life force, is a tool for self-regulation and for introspection. Breathing can also open up other states of consciousness.

Since 2018 I have studied breathing from all angles. I have trained as an Integrative Breathing Therapist with Rosalba Courtney, Ashtanga Yoga teacher with Alexander Medin, Mindfulness therapist with Mindfulness Now and Phillip Neess, Advanced Wim Hof courses and Firewalk Instructor Training . October 2024 and January 2025 I was in India and Mexico doing Breathwork with Dan Brule.

In the fall of 2023, I conducted a pilot research project , where I looked at breathing as a tool for patients with persistent symptoms and ailments. The results were good, and an article is on the way.

I hold courses, lectures and retreats based on my experience as a doctor, knowledge of holistic health, stress management, breathing therapy, meditation, yoga and breathwork.

Now she’s going to say it’s backed by science.

 

[rvallee]

When you're at this stage, why not go for it and do stuff like tuning the vibrational energies of their auras? There is literally no connection between whatever this is and reality, it's pure delusional fantasy.

What the hell is a Norwegian county wasting money on crap like this?

Funded by: Regional Research Foundation, County of Agder, Norway

Literally no one benefits outside of being a jobs program for quacks. Might as well just publicly fund alternative clinics, there is literally zero difference here.

 

[rvallee]

I discovered how incredibly powerful the breath is as a tool and medicine

Simon Wessely once said something like:

The placebo is one of the most powerful interventions we have

This is completely dysfunctional. Any system that does bullshit like this is illegitimate.

Since 2018, breathing has been my great passion, simply because it works!

Yes, breathing works. Very powerful insight. 100% of people who don't breathe die. This is systemic degeneracy.

 

[Hutan]

This is completely dysfunctional. Any system that does bullshit like this is illegitimate.

It really does feel as though pseudoscience is having its time in the sun. It seems to be everywhere, on the radio there seems to be someone pushing some sort of woo every day. It's so prevalent in mainstream medicine. Maybe it has always been there, and I'm just noticing it more.

 

[Trish]

I tnink there are some genuinely disordered breathing patterns, such as hyperventilation, shallow breathing, breathing mainly with the chest not the diaphragm. I don't know how difficult it is to change this and what is the most useful way of helping people to do so.
I have found some breathing techniques as a short term thing to calm me when stressed are useful, some I think come from yoga.
I haven't read this particular paper and have no idea whether any of it is scientifically valid, but I think we need to be careful of dismissing out of hand everything to do with breathing.

 

[Sean]

I tnink there are some genuinely disordered breathing patterns, such as hyperventilation,

Ironically, for ME/CFS at least, it was Wessely who showed early on that hyperventilation was not a feature of the condition.

 

[Jonathan Edwards]

I strongly suspect pretty much all theories of bad breathing are pseudoscience. Hyperventilation can make you dizzy but you tend to stop once you are dizzy. A comforting hand is probably as much use as any exercises. When there are no comforting hands maybe a sense of being in control helps.

I noted recently that something I was taught as a student that I thought was sound science about breathing probably isn't. We were taught that people with emphysema pursed their lips when breathing because it shifted the steep pressure gradient from collapsed bronchioles to the mouth and improved emptying of alveoli. BS. I found myself pursing my lips when a bit short of breath despite having no emphysema. It is the normal thing to do. I have no idea why and I doubt anybody has.

 

[rvallee]

I tnink there are some genuinely disordered breathing patterns, such as hyperventilation, shallow breathing, breathing mainly with the chest not the diaphragm. I don't know how difficult it is to change this and what is the most useful way of helping people to do so.
I have found some breathing techniques as a short term thing to calm me when stressed are useful, some I think come from yoga.
I haven't read this particular paper and have no idea whether any of it is scientifically valid, but I think we need to be careful of dismissing out of hand everything to do with breathing.

I'm sure there are unrelated issues where something like this can help, but I find it very easy to dismiss entirely because from the start of Long Covid, many rehabilitation specialists have made assertive claims of "dysfunctional breathing patterns" that must be, unquestionably so, the cause of shortness of breath and exhaustion, and especially from lung rehab specialists, have made equally assertive claims that breathing rehabilitation is obviously the answer to everything from PEM to headaches and so on.

Best case it can help some people, but even specialists can't tell the difference anyway, so things essentially get stuck in the same way as with GET: they think they have the answer, and no amount of debunking will make them budge away from it, so nothing moves.

From the tens of thousands of comments and testimonies I have read about Long Covid, I don't remember more than a handful mention any of hyperventilation or having difficulty with the mechanics of breathing. I did see lots report benefits, or being told that they should benefit, from breathing exercises of all kinds, from meditation and so on, but I saw at least as many, usually more, reporting the same from the dozens of supplements, from dietary changes and a host of other treatments that don't seem to work any better than someone putting an potato in their socks to recover from a cold. Which works 100% of the time, in that after a few days, no cold. And damp smelly socks, probably some ants. But no cold.

 

[Alinda]

I agree that it very much seems like mostly pseudoscience, but at least it isn't actively harmful. Sorry if this is a bit off-topic, but what do people here think about the whole HRV thing? It's tightly related, as HRV can change a lot depending on breathing patterns, but it often feels like it's very overstated how important it actually is between patients and "specialists".