Who should be careful with breathing practices

Author: Raymond Hackland · Last reviewed: 18 October 2026 · Reading time: about 8 minutes

In short

• What this is: A calm, practical guide to when gentle breathing practices, including the Six Healing Sounds, call for extra care: pregnancy, heart and blood pressure conditions, epilepsy, panic or anxiety disorders, and recent surgery. It also lists the signs that mean you should stop.
• What the evidence says: Slow, soft breathing is generally well tolerated, but safety reporting in breathing and movement research is patchy. Most known risks come from fast or forced breathing, long breath holds and straining, which are not part of a gentle practice. The clearest example is epilepsy: deliberate over-breathing is used in hospital EEG tests because it can bring on certain seizures.
• What it means for your practice: If any of the situations below applies to you, talk to your doctor or midwife before you start. Whatever your health, stop as soon as you feel dizzy, tingly, short of breath or unwell. This article is general information, not a diagnosis or a personal recommendation.

What science says

First, the good news, and its limits. Label: Early evidence. A systematic review of 153 randomised trials of tai chi, a related Chinese mind-body practice, found that reported side effects were usually minor and mostly musculoskeletal, such as knee or back pain, with no serious adverse events attributed to the practice. However, only a third of the trials reported on side effects at all [1]. Breathwork research has the same weakness: in a 2023 meta-analysis of breathwork trials [2], fewer than a quarter of the studies actively reported on adverse effects, as the authors later noted [3]. In their own trial with 200 healthy young adults, about half practised fast breathing with breath holds for three weeks; in that group, about one in ten said they had unpleasant short-term effects, such as light-headedness, dizziness, or tingling with stiff, cramped fingers [3]. In short: gentle practices look low-risk, but “low-risk” is not “no risk”, and the evidence is thinner than it should be.

Pregnancy. Label: Well studied (general exercise guidance) · Early evidence (breathing practices specifically). Exercise in pregnancy is considered safe and beneficial for most people, and the NHS advises starting anything new gently, telling your instructor you are pregnant and stopping if you feel uncomfortable, too hot or unwell [4]. In later pregnancy it advises avoiding lying flat on your back for more than a few minutes, because it can make you feel dizzy [4]. The American College of Obstetricians and Gynecologists lists warning signs that mean you should stop exercising, including vaginal bleeding, abdominal pain, regular painful contractions, leaking fluid, breathlessness before exertion, dizziness, headache, chest pain, muscle weakness affecting balance, and calf pain or swelling [5]. Heavy straining with a held breath during high-intensity exercise has generally been discouraged in pregnancy, mainly because there has been so little research on its safety [6]. A small 2025 laboratory study with 10 healthy pregnant participants found short sets of heavy lifting, including with a held breath, well tolerated by mother and baby [6]; it is a single small study, and it did not look at breathing practices. In practice: choose soft, natural breathing without holds, practise sitting rather than lying flat later in pregnancy, and check with your midwife or doctor first.

Heart and blood pressure conditions. Label: Well studied. Straining with the airway closed, the “Valsalva manoeuvre”, is something you often do without noticing when you lift something heavy or push while holding your breath. It raises the pressure in your chest, and blood pressure first rises briefly, then falls; when you let go, it dips for a moment and then overshoots [7]. That is why straining and long breath holds deserve caution if you have a heart or blood pressure condition. Even in hospitals, deliberate over-breathing during EEG tests is not done in people who had a heart attack or stroke in the past 12 months, or who have poorly controlled angina [8]. Low blood pressure matters too: it can cause light-headedness, dizziness and fainting, especially when you stand up quickly, and the NHS advises moving slowly from lying to sitting to standing [9]. In practice: if you have a heart condition, high or low blood pressure, or take medication for them, ask your doctor before starting, avoid holding or forcing your breath, and get up slowly after practising.

Epilepsy. Label: Well studied. Over-breathing (hyperventilation) is a known seizure trigger for some people. It is used on purpose during EEG tests because it brings on seizures in over 90% of people with absence epilepsy, a type best known in children, though not limited to them [10]. For other types of epilepsy the risk seems much lower: in a study of 433 people with confirmed epilepsy, mostly focal epilepsy, five minutes of deliberate over-breathing led to a seizure in two of them (0.46%) [11]. In a large UK audit, hospital staff saw seizures in 2.2% of people with known or possible epilepsy during this test, most of them absences [8]. Over-breathing is not on the Epilepsy Society’s list of possible triggers, and triggers differ from person to person [12]. In practice: if you have epilepsy, talk to your neurologist or epilepsy nurse first, avoid fast or forceful breathing, and don’t practise alone in a situation where a seizure could be dangerous.

Panic and anxiety disorders. Label: Well studied (CO₂ sensitivity in panic disorder) · Early evidence (what it means for breathing practices). Breathing and panic are closely linked. Many people with panic disorder react unusually strongly to air with extra carbon dioxide (CO₂), and over-breathing lowers CO₂, which brings its own sensations, such as dizziness and tingling [3, 8, 13, 14]. Researchers still debate exactly how these fit together, but one point is clear: how you interpret body sensations matters, and fearful interpretations can feed panic [13]. That cuts both ways. Breathing retraining is one of the methods therapists use [13], yet paying close attention to the breath, or getting slightly light-headed, can also bring on the very sensations someone fears. In practice: if you have panic attacks or an anxiety disorder, discuss breathing practices with your doctor or therapist, keep the breath natural and unforced, keep your eyes open if that feels safer, and know that you can stop at any moment.

Recent surgery. Label: Well studied (standard post-operative advice). After surgery, follow your own surgical team’s instructions first; the examples below come from NHS patient leaflets. After hernia repair, a common operation on the abdominal wall, avoid heavy lifting and strenuous exercise for about two weeks after keyhole surgery and four weeks after open surgery, and avoid straining on the toilet [15]. After eye surgery, don’t press on the eye, and avoid strenuous exercise and heavy lifting for two weeks [16]. After ear surgery, avoid straining and heavy lifting for the first few weeks, don’t blow your nose hard, sneeze with your mouth open, and don’t fly, swim or dive for six to eight weeks [17]. What these instructions share is avoiding pressure and strain. In practice: leave out breath holds, pushing the breath against a closed throat and any forceful sounds until your surgeon says it’s fine. If you have had nose or sinus surgery, ask your surgeon which breathing and sound exercises are allowed.

Hyperventilation, dizziness and the signs that mean stop. Label: Well studied. Breathing faster or deeper than your body needs lowers CO₂ in the blood [10]. Typical effects include dizziness, light-headedness, tingling or numbness, muscle cramps or stiff fingers, and feeling confused or distressed [3, 8, 14]. During EEG tests, staff stop the over-breathing if the person develops chest pain [8].

Stop, and breathe normally and quietly, if you notice:

• dizziness, light-headedness or feeling faint
• tingling or numbness in your hands, feet, lips or face
• cramps or stiffness in your hands
• chest pain or tightness, a racing or irregular heartbeat, or breathlessness
• a headache, blurred vision or confusion
• rising panic or distress
• if you are pregnant: any of the warning signs listed above [5]

Sit or lie down until the feeling has passed. If you have chest pain, faint, or your symptoms don’t settle soon after you stop, get medical help straight away; in an emergency, call your local emergency number (112 in the EU, 999 in the UK).

Water, driving and breath holds. Label: Well studied. Never practise breathing exercises in water, in the bath or while driving. A CDC report describes healthy young swimmers who drowned after deliberately over-breathing and holding their breath underwater [18]. Breathwork researchers recommend practising only in a safe place, away from water and hard ground and anywhere fainting could be dangerous [3].

Before you start: a calm checklist

1. If any of the situations above applies, or you are unsure, talk to your doctor or midwife first. Take this article with you if it helps.
2. Keep taking any medication as prescribed. A breathing practice does not replace medical care.
3. Practise sitting comfortably, on a stable surface, never in water or while driving.
4. Keep the breath soft and natural: no breath holds, no forcing, no squeezing out the last bit of air.
5. Start with a few minutes and stop as soon as you feel any of the signs above.

If you want to know what slow breathing does in the body, read Slow breathing and heart rate variability; for what is known about longer out-breaths, see Long exhalation and the vagus nerve; and for a very gentle sound practice, see Humming and nitric oxide in the nose.

Where popular claims go beyond the evidence

Label for this section: Early evidence.

• “Breathing is natural, so any breathing exercise is safe for everyone.” Ordinary breathing is natural; deliberately fast breathing, long holds and straining are not, and they carry the risks described above [7, 8, 10].
• “Tingling and dizziness mean the practice is working.” During fast or forced breathing, these are typical signs of over-breathing [3, 8, 14]. They are a reason to stop, not to push on.
• “A gentle practice can’t hurt, so you don’t need to ask anyone.” Gentle practices do look low-risk, but side effects are often not even reported in studies [1, 3]. If you have a health condition or are pregnant, a short conversation with your doctor or midwife is still the safest first step.
• “Breathwork can replace medication.” No study cited here supports that. Never change or stop medication without your doctor.

How this relates to the Six Healing Sounds, Qigong and neigong

Label for this section: Tradition only (for Qigong concepts) · Well studied (for the general safety guidance above).

Liu Zi Jue, as described in our article on slow breathing, is built on a quiet in-breath through the nose and a soft, long out-breath carrying each sound. In our Six Healing Sounds forms the breathing is slow and controlled, for concentration, calm and safety, with no fast breathing and no breath holds, so it sits at the gentle end of breathing practices. Gentle does not mean suitable for everyone in every situation, though. Rushing the sounds, voicing them very loudly or pushing out the last bit of air can tip you into over-breathing or straining, which is why our long-exhalation article advises never to squeeze the out-breath.

Separately from the forms, after the deep music part of a session, we offer a gentle 4-4-4 breath to help you come back and settle: in for 4, a short pause for 4, out for 4. The count is your own, not seconds, so you stay completely comfortable and never force it. The pause is a soft rest with the throat relaxed, not holding your breath against a closed throat. If even a short pause feels like effort, or if any of the situations above applies to you, simply leave it out and breathe naturally. And as everywhere in this article: if you feel dizzy, tingly, short of breath or unwell, stop and breathe normally.

Qigong and neigong traditions sometimes describe sensations such as warmth or tingling as qi moving. That is a traditional way of describing experience, and it is worth knowing on its own terms. But it is not a safety test: dizziness, numbness, chest pain or rising panic during practice are signs to stop and breathe normally, whatever framework you use. A good teacher of any tradition will tell you the same and adapt the practice to you.

Resonance Heritage Qi is a personal, music-assisted practice inspired by Liu Zi Jue: connected to it, not a replacement for the traditional form or for study with a teacher of that tradition. It is not a treatment, and nothing in this article suggests that the practice is safe or helpful for any particular condition. That is a question for your doctor.

Sources

1. Wayne PM, Berkowitz DL, Litrownik DE, Buring JE, Yeh GY, 2014. What do we really know about the safety of tai chi?: A systematic review of adverse event reports in randomized trials. Archives of Physical Medicine and Rehabilitation 95(12):2470–2483. https://doi.org/10.1016/j.apmr.2014.05.005
2. Fincham GW, Strauss C, Montero-Marin J, Cavanagh K, 2023. Effect of breathwork on stress and mental health: a meta-analysis of randomised-controlled trials. Scientific Reports 13:432. https://doi.org/10.1038/s41598-022-27247-y
3. Fincham GW, Epel E, Colasanti A, Strauss C, Cavanagh K, 2024. Effects of brief remote high ventilation breathwork with retention on mental health and wellbeing: a randomised placebo-controlled trial. Scientific Reports 14:16893. https://doi.org/10.1038/s41598-024-64254-7
4. NHS. Exercise in pregnancy. Accessed 18 October 2026. https://www.nhs.uk/pregnancy/keeping-well/exercise/
5. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice, 2020. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 804. Obstetrics & Gynecology 135(4):e178–e188. https://doi.org/10.1097/AOG.0000000000003772 (online: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period)
6. Moolyk AN, Wilson MK, Matenchuk BA, Bains G, Gervais MJ, Wowdzia JB, Davenport MH, 2025. Maternal and fetal responses to acute high-intensity resistance exercise during pregnancy. British Journal of Sports Medicine 59(3):159–166. https://doi.org/10.1136/bjsports-2024-108804
7. Goldstein DS, Cheshire WP Jr, 2017. Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver. Clinical Autonomic Research 27(6):361–367. https://doi.org/10.1007/s10286-017-0474-y
8. Association of Neurophysiological Scientists (ANS) and British Society for Clinical Neurophysiology (BSCN), 2013. Guidelines for hyperventilation during EEG recordings (version 1.3). https://www.bscn.org.uk/data/files/Guidelines/Hypervent.pdf
9. NHS. Low blood pressure (hypotension). Accessed 18 October 2026. https://www.nhs.uk/conditions/low-blood-pressure-hypotension/
10. Salvati KA, Beenhakker MP, 2019. Out of thin air: hyperventilation-triggered seizures. Brain Research 1703:41–52. https://doi.org/10.1016/j.brainres.2017.12.037
11. Holmes MD, Dewaraja AS, Vanhatalo S, 2004. Does hyperventilation elicit epileptic seizures? Epilepsia 45(6):618–620. https://doi.org/10.1111/j.0013-9580.2004.63803.x
12. Epilepsy Society (UK). Seizure triggers. Information updated January 2026, accessed 18 October 2026. https://epilepsysociety.org.uk/understanding-epilepsy/seizure-triggers
13. Papp LA, Klein DF, Gorman JM, 1993. Carbon dioxide hypersensitivity, hyperventilation, and panic disorder. American Journal of Psychiatry 150(8):1149–1157. https://doi.org/10.1176/ajp.150.8.1149
14. Meuret AE, Ritz T, 2010. Hyperventilation in panic disorder and asthma: empirical evidence and clinical strategies. International Journal of Psychophysiology 78(1):68–79. https://doi.org/10.1016/j.ijpsycho.2010.05.006
15. Guy’s and St Thomas’ NHS Foundation Trust. Recovery after hernia repair surgery. Last reviewed January 2026, accessed 18 October 2026. https://www.guysandstthomas.nhs.uk/health-information/hernia-repair/recovery-after-hernia-repair-surgery
16. Leeds Teaching Hospitals NHS Trust. General ophthalmic post operative advice. Accessed 18 October 2026. https://www.leedsth.nhs.uk/patients/resources/general-ophthalmic-post-operative-advice/
17. Cambridge University Hospitals NHS Foundation Trust. Advice following ear surgery (version 8, approved 3 November 2023). Accessed 18 October 2026. https://www.cuh.nhs.uk/patient-information/advice-following-ear-surgery/
18. Boyd C, Levy A, McProud T, Huang L, Raneses E, Olson C, 2015. Fatal and nonfatal drowning outcomes related to dangerous underwater breath-holding behaviors: New York State, 1988–2011. Morbidity and Mortality Weekly Report 64(19):518–521. https://pubmed.ncbi.nlm.nih.gov/25996093/

Source quality note: [4], [5], [8], [9], [12] and [15]–[17] are clinical guidance or patient information from health services and professional bodies; they describe general practice, not breathing practices specifically. [1] and [2] are systematic reviews; [3] is a large randomised trial in healthy young adults of a fast breathing technique, far more intense than the practices on this site. [7], [10], [13] and [14] are reviews of physiology and clinical research; [13] is from 1993 and the exact link between breathing and panic is still debated. [11] is a single-centre study and [6] a small laboratory study (10 pregnant participants). [18] is a public-health case review. None of these sources studied the Six Healing Sounds.