Breathing Exercises for SMA: 5 Techniques You Can Do at Home

For a child with spinal muscular atrophy (SMA), every breath can take real effort. The muscles that control breathing — the diaphragm, the intercostal muscles — gradually weaken. Breathing becomes shallow, coughing becomes weak, and mucus doesn't clear properly. The result is frequent respiratory infections and a risk of serious complications.

Regular breathing training is one of the main lines of defense. It won't cure SMA, but it can help preserve what function remains and slow the decline in respiratory function.

Why Breathing Training Matters in SMA

Five concrete reasons to practice regularly:

1. Slowing the decline in respiratory function. Targeted exercises help maintain the strength and endurance of the breathing muscles — as much as is possible with a progressive disease.
2. Improving ventilation. Techniques like diaphragmatic breathing teach a child to breathe more efficiently — increasing vital capacity (VC, the maximum volume of air a person can inhale and exhale), so oxygen reaches the blood more fully.
3. Strengthening the cough. A cough isn't the enemy — it's a defense mechanism: it's what clears mucus from the airways. Training helps a child cough more forcefully, keeping mucus from building up.
4. Reducing pulmonary complications. Effective coughing and good ventilation lower the risk of pneumonia and atelectasis — a condition in which a section of the lung collapses and stops taking part in breathing.
5. Improving quality of life. Better breathing means it's easier to talk, play, and learn. Less shortness of breath means more possibilities.

Practical Methods: 5 Techniques

Important. All exercises should be carried out under the guidance of a physician (a pulmonologist or rehabilitation specialist) and a physical therapist. The program is built individually, based on the type of SMA, the severity of the condition, and the child's age. The methods below are a guide, not a ready-made prescription.

Technique 1. Diaphragmatic (Abdominal) Breathing

Goal: to strengthen the diaphragm — the primary muscle of inhalation — and improve breathing efficiency.

How to do it:

1. Lay the child on their back or in a semi-reclined position. Knees slightly bent (a pillow underneath can help).
2. One hand rests on the chest, the other on the belly.
3. The child breathes in slowly through the nose. The belly rises like a balloon. The hand on the chest stays still — that's the sign that the diaphragm is doing the work.
4. Exhale through pursed lips (as if blowing out a candle), slowly and evenly. The belly gently falls. The exhale should be roughly twice as long as the inhale.

Frequency: several times a day, 5–10 minutes each. The key is to stop before the child gets tired.

Technique 2. Chest Expansion

Goal: to increase chest mobility and improve lung volume.

How to do it:

1. The child sits or lies on their back. The parent gently places their hands on the child's lower ribs, one on each side.
2. On the inhale, the parent applies light resistance with their hands — as if opening a book. The child tries to "push apart" the parent's hands, expanding the rib cage.
3. On the exhale, the resistance is released and the chest returns to its starting position.

Frequency: 5–10 deep breaths per set, 2–3 sets a day.

Technique 3. Respiratory Muscle Training (With Equipment)

Goal: to specifically strengthen the muscles of inhalation and exhalation.

How to do it:

Special trainers are used — for example, the Threshold IMT and Threshold EMT. These are small devices with adjustable resistance:

• IMT (inspiratory muscle trainer): the child inhales through the device against resistance. This strengthens the diaphragm and the accessory muscles of inhalation.
• EMT (expiratory muscle trainer): the child exhales forcefully against resistance. This is especially important for strengthening the cough.

Note. The resistance level, frequency, and duration of training should be determined only by the therapist based on an assessment. The load should never be increased on your own.

Technique 4. Effective Coughing and Cough Assistance

Goal: to teach the child to cough more effectively, or to help when their own strength isn't enough.

The "Ha" technique: the child takes a deep breath, then exhales sharply and briefly with a "Ha! Ha! Ha!" sound — as if trying to fog up a piece of glass. This mimics the exhalation phase of a cough and helps loosen mucus.

Manual Assisted Cough: after a deep breath, at the moment of coughing or saying "Ha," the parent applies a quick, directed push with their hands to the lower chest / upper abdomen — inward and upward. This creates an extra burst of airflow and strengthens the cough. The technique and the amount of pressure to use should be demonstrated in person by a therapist.

Mechanical assistance (Cough Assist): for children with a very weak cough, a doctor may prescribe a mechanical insufflator-exsufflator device. It delivers air under pressure (inhalation), then quickly creates negative pressure (exhalation), mimicking a cough. It is used only as prescribed and under a specialist's supervision.

Technique 5. Positioning and Postural Drainage

Goal: to use gravity to help clear mucus from the lungs.

How to do it:

Under a physician's or therapist's guidance, the child is placed in specific positions — for example, on their side, or with the hips raised and the head lowered. This helps mucus drain from the small bronchi into the larger airways, where it's easier to cough out. Gentle back patting (percussion) can also be used — but only with the correct technique, which a specialist should demonstrate.

When to use it: typically in the morning and before bed, when mucus tends to build up most. Also during flare-ups and respiratory infections.

Safety: 7 Rules

1. An individualized approach is the foundation. There's no universal protocol. Intensity, frequency, and the set of exercises are determined based on an assessment — taking into account the child's lung function, muscle strength, and endurance.
2. Comfort comes first. Practice when the child is feeling well. Stop immediately if you notice: rapid or labored breathing, bluish skin color, distress, heavy sweating, or a racing pulse. The simple rule: "a bit of effort is fine, but never pain or fear."
3. Increase the load gradually. Start small — short sessions, minimal intensity. Build up gradually, guided by how well the child tolerates it.
4. Keep the airways moist. Offer the child water before and after training (if there are no contraindications). A room humidifier can help thin the mucus.
5. Infection prevention. Trainer mouthpieces, cough-assist tubing, and any other parts that come into contact with the child must be thoroughly cleaned and disinfected. Don't train in a room with someone who is sick.
6. Work with the medical team. Breathing training is part of comprehensive care. Regular lung function checks, vaccination (flu, pneumococcal), and, when needed, noninvasive ventilation (BiPAP) and medication-based mucus management. Review the program with the doctor periodically.
7. Make training fun. Games, music, stories, timed challenges — anything that engages the child. Parental support and praise are the best motivators.

A Marathon, Not a Sprint

Breathing training isn't a one-time effort — it's a daily habit. It won't reverse the disease, but research and clinical experience confirm that regular, well-designed sessions slow the decline in respiratory function, reduce the frequency of dangerous lung infections, and help a child breathe more freely.

Every exercise is a small step. But small steps add up to a journey.

Book a consultation, and we'll help put together a breathing-training program for your child.