Strelnikova paradoxical breathing

1. Introduction

Version followed: the method as presented by Mikhail N. Shchetinin, pupil and heir of A. N. Strelnikova and head of the A. N. Strelnikova Center for Breathing Gymnastics, in his AST editions (publisher previews), with Russian secondary sources (Cyclopedia, Pharmaceutical Herald 1995, RBC Style 2025, T—Zh 2026, Amosova's guide) filling gaps. Russian passages are translated briefly in this guide's own words and marked [translation]. [source: Shchetinin, Полный курс, preview; AST author page]

What it is. Strelnikova breathing gymnastics (дыхательная гимнастика Стрельниковой), often called "paradoxical" gymnastics, is a set of standing (or, if necessary, seated or lying) whole-body movements, each paired with a short, sharp, noisy sniff through the nose, while exhalation is left passive through the nose or slightly open mouth. It is "paradoxical" because the inhalation is taken on movements that compress or narrow the chest (bending, hugging the shoulders, squatting with a turn), the reverse of the usual cue to expand the chest on the in-breath, and because it reverses the usual emphasis on long exhalation and breath-holding. [source: T—Zh 2026; Pharmaceutical Herald 1995; Cyclopedia]

Origins. The method grew out of voice and breath exercises for singers and actors. Alexandra Nikolaevna Strelnikova (given as 1912–1989 in Shchetinin's book; died in a road accident) was an opera singer and teacher who worked in Moscow musical theatre; after losing her singing voice she developed the exercises with her mother, who is named in Shchetinin's preview only by the initials "А. С." and is described elsewhere as a singer with a heart condition. The mother's full patronymic ("Severovna") is [uncertain: not verified]. Shchetinin dates the method's official birth to a document of the People's Commissariat of Health of 29 April 1941; the war halted development, and in 1972 A. N. Strelnikova received author's certificate No. 411865 for a "method of treating diseases associated with loss of voice". Cyclopedia tells a separate story of a 1949 suffocation attack at home that she managed with the exercises; the dates in the various accounts do not fully agree [uncertain]. [source: Shchetinin, Полный курс, preview; RBC Style 2025; Pharmaceutical Herald 1995; Cyclopedia]

Mikhail Shchetinin. He came to Strelnikova as a directing student who had lost his voice, reports that the method restored his voice and nasal breathing and relieved his bronchial asthma, became her assistant for the last twelve years of her life, took a medical degree at her urging, inherited her archive, and reports holding patents on its use for respiratory disease and training physicians in it. These are his own biographical statements. [source: Shchetinin, Полный курс, preview; AST author page]

Core idea of change (as the authors state it). The authors hold that a short active in-breath is healthy and a long in-breath is a breathing disturbance; that movement-paired sniffs train the whole respiratory apparatus, fill the lungs "сверху донизу" ("from top to bottom" [translation]) and act on the nervous regulation of breathing, balancing cortical excitation and inhibition. These are the method's own explanations, not established physiology. [source: litres preview of Shchetinin; Pharmaceutical Herald 1995; Amosova preview]

Evidence status in brief. Official medicine does not recognise the method as a treatment; nearly all studies are in Russian or Ukrainian, small and uncontrolled, often combining Strelnikova with Buteyko exercises; no international trials or clinical-guideline recommendations specific to the method were identified [source: Cyclopedia; T—Zh 2026]. A rehabilitation physician quoted by RBC Style (E. Koneva, Medsi / Sechenov University) states there are no demonstrative studies of its effect in rehabilitation and that it is used alongside, not instead of, other therapy. Details by condition are in Section 4. It is not a treatment for asthma, COPD, COVID-19, cancer or any other physical disease, and clients must never change asthma or other medicines on its account. [source: RBC Style 2025]

Who delivers it. The authors' route is instruction by the Strelnikova Center and instructors and physicians it trains, or self-study from Shchetinin's books. No published route for psychotherapists to deliver it, and no statutory regulation of instructors, was identified [uncertain: not verified]. The psychotherapist's role in this guide is therefore screening, referral, informed consent, collaboration with the instructor and the client's physician, recognising over-breathing and other adverse effects, and integrating the experience into therapy. [synthesis]

2. Framework

The method is a set of exercises, not a staged psychotherapy; the authors describe no session count or formal phases [source: Cyclopedia; Amosova preview]. As published:

Format. Done standing; seated or lying if standing is not possible (for example, after a stroke, a post-stroke patient began the short sniffs in bed). Movements follow a marching rhythm, are organised into counted series with short rests, and are practised regularly at home. Exact counts, series sizes and frequencies are given in the authors' books and are deliberately not reproduced here; the client learns them from the instructor or physician. [source: Cyclopedia; litres preview; Amosova preview; T—Zh 2026]
Order of learning. Learners begin with the warm-up exercise "Ladoshki" ("Palms") and add exercises gradually, with the authors stressing precise, regular performance and "strict discipline". Some exercises are deferred at first (RBC Style notes that "Hug the shoulders" is avoided in the first week by some learners) and condition-specific adaptations are given in the books. [source: Amosova preview; RBC Style 2025]
Movement between steps. The authors' criterion is correct, comfortable performance of the current exercise before adding the next; an injured limb starts on the healthy side. [source: Amosova preview; Cyclopedia]

Psychotherapy frame around it [synthesis]:

Screening and decision (one session or part of one): psychological and physical screening, discussion of evidence status, informed consent.
Medical clearance and referral: GP, cardiologist, respiratory or ENT physician as relevant; referral to an instructor of the Center or a physician who uses the method.
Learning phase: the client learns from the instructor; therapy sessions review experience and any adverse effects.
Integration: what the practice brings up (body awareness, sense of agency, anxiety about sensations), and how it fits the treatment plan.
Ending or maintenance: the client continues independently or stops; the therapist does not monitor counts or performance.

Criteria for moving on: clearance obtained before practice starts; no unexplained adverse symptoms before adding exercises; for clients with panic, a shared plan for interoceptive sensations before practising alone. [synthesis]

3. Guiding principles

The in-breath is short, active and noisy; the out-breath is left alone. The authors' core rule: "короткий, активный и шумный вдох" ("a short, active and noisy in-breath" [translation]); "На выдох не надо обращать внимания, он произойдет сам собой" ("no need to attend to the out-breath; it happens by itself" [translation]). Practical meaning: the therapist does not coach long exhalations or holds within this method. [source: Pharmaceutical Herald 1995]
Inhale on chest-compressing movement. Practical meaning: the method feels counter-intuitive; expect confusion and let the instructor correct form. [source: T—Zh 2026]
Every sniff is paired with a movement. Practical meaning: the method is physical exercise with breathing, so physical screening applies as for exercise. [source: Cyclopedia; RBC Style 2025]
Precision and regularity. The authors stress exact, regular practice. Practical meaning: support routine without turning practice into a performance test or a source of shame. [source: Amosova preview; synthesis]
Exercise-specific contraindications. The method's own literature restricts particular movements for particular conditions (Section 4). Practical meaning: screening is exercise by exercise, not yes or no. [source: Cyclopedia]
Adjunct, not replacement. "Следует проконсультироваться с врачом и не заменять дыхательными упражнениями терапию" ("consult a doctor and do not replace treatment with breathing exercises" [translation]). Practical meaning: no change to medicines; the client's physician stays in charge of physical illness. [source: RBC Style 2025]
Claims are the authors' own. Books in the method's literature carry titles claiming effects on "any illness" and cancer ("АнтиРак"). Practical meaning: name these as unproven claims and steer clients away from substituting the method for medical care. [source: AST author page; T—Zh 2026]
Watch for over-breathing. Repeated sharp inhalations can, in some people, produce hyperventilation effects (dizziness, tingling, cramping, panic). The opened method texts do not discuss this [uncertain]; the caution is drawn from general medical sources. Practical meaning: give clients a stop rule. [source: UMM Health; West Suffolk NHS; synthesis]
Never in or near water, and never while driving. Practical meaning: dizziness or faintness from over-breathing is dangerous in these settings. [synthesis]
Within competence. Practical meaning: unless the therapist has trained with the method's teachers, the therapist screens, refers and integrates, and does not teach the movement set. [synthesis]

4. Intervention inventory

Part A covers what the psychotherapist does around the method. Part B describes the method's own exercises descriptively so the therapist knows what the client is being taught and what to screen for; counts, series sizes, tempo and frequency are left to the instructor and the authors' books. All therapist wording is illustrative.

A1. Screening for physical contraindications

Purpose / when: before a client starts, or as soon as a client mentions practising it.
Steps:
1. Ask about the general contraindications named in the method's literature and commentary: head injury, high or uncontrolled blood pressure, kidney or gallstones, fever with weakness, internal bleeding [source: RBC Style 2025]. Note that the Center's own site is reported to list only internal bleeding and to allow practice with fever, a position T—Zh disputes [source: T—Zh 2026].
2. Ask about conditions specialists cited by T—Zh flag as risky: unstable cardiovascular disease (including recent heart attack or unstable angina), recent chest or abdominal surgery, severe respiratory failure, coughing up blood, active tuberculosis, facial injury or fracture [source: T—Zh 2026].
3. Ask about the exercise-specific restrictions (head and spine injury, disc problems, hernia, radiculitis, osteochondrosis, raised intracranial or intraocular pressure including glaucoma, high myopia, epilepsy, chronic headache, serious heart disease, thrombophlebitis, pregnancy); see Part B for which movements each affects [source: Cyclopedia].
4. Any yes means medical clearance before practice (A3).
Example language (illustrative): "This is a fairly vigorous exercise routine as well as a breathing method. Before you start, I'd like to check a few things about your heart, blood pressure, eyes, back and neck, and whether you could be pregnant."
Watch for: minimising ("it's only breathing"); clients already practising despite a listed condition. Working: the client can name which exercises, if any, they have been told to avoid.

A2. Screening for psychological risk

Purpose / when: at the same point as A1.
Steps [synthesis, drawing on the general breathwork cautions and hyperventilation sources]:
1. Ask about panic disorder or panic attacks, health anxiety, breathing-pattern problems (sighing, air hunger), fainting history, seizures, psychosis or bipolar disorder, and severe dissociation.
2. Where over-breathing is suspected, a breathing-pattern disorder screen such as the Nijmegen Questionnaire may be used as the instrument's own guidance and licensing allow (it is the hyperventilation-symptom measure used in the Cochrane asthma review) [source: Cochrane, Santino et al. 2020].
3. For panic clients, decide with the client whether the method is postponed, practised only with the instructor present, or folded into a CBT plan (A6).
Example language (illustrative): "The breathing here is quick and sharp. For some people that brings on dizziness or a racing heart, which can feel like panic. Has anything like that happened to you with breathing or exercise before?"
Watch for: fear of bodily sensations; a wish to use the method to "fix" panic quickly. Working: a shared, written plan for what the client does if sensations rise.

A3. Medical clearance and referral

Purpose / when: whenever A1 or A2 raises a concern, and for any client with asthma, COPD, heart disease, pregnancy or a voice disorder.
Steps:
1. Ask the client to discuss the method with their GP or specialist (cardiologist, respiratory physician, ENT or phoniatrician for voice problems), naming the exercises involved.
2. Say clearly that prescribed treatment, including inhalers and other asthma medicines, stays unchanged [source: RBC Style 2025].
3. Refer for teaching to an instructor of the Strelnikova Center or a physician who uses the method; the Center is directed by M. N. Shchetinin [source: AST author page]. Instructor credentialing outside the Center is [uncertain: not verified].
4. With consent, share relevant screening findings with the instructor.
Example language (illustrative): "Please keep taking everything your doctor has prescribed. This would sit alongside that, not replace it, and I'd like your doctor to know you're trying it."
Watch for: reluctance to tell the doctor; plans to cut medication. Working: written or verbal clearance recorded.

A4. Informed consent and the evidence conversation

Purpose / when: before practice starts; again if the client brings in strong claims from books or websites.
Steps: explain what the method is, its origins in voice training, that it is not recognised by official medicine as a treatment, and the evidence by area as below. Record consent. [synthesis]
Evidence by area:
- Voice: the method began as voice restoration and its 1972 author's certificate concerns treating voice-loss disorders; Shchetinin reports his own voice recovery. No controlled voice studies were identified [uncertain: not verified]. [source: Shchetinin, Полный курс, preview; RBC Style 2025]
- Asthma: authors and the 1995 Pharmaceutical Herald article claim benefit; no international trials or guideline recommendations specific to the method were identified [source: Pharmaceutical Herald 1995; T—Zh 2026]. The Cochrane review of breathing exercises for adult asthma (22 randomised trials, mainly yoga, Buteyko, pranayama, Papworth and breathing retraining) found a small short-term gain in quality of life and fewer hyperventilation symptoms at moderate certainty, with unclear effects on asthma control and lung function; Strelnikova or paradoxical breathing does not appear among the listed interventions, so those findings cannot be transferred to it [source: Cochrane, Santino et al. 2020].
- COPD: a small Ukrainian programme study (23 patients aged 40–60, control and main groups, randomisation not stated) combined paradoxical Strelnikova and Buteyko exercises and reported better respiratory measures [source: Kovaleva & Kovalyova 2022].
- COVID-19 pandemic: a single-group before-and-after study in 51 healthy schoolchildren used a course based on Buteyko and Strelnikova methods and reported gains on breath-hold tests and vital capacity; it measured no infection outcomes [source: Semenova et al., Human. Sport. Medicine]. Trials of the method in COVID-19 rehabilitation specifically were not identified [uncertain: not verified].
- Children with lower respiratory infections: a 2026 quasi-experimental study in India examined Strelnikova exercises; its results are [uncertain: not verified] [source: Renita et al. 2026].
- Rehabilitation generally: "no demonstrative studies", per a rehabilitation physician; used alongside other therapy [source: RBC Style 2025].
- Mental health: breathing may help relaxation and anxiety but does not treat severe depression or anxiety [source: T—Zh 2026].
- Cancer and "all diseases": titles in the method's literature make such claims; no evidence supports the method as a treatment for cancer or other physical disease [source: AST author page; T—Zh 2026].
Example language (illustrative): "There's a long tradition and lots of personal reports behind this, but very little research, and none that shows it treats asthma or any other illness. People mostly use it as a vigorous daily routine. If you'd like to try it as that, alongside your treatment, we can."
Watch for: hope that the method will replace treatment; disappointment when claims meet evidence. Working: the client can describe the method in their own words as an adjunct.

A5. Psychoeducation on over-breathing and a stop rule

Purpose / when: before first practice, for every client.
Steps:
1. Explain that breathing faster or deeper than the body needs lowers carbon dioxide in the blood, which can bring dizziness, tingling or numbness around the mouth and in the fingers, cramping in the hands or feet, chest tightness, a racing heart, and fear or panic; very low levels can cause fainting and, rarely, seizures [source: UMM Health].
2. Explain that over-breathing can become a habit that keeps symptoms going [source: West Suffolk NHS].
3. Agree a stop rule: at dizziness, tingling, cramping, chest pain or fear, stop, sit, and let breathing settle quietly; seek medical help for chest pain, fainting or symptoms that do not settle [source: UMM Health; synthesis].
4. Agree: never in or near water (bath, pool, open water) and never while driving or operating machinery [synthesis].
Example language (illustrative): "If you feel light-headed, tingly or crampy, that's a sign of breathing off too much carbon dioxide. Stop, sit down, and let your breathing go quiet and slow on its own. You don't have to push through anything."
Watch for: clients who read symptoms as "detox" or progress. Working: the client restates the stop rule unprompted.

A6. Working with panic and the CBT frame

Purpose / when: clients with panic disorder or health anxiety who want to use the method. [synthesis throughout; no source for the method addresses this]
Steps:
1. Clarify the function: a daily exercise routine, not an in-the-moment rescue for panic.
2. Discuss the CBT debate that breathing techniques used to avert feared sensations can act as safety behaviours that maintain fear.
3. Because the sharp sniffing may itself provoke dizziness or a racing heart, decide with the client whether to postpone the method until panic treatment is under way, or to treat those sensations explicitly as feared sensations within a planned exposure frame.
4. Review predictions before practice and what actually happened after.
Example language (illustrative): "If doing this makes your heart race, what do you predict will happen? Let's write that down and compare it with what you notice."
Watch for: escalating checking of breath or pulse; using the routine to escape anxiety. Working: fear of sensations reduces; practice is not used as an escape.

A7. Voice clients (singers, actors, teachers, people who stutter)

Purpose / when: clients drawn to the method for its voice-training origin, or for stuttering, which followers report it helps [source: RBC Style 2025; Pharmaceutical Herald 1995].
Steps: ensure assessment by ENT or a speech and language therapist or phoniatrician first; treat the method as an adjunct to their plan; explore performance anxiety and identity loss around the voice in therapy. [synthesis]
Example language (illustrative): "Before we add breathing work, has a voice specialist looked at your throat? Losing your voice as a performer is a big loss in itself, and we can make room for that here."
Watch for: self-treatment of a hoarseness lasting weeks without examination. Working: a specialist is involved.

B0. The core breathing rule (applies to every exercise)

Purpose / when: the element all exercises share; the authors treat it as the method's essence.
Description (as published): a short, sharp, audible sniff through the nose, likened to a clap, taken at the moment of a movement; shoulders down; exhalation passive and unattended, through the nose or a slightly open mouth; no holding of air in the chest and no forced out-breath; movements in a marching rhythm with silent counting in series and short rests between series. Specific numbers are in the authors' books and are taught by the instructor. [source: T—Zh 2026; Pharmaceutical Herald 1995; Amosova preview; Cyclopedia]
Therapist's role: recognise the rule when the client describes it; do not coach it unless trained. [synthesis]
Example language (illustrative): "So the in-breath is the quick, noisy part, and the out-breath you just let go. How does that feel compared with how you usually breathe?"
Watch for: forced exhalations or breath-holding creeping in (both contrary to the method's rule); over-breathing signs (A5). Working, by the client's report: the sniff and movement feel coordinated without strain. [source: Pharmaceutical Herald 1995; synthesis]

B1. "Ladoshki" («Ладошки», "Palms"), the warm-up

Purpose / when: the first exercise learned; a warm-up. [source: Amosova preview; Cyclopedia]
Description: standing straight, forearms raised with palms forward at about shoulder height; on each sniff the hands clench into fists as if grabbing something, and on the passive out-breath they relax open, fingers loose rather than spread. [source: Amosova preview]
Example language (illustrative): "Which part did your instructor start you with? Tell me what happens in your body during the hand part."
Watch for: tension in neck and jaw; light-headedness. Generally the least physically demanding exercise. [synthesis]

B2. "Pogonchiki" («Погончики», "Shoulder straps")

Purpose / when: an early arm exercise in the standard set. [source: Cyclopedia; T—Zh 2026]
Description: a pushing movement of the arms paired with each sniff; finer detail of the movement is [uncertain: not verified]. [source: T—Zh 2026]
Example language (illustrative): "Any shoulder or arm pain when you do that one?"
Watch for: shoulder injury; start on the healthy side if one arm is injured, as the method advises for arm exercises. [source: Cyclopedia]

B3. "Nasos" («Насос», "Pump")

Purpose / when: a core exercise of the set. [source: Cyclopedia; RBC Style 2025]
Description: forward bends with a sniff at the bottom of each bend, as if pumping. [source: T—Zh 2026; RBC Style 2025]
Contraindications as sources state them: low bending is forbidden with head or spine injury, disc displacement, hernia, radiculitis, osteochondrosis, high blood pressure, raised intracranial or intraocular pressure, gall, kidney or bladder stones, and high myopia [source: Cyclopedia; RBC Style 2025]. The method's books describe reduced-range versions for some of these [uncertain: not verified].
Example language (illustrative): "Your eye doctor mentioned pressure in your eyes. Bending low is one of the moves the method itself says to avoid with that, so let's check with your doctor first."
Watch for: headache, visual disturbance, back pain, dizziness on rising.

B4. "Koshka" («Кошка», "Cat")

Purpose / when: core exercise of the set. [source: Cyclopedia]
Description: a half-squat with a turn of the trunk to one side and then the other, sniffing on each turn. [source: T—Zh 2026; RBC Style 2025]
Example language (illustrative): "How are your knees and balance with the squatting turn?"
Watch for: knee or hip pain, loss of balance, falls risk in older clients. [synthesis]

B5. "Obnimi plechi" («Обними плечи», "Hug the shoulders")

Purpose / when: core exercise; the clearest example of inhaling on a chest-compressing movement. [source: Cyclopedia; T—Zh 2026]
Description: the arms are thrown across the chest as if hugging the shoulders, with a sniff on each hug. [source: Cyclopedia; RBC Style 2025]
Contraindications as sources state them: contraindicated for people with serious illness [source: Cyclopedia]; not advised in ischaemic heart disease or after a heart attack, and avoided in the first week [source: RBC Style 2025].
Example language (illustrative): "Since you've had heart trouble, this is one your cardiologist should look at before you try it."
Watch for: chest pain, palpitations, breathlessness: stop and seek medical advice.

B6. "Bolshoi mayatnik" («Большой маятник», "Big pendulum")

Purpose / when: a combined movement in the set. [source: Cyclopedia]
Description: a pendulum-like movement combining bending forward and leaning back with arching of the lower back. [source: Cyclopedia; synthesis from the contraindication wording]
Contraindications as sources state them: severe lumbar osteochondrosis or back trauma; plus the low-bending restrictions in B3. [source: Cyclopedia]
Example language (illustrative): "Does arching back bring on any back pain?"
Watch for: back pain, dizziness on changing head position.

B7. Head exercises: head turns, "Ushki" («Ушки», "Ears") and "Maly mayatnik" («Малый маятник», "Small pendulum")

Purpose / when: neck and head movements in the set. [source: Cyclopedia; RBC Style 2025]
Description: turning the head side to side; tilting the head towards each shoulder ("Ears"); a small pendulum movement of the head, each with a sniff. Details of the small pendulum are [uncertain: not verified]. [source: Cyclopedia; RBC Style 2025]
Contraindications as sources state them: sharp head movements are prohibited with head injury, high blood pressure, raised intracranial or intraocular pressure, epilepsy, chronic headache, and severe cervical or thoracic osteochondrosis. [source: Cyclopedia]
Example language (illustrative): "With your seizure history, the quick head movements are ones the method itself rules out. Let's make sure your neurologist knows."
Watch for: dizziness, headache, neck pain, any seizure-like event (urgent medical review).

B8. "Perekaty" («Перекаты», "Rolls")

Purpose / when: a stepping exercise in the set. [source: Cyclopedia]
Description: rocking or rolling weight from one leg to the other in a step stance, with sniffs on the weight shifts. [source: RBC Style 2025; finer detail uncertain]
Example language (illustrative): "How steady do you feel shifting weight like that?"
Watch for: balance problems, leg pain. [synthesis]

B9. "Shagi" («Шаги», "Steps"), forward and backward

Purpose / when: stepping exercises closing the standard set. [source: Cyclopedia]
Description: stepping movements lifting the legs forward and backward, with a sniff on each step. [source: Cyclopedia; RBC Style 2025; finer detail uncertain]
Contraindications as sources state them: restricted for serious heart disease (ischaemic heart disease, congenital heart defects, previous heart attack); caution in pregnancy and thrombophlebitis. [source: Cyclopedia]
Example language (illustrative): "Because you're pregnant, the method's own literature advises caution here. Your midwife or obstetrician should be the one to say yes."
Watch for: calf pain or swelling, breathlessness, chest symptoms.

B10. "Vzlet vpered" («Взлёт вперёд», "Take-off forward")

Purpose / when: listed among the exercises in one popular account; not in the Cyclopedia list, so its place in the canonical set is [uncertain]. [source: RBC Style 2025]
Description: arm circles paired with sniffs. [source: RBC Style 2025]
Watch for: shoulder problems. Example language (illustrative): "Is this one your instructor teaches, or one from a book or video?"

B11. Adapted practice seated or lying

Purpose / when: when standing is impossible (illness, frailty, after stroke). [source: Cyclopedia; litres preview of Shchetinin]
Description: the same sniff-and-movement rule in a seated or lying position, adapted by the instructor or physician. [source: Cyclopedia]
Example language (illustrative): "Your physiotherapist and doctor are the right people to adapt this while you're recovering. I'm here for how it feels to be rebuilding your strength."
Watch for: practising in hospital or rehabilitation without the treating team's knowledge. [synthesis]

C1. Integration review in therapy

Purpose / when: at regular check-ins once the client is practising. [synthesis]
Steps: ask what the client noticed in body and mood; link experiences of agency and energy to therapy goals; explore any shame about missed practice; check symptoms against A5.
Example language (illustrative): "What did you notice this week, in your body and in your mood, on the days you practised and on the days you didn't?"
Watch for: rigid, perfectionistic practice; use of the routine to avoid feelings. Working: practice is flexible and the client can talk about it with curiosity.

C2. Responding to adverse effects

Purpose / when: any report of dizziness, fainting, chest pain, palpitations, seizure, visual change, persistent headache, pain, or panic linked to practice. [synthesis; symptom list from UMM Health]
Steps: advise stopping; arrange medical assessment (urgent for chest pain, fainting or seizure); inform the instructor with consent; record; review whether to resume only after clearance.
Example language (illustrative): "Please pause the exercises until your doctor has checked this. It's not a failure on your part; it's information."
Watch for: clients pushing on because books promise healing.

C3. Ending or maintenance

Purpose / when: when therapy ends or the client decides to continue or stop the practice. [synthesis]
Steps: review what the practice has and has not done for the client; confirm the stop rule and medical-care plan remain; leave the routine to the client and instructor.
Example language (illustrative): "If you keep this up after we finish, what would tell you it's time to stop or check with your doctor?"
Watch for: the method becoming the client's only route to coping.

5. Handling problems

The method's literature addresses physical restrictions (Section 4) but not psychological difficulties; the responses below are [synthesis] unless a source is given.

Client wants to stop medication or treatment because books promise a cure. Name the claims as the authors' own; quote the rehabilitation physician's advice not to replace treatment with breathing exercises; involve the prescriber; do not proceed with integration work until the treatment plan is safe. [source: RBC Style 2025; AST author page]
Dizziness, tingling, cramping or panic during practice (over-breathing). Stop, sit, let the breath settle without forcing; medical review if chest pain, fainting or seizure; consider whether the client is unconsciously speeding up or adding extra breaths; discuss with the instructor before resuming. [source: UMM Health; West Suffolk NHS]
Practice used as a panic-escape ritual. Reframe it as a daily routine; work on the feared sensations within CBT; consider postponing the method (A6).
Overwhelm or emotional release. The method is not designed as an emotional-release breathwork, but vigorous breathing can still stir feelings or memories. Slow down, ground in the room, and process in session; if a client seeks intense cathartic breathwork, see the Domain VII Holotropic Breathwork guide and its cautions instead of using this method for that purpose.
Non-adherence. Explore meaning rather than push targets; the authors' emphasis on "strict discipline" can fuel shame in perfectionistic or depressed clients [source: Amosova preview]. Agree a version the client and instructor find realistic.
Rigid over-practice. Notice compulsive counting or distress at missed sessions; treat as a clinical theme (perfectionism, obsessional traits) rather than a method issue.
Stuck: "I'm doing it and nothing changes." Revisit what the client hoped for against the evidence (A4); separate realistic gains (feeling energised, a sense of agency, enjoyment of routine) from disease claims.
Conflicting instructions from books, videos and instructors. Versions differ in exercise lists and details (for example, "Take-off forward" appears in one account only) [source: RBC Style 2025; Cyclopedia]. Encourage the client to follow one qualified teacher and to tell the doctor which version they use.
Rupture: client feels the therapist dismisses a method that helped them or their family. Acknowledge the personal and cultural meaning of the method, popular in Russia and former Soviet countries [source: T—Zh 2026]; repair by separating respect for their experience from the safety questions.
Fever, acute infection or flare-up. The Center's site is reported to permit practice with fever, while T—Zh disputes this; advise following the treating doctor's guidance during acute illness. [source: T—Zh 2026]
Pregnancy, children and older adults. Pregnancy needs obstetric clearance (stepping exercises carry the method's own caution) [source: Cyclopedia]; children practise only with parental consent and the paediatrician's knowledge, and with an adult present; older adults need falls and cardiac screening. [synthesis]
Water and driving. Repeat that practice is never done in a bath, pool or open water, or while driving, because over-breathing can cause faintness.

Sources

Web sources:

Books:

Shchetinin, M. N. (2007). Дыхательная гимнастика А. Н. Стрельниковой (2nd ed.). Moscow: Metafora. As cited by Cyclopedia [uncertain: not verified].
Shchetinin, M. N. Полный курс дыхательной гимнастики Стрельниковой. Moscow: AST (preview only; print year [uncertain]).

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