[Young journalist Hayoon Cho] A research team led by Professor Paul H. Min of the Department of Radiology at Mayo Clinic has quantitatively analyzed, through human experiments, how breathing affects the flow of cerebrospinal fluid (CSF) while people are awake. The researchers said their findings suggest that systematic breathing training may influence both the amount of CSF movement and its net flow.

Cerebrospinal fluid circulates between the brain and spinal cord, supplying nutrients, carrying immune signals, removing waste products, and helping maintain brain homeostasis. Previous studies have shown that CSF circulation becomes especially active during sleep, but research on how different breathing patterns affect CSF flow while people are awake has been limited.

The study involved 20 participants who had practiced systematic breathing training for at least one year and 25 participants with no previous breathing-training experience. The researchers used the Seokmun Hoheup program, developed by Korea’s Seokmun Domun, as the breathing-training model.

Real-time phase-contrast magnetic resonance imaging (PC-MRI) was used in the study. Participants performed both regular breathing (RB), in which they breathed normally, and deep breathing (DB), in which they intentionally took deeper breaths. Researchers then measured CSF flow at the foramen magnum (FM), where the skull meets the spinal cord, and in the lateral ventricles (LV) deep inside the brain.

During deep breathing, CSF displacement at the foramen magnum in the trained group reached 0.594 mL, about 2.7 times higher than the 0.220 mL measured in the untrained group. Net CSF flow was also higher in the trained group, at 70.28 μL compared with 37.28 μL in the untrained group, about 1.9 times as high.

Differences between the two groups were also observed during regular breathing. At the foramen magnum, CSF displacement in the trained group was about 2.85 times higher than in the untrained group. In the lateral ventricles, displacement and net flow were approximately 2.7 times and 2.5 times higher, respectively.

The researchers paid particular attention to the finding that significant net CSF flow was detected in the lateral ventricles during regular breathing. The lateral ventricles are located deep in the brain, close to the hippocampus and entorhinal cortex, which are associated with memory, and have generally been considered relatively less affected by cardiac pulsation and respiratory pulsation.

The groups also showed clear differences in breathing patterns. The average inhalation time in the trained group was 5.05 seconds, about 1.9 times longer than the 2.65 seconds recorded in the untrained group. Diaphragm displacement during breathing was also significantly greater in the trained group.

The research team explained that inhalation duration and diaphragm movement were the respiratory variables most strongly correlated with CSF displacement and net flow. Their analysis suggests that, rather than simply inhaling a larger volume of air, taking a longer breath in and allowing the diaphragm to move more fully may be more closely related to CSF dynamics.

Using structural equation modeling (SEM), the researchers also analyzed the pathways through which breathing may affect CSF flow. They found that breathing influences CSF movement through both a mechanical pathway driven by changes in pressure inside the chest and an autonomic nervous system pathway related to heart-rate regulation.

In the mechanical pathway, downward movement of the diaphragm changes pressure within the thoracic cavity, promotes venous return, and physically drives CSF movement. In the autonomic pathway, breathing rhythm influences heart rate through respiratory sinus arrhythmia (RSA), indirectly affecting CSF flow.

At the foramen magnum, both the mechanical and autonomic pathways appeared to contribute, while in the lateral ventricles the mechanical pathway associated with diaphragm movement had a relatively greater influence.

The researchers described the mechanism by which breathing rhythm affects fluid dynamics inside the brain as a form of “respiration technology.” However, because this study compared a relatively small number of trained and untrained participants, its results should not be interpreted as evidence that breathing practice can prevent or treat specific brain diseases.

Professor Min’s team said it plans to conduct follow-up clinical studies to investigate whether these findings could be relevant to brain-health management in older adults and to the prevention of cognitive decline associated with conditions such as dementia and Alzheimer’s disease.

The study was published in Volume 16 of the international journal Nature Communications as article number 11499.

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