{
  "resourceType": "ActivityDefinition",
  "id": "diaphragmatic-breathing",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/diaphragmatic-breathing",
  "version": "1",
  "name": "DiaphragmaticBreathing",
  "title": "Diaphragmatic / Rib Expansion Breathing Exercises",
  "status": "draft",
  "experimental": true,
  "description": "Physiotherapeutic breathing exercises targeting diaphragmatic excursion and rib cage expansion. Patient practices belly breathing in supine progressing to seated and standing. Significantly improves chest expansion, spinal mobility (especially lateral flexion), and posture. Equally effective as yoga and Pilates for improving spinal mobility while enhancing respiratory function.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "diaphragmatic-breathing",
          "display": "Diaphragmatic / Rib Expansion Breathing Exercises"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "thoracic-spine",
          "display": "Thoracic Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "5261000",
          "display": "Structure of thoracic intervertebral disc"
        }
      ],
      "text": "Thoracic Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "10 breaths × 3 sets, 2-3x daily; 4-count inhale, 6-8 count exhale"
    }
  ],
  "usage": "Evidence: moderate. Improves chest expansion, spinal mobility, and posture comparably to yoga/Pilates [Csepregi 2022]",
  "note": [
    {
      "text": "Soft belly rises before chest — let the diaphragm drop",
      "authorString": "focus:internal"
    },
    {
      "text": "Push the band outward with your lower ribs",
      "authorString": "focus:external"
    },
    {
      "text": "Pursed-lip exhale slow, like fogging a mirror",
      "authorString": "focus:external"
    },
    {
      "text": "Hands on lower ribs — feel them spread sideways",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    },
    {
      "type": "citation",
      "label": "csepregi-breathing-posture-2022",
      "citation": "Csepregi É, Gyurcsik Z, Veres-Balajti I, et al.. (2022). Effects of Classical Breathing Exercises on Posture, Spinal and Chest Mobility Among Female University Students Compared to Currently Popular Training Programs",
      "document": {
        "url": "https://doi.org/10.3390/ijerph19063728"
      }
    },
    {
      "type": "citation",
      "label": "eftekhari-breathing-kyphosis-2024",
      "citation": "Eftekhari E, Sheikhhoseini R, Salahzadeh Z, Dadfar M. (2024). Effects of Telerehabilitation-Based Respiratory and Corrective Exercises Among the Elderly With Thoracic Hyper-Kyphosis: A Clinical Trial",
      "document": {
        "url": "https://doi.org/10.1186/s12877-024-04779-8"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Diaphragm"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5798000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Transversus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "86493009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Internal Oblique"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "External Oblique"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    }
  ]
}