The Role Of Aerobic And Diaphragmatic Breathing Exercises In Enhancing Cardiac Fitness And Hemoglobin Levels In Anemic Patients: A Narrative Review

Abstract

Anemia is a widespread condition marked by reduced hemoglobin levels, leading to impaired oxygen transport and compensatory cardiovascular and respiratory strain. While pharmacological and nutritional interventions remain central to treatment, non-pharmacological strategies—such as aerobic and diaphragmatic breathing exercises offer potential benefits in improving cardiac fitness and functional capacity in anemic patients. This narrative review explores the physiological rationale and clinical implications of incorporating these interventions into anemia management. Aerobic exercise enhances cardiovascular efficiency, promotes peripheral oxygen utilization, and improves endothelial function. Although it does not directly elevate hemoglobin levels, it reduces cardiac workload and increases functional endurance. Diaphragmatic breathing optimizes respiratory mechanics, reduces the work of breathing, and stimulates parasympathetic activity, thereby easing dyspnea and lowering myocardial oxygen demand. Together, these modalities can create a synergistic effect across the oxygen cascade—from enhanced pulmonary ventilation to improved tissue oxygen extraction. Evidence from related chronic conditions (e.g., heart failure, COPD, cancer-related anemia) supports the use of these exercises to improve quality of life, though direct studies in anemia populations are limited. Clinical application requires individualized exercise prescription, gradual progression, and careful monitoring, especially in severe anemia. While these interventions may not substantially raise hemoglobin, they contribute meaningfully to symptom relief and enhanced functional independence. This review underscores the need for further research to define optimal exercise parameters and evaluate long-term outcomes. Integrating aerobic and diaphragmatic breathing exercises with standard care offers a holistic approach to improving health outcomes in anemic individuals.