Volitional Yoga Breathing for Smokers: Development, Validation, and Feasibility of a 30-Minute Breathing-Only Intervention for Smoking Cessation and Pulmonary Rehabilitation.

Background Cigarette smoking is a major preventable cause of morbidity and premature mortality. It is associated with respiratory symptom burden, impaired pulmonary function, and high relapse rates during quit attempts. Relapse is often driven by nicotine craving, stress, and emotional dysregulation. Volitional yoga breathing (VYB) has shown potential benefits for reducing craving, improving emotional regulation, and supporting pulmonary health. However, no standardized breathing-only intervention has been developed specifically for smokers. The purpose of this study was to develop and validate a structured 30-minute VYB module and assess its feasibility and acceptability among chronic smokers. Methods The study employed a three-phase design. Phase 1 involved the development of a structured VYB module based on classical and contemporary yoga texts, supported by relevant scientific literature. Phase 2 comprised expert validation by 32 qualified yoga professionals using a 3-point Likert scale, with content validity quantified using Lawshe's content validity ratio (CVR). Phase 3 evaluated feasibility in 20 high nicotine-dependent smokers, assessed using the Fagerström Test for Nicotine Dependence (FTND > 7), in a single-arm pre-post design in which participants completed 20 supervised 30-minute sessions over four weeks. Feasibility was assessed through intervention fidelity, participant feedback, and instructor ratings, while preliminary effects were examined through changes in smoking urges and pulmonary function from baseline to four weeks. Results The final module retained nine yoga breathing practices that met the content validity threshold (CVR ≥ 0.31). Feasibility outcomes demonstrated a 100% acceptance rate and an 80% retention rate over the intervention period, with no adverse events reported. The instructor rated all practices as easy to learn and implement, while participants found them highly satisfactory, useful, and simple. At the end of four weeks, frequency and intensity of smoking urges showed significant reductions of 38.5% (p < 0.001) and 39.4% (p = 0.004), respectively, alongside a significant improvement in pulmonary function, with forced expiratory volume in 1 second (FEV₁) increasing by 17.98% (p < 0.001). Conclusions This study provides smokers with a structured, validated VYB module that is acceptable, safe, and feasible, with promising preliminary efficacy in reducing smoking-related urges, supporting cessation efforts, and improving pulmonary function. The findings highlight the potential clinical and public health relevance of this low-cost, nonpharmacological, breathing-only intervention for smoking cessation and pulmonary rehabilitation.