Free Living a Healthy Life with Chronic Pain by Sandra M. LeFort, Lisa Webster, Kate Lorig, Halsted Holman, David Sobel, Diana Laurent, Virginia González, Marian Minor Page B

week increase your time in the garden by a maximum of 5 minutes. Once you can garden comfortably for 25 minutes, you can again add a few more minutes. Chapters 6 through 9 discuss ways to increase your physical activity safely.
    Finally, it is very important that you don’t smoke. It might seem strange to think that smoking affects chronic pain, but it does. Recent studies have found a 20 percent increased risk of chronic musculoskeletal pain (such as back pain) in smokers.
    Since we know that being exposed to secondhand smoke is also a health risk, you may want to avoid smokers as well. This can be difficult because smoking friends may not realize how they may be impacting your health. Your job is to tell them. Explain that you would appreciate it if they would not smoke when you are around. Also, make your house and especially your car “no smoking” zones. At home, ask people to smoke outside. In the car, tell them they can smoke before they get in or after you reach your destination.
    There are several tools that can help with better, more effective breathing. Here we describe two effective techniques:
Diaphragmatic Breathing
    Ineffective breathing can be caused by a deconditioned diaphragm (a large muscle at the bottom of your rib cage) and breathing muscles in the chest, as well as by poor posture. In either case, the lungs are not able to function prop-erly—that is, they do not fill well, nor do they get rid of old air effectively. Most of us mainly use our upper lungs and chest for breathing. But we can breathe more deeply if we use diaphragmatic breathing, called “belly breathing.” When you do this breathing technique properly, the diaphragm moves down into the abdomen and allows your lungs to expand fully with air. Diaphragmatic breathing strengthens the breathing muscles and makes them more efficient, so breathing is easier and more oxygen is available to the body.
    Interestingly, babies belly breathe instinctively with little effort. For adults, though, deep breathing requires a little practice to learn to fully expand the lungs. These are the steps to practice diaphragmatic breathing:
Lie on your back with pillows under your head and knees.
Place one hand on your stomach (at the base of your breastbone) and the other hand on your upper chest.
Breathe in slowly through your nose, allowing your stomach to expand outward. Imagine your lungs filling with fresh air. The hand on your stomach should move upward, and the hand on your chest should not move or should move only slightly.
Breathe out slowly, through pursed lips. At the same time, use the hand that is on your stomach to gently push inward and upward on your abdomen.
Practice this technique for 10 minutes, three or four times a day, until it becomesautomatic. If you begin to feel a little dizzy, rest or breathe out more slowly.
    You can also practice diaphragmatic breathing while sitting in a chair.
Relax your shoulders, arms, hands, and chest. Do not grip the arms of the chair or your knees.
Think about your posture. Sit straight, gently slide your chin back, and feel your neck lengthen. Imagine the top of your head being gently tugged upward toward the ceiling. You may notice your abdominal muscles tightening just a little.
Put one hand on your stomach and the other on your chest.
Breathe in through your nose, filling the area around your waist with air. The hand on your chest should remain still and the hand on your stomach should move.
Breathe out without force or effort.
    Once you are comfortable with this technique, you can practice it almost anytime, while lying down, sitting, standing, or walking. Diaphragmatic breathing and paying attention to your posture can help strengthen and improve the coordination and efficiency of the breathing muscles. It also decreases the amount of energy needed to breathe and reduces overall muscle tension in your body. It can be incorporated with any of the relaxation techniques that use the power of your mind to