Acid reflux

Also called: GERD; heartburn

Exercise strongly helps Strength Breathing

Burning behind the breastbone, worse lying down or after a big meal. The valve at the top of the stomach is partly formed by the diaphragm - which means it is a muscle, and muscles can be trained.

How common: ~20% of adults in Western countries have weekly symptoms

Open the Digestion & Gut Comfort routine All problems

What it is

Reflux happens when stomach contents pass upward past the lower oesophageal sphincter. That sphincter is not purely a ring of smooth muscle: the crural diaphragm wraps around the oesophagus at the same point and forms an external component of it, tightening with each breath.

That anatomical detail is the reason breathing training turns up as a treatment. Trials of diaphragmatic breathing exercises show reduced reflux symptoms and reduced acid exposure, presumably by improving the function of that external sphincter - which is a genuinely unusual example of a muscle exercise treating a digestive problem.

What it feels like

Burning behind the breastbone, often rising toward the throat
Worse lying down, bending over, or after a large or late meal
An acid or bitter taste, sometimes with regurgitation
A persistent cough, hoarseness or the sensation of a lump in the throat
Sometimes chest pain that can be difficult to distinguish from cardiac pain

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

A weak or frequently relaxing lower sphincter: The sphincter should stay closed except when swallowing. Transient inappropriate relaxations are the commonest mechanism, and they increase with a distended stomach.
Poor crural diaphragm function: The diaphragm forms the external part of the sphincter. Weak or poorly coordinated diaphragmatic function reduces that support, which is why breathing training helps and why it is so rarely offered.
Hiatus hernia: Part of the stomach sliding up through the diaphragm separates the two components of the sphincter, so they no longer act at the same point. It is common and it substantially worsens reflux.
Raised abdominal pressure: Central obesity, pregnancy, tight clothing and heavy lifting with a held breath all push stomach contents upward against the sphincter.
Large or late meals: A distended stomach triggers more sphincter relaxations, and lying down within a few hours removes gravity's help. This combination is the classic trigger.
Specific foods and drinks: Alcohol, caffeine, chocolate, peppermint and fatty meals all reduce sphincter tone. Citrus and spicy food tend to irritate an already inflamed oesophagus rather than causing the reflux itself.
Smoking: Smoking reduces sphincter pressure and reduces saliva, which normally helps neutralise refluxed acid. It affects both mechanisms.
Delayed stomach emptying: Anything slowing gastric emptying - some medications, diabetes-related gastroparesis, a very high fat meal - keeps the stomach distended for longer and increases the exposure.
Some medications: Calcium channel blockers, nitrates, some asthma drugs and anticholinergics all reduce sphincter tone. Anti-inflammatories irritate the lining directly.
Certain exercise positions: High-impact activity, and anything inverted or with sustained abdominal compression, increases reflux episodes. This is a reason to choose the activity rather than to avoid exercise.

Who tends to get it

Anyone with central weight gain
Pregnant women, in whom it is very common in later pregnancy
Smokers and regular drinkers
People with a hiatus hernia
Anyone eating late and lying down soon afterwards

What makes it worse, and what settles it

Makes it worse

Large meals, particularly late in the evening
Lying down within three hours of eating
Alcohol, caffeine, chocolate and high-fat meals
Tight waistbands and heavy lifting with the breath held
Smoking

Settles it

Diaphragmatic breathing training, which has trial evidence for reducing symptoms and acid exposure
Raising the head of the bed, which uses gravity for the whole night
Not eating within about three hours of lying down
Losing central weight, which reduces the pressure driving it
Regular moderate exercise, which improves symptoms - though not immediately after eating

What actually helps

The short version: Incompetent lower esophageal sphincter; the crural diaphragm forms part of that sphincter and can be trained

Strength work: Core: Diaphragm - diaphragmatic breathing training; avoid heavy loaded Valsalva while symptomatic

Stretching: Trunk; Chest

Massage: Not primary

Also worth doing: Meal timing; head-of-bed elevation; weight loss

What the evidence says: Diaphragmatic breathing training reduced reflux episodes and PPI use in RCTs. Small literature but consistent and low-risk.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routineDigestion & Gut Comfort

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Open this routine in my Checklist

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Difficulty swallowing, vomiting blood, unexplained weight loss, or anemia - urgent endoscopy

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Positional and meal-timing changes help within days. Breathing training shows benefit over four to eight weeks and is worth doing properly rather than casually. Medication is effective and is not a failure, though long-term acid suppression has its own considerations worth discussing with a prescriber. Difficulty swallowing, food sticking, unintentional weight loss, vomiting blood or black stools are alarm symptoms needing prompt investigation - and chest pain that could be cardiac should always be treated as cardiac until it is excluded.

Prevalence basis: Systematic reviews of GERD prevalence

Others the same routine covers

These share the Digestion & Gut Comfort routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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