By Shannon WIllits, Master Pilates Instructor, FAFS
Joseph Pilates built his entire method around breath. It’s one of his original six principles, standing alongside centering and control, treated as the engine of the work rather than a detail layered on afterward. Gastroparesis, in an odd way, proves him right.
Gastroparesis means the stomach empties too slowly. No blockage. No obstruction. Just a nervous system signal that isn’t landing the way it should. The body runs on rhythm, and this is what happens when one part of that rhythm falls out of step.
The vagus nerve runs this show. It coordinates the rhythmic contractions that move food from stomach to small intestine, a kind of internal drumbeat that keeps digestion moving forward. When vagal signaling is weak or delayed, the beat drops. Food sits. Nausea builds. Bloating follows. Blood sugar swings. Diabetes is the leading known cause. Others follow abdominal surgery, certain medications, GLP-1 receptor agonists among them, viral illness, or no identifiable cause at all.
Breathwork does not treat gastroparesis. It works with the tissue and the breathing patterns that surround it. That distinction matters, and it’s worth stating plainly before anything else.
The Diaphragm Is a Fascial Hub, Not Just a Breathing Muscle
Anatomically, the diaphragm connects through the esophageal hiatus, through the crura into the lumbar spine, through the central tendon, through the deep front fascial line running from jaw to foot. Few structures in the body sit at that kind of crossroads. Dissection makes this obvious: nothing in the abdomen moves in isolation from how the diaphragm moves.
Think of the diaphragm as the metronome for everything below it. When its rhythm gets shallow or erratic, that unsteadiness ripples outward. A digestive complaint rarely starts at the stomach. It starts at the diaphragm losing its beat. This is exactly why Pilates work rarely isolates the diaphragm from the rest of the body — every exercise asks the breath to organize the trunk first, and the limbs follow. Powerhouse, centering, the core canister: all of it depends on the diaphragm doing its job as the hub it actually is.
Breath Changes the Nervous System State
Slow, diaphragmatic breathing increases vagal tone. It shifts the nervous system from sympathetic drive toward parasympathetic, rest and digest. Gastric emptying depends on parasympathetic input. Improving that input doesn’t reverse nerve damage. It does create the conditions where whatever function remains has a better chance of working.
Every diaphragmatic breath is also a pump, and every pump keeps time. The diaphragm descends. Intra-abdominal pressure rises slightly. Abdominal contents compress, gently, rhythmically. Exhale releases it. Connective tissue responds to consistent, gentle pressure changes far more than it responds to force. A slow, even rhythm does more for this tissue than any single hard push ever could, which is one reason breathwork shows up so often in pelvic floor and GI rehabilitation.
Where Most People Go Wrong
Force is the problem. A well-meaning cue to “engage your core” often turns into a hard abdominal brace, and a brace has no rhythm. It’s a held note where there should be a pulse. The transverse abdominis (TVA) should narrow gently on the exhale, not clamp. Bracing creates compensation. Compensation creates guarding. Guarding restricts the very pressure changes the gut relies on to move.
A properly sequenced exhale looks like this. Diaphragm ascends. TVA narrows the abdominal cylinder by roughly 20 to 30 percent, a narrowing, not a squeeze. The pelvic floor recoils upward. Multifidus supports the spine. Four systems, one coordinated pressure shift, moving on the same beat. This is almost word for word what Pilates instructors already cue when they say “scoop, don’t grip.” The method has understood for decades that a core moving with the breath does more than a core held against it.
Chronic digestive dysfunction almost always travels with dysfunctional breathing: chest breathing, breath holding, excess abdominal gripping. These patterns raise abdominal wall tension and amplify the sensation of bloating, independent of what’s happening at the level of gastric motility. Restore diaphragmatic excursion, restore the beat, and perceived pressure often drops, even when emptying time itself hasn’t changed.
A Pre-Meal Practice
Sit upright, feet supported. Inhale through the nose for four seconds, letting the lower ribs and abdomen expand in all directions, 360 degrees, not just forward. Exhale through pursed lips for six to eight seconds. In the final half of that exhale, narrow the waist gently, TVA engaging without gripping. Pause. Repeat five to ten breaths.
Slow. Relaxed. Never forced. This is less an exercise than a signal, telling the nervous system it’s safe to shift gears before a meal even begins — the same opening ritual that begins nearly every Pilates class, pointed at a different moment in the day.
What the Evidence Actually Supports
Diaphragmatic breathing improves vagal tone, reduces stress-related GI symptoms, improves abdominal pressure regulation, and reduces bloating in some individuals. It does not accelerate gastric emptying in established gastroparesis on its own. That limit deserves to be stated directly, because trust matters more than reassurance.
This work is an adjunct, sitting alongside medical management rather than replacing it. The goal is to reduce the muscular guarding and breathing dysfunction that compound the problem, so whatever capacity the gut retains isn’t further limited by tension it never needed to carry in the first place.
The Beat Underneath Everything
The breath won’t fix a nerve. It can stop getting in the nerve’s way. For many people, that alone changes how a meal feels, how the day settles, and how much tension gets carried without ever being noticed. Every system in the body is looking for a rhythm it can trust. The diaphragm is where that search usually begins, the same place Joseph Pilates chose to begin nearly a century ago.
As Joseph Pilates famously said: “After 10 sessions, you’ll feel the difference. After 20, you’ll see the difference. And after 30, you’ll have a whole new body.” A whole new body, built one steady breath at a time.
Shannon Willits, Master Pilates Educator
Shannon Willits is a Master Pilates Educator with more than 25 years of experience in functional movement, rehabilitation-informed training, and athletic performance. As the owner of seven growing Club Pilates studios in Lee County, Florida, she has become one of the region’s leading voices in Pilates education, mentoring and certifying aspiring instructors through comprehensive training programs rooted in movement science.
Shannon is STOTT Pilates certified, a Fellow of Applied Functional Science (FAFS), a Functional Golf Specialist, and a certified Gyrotonic® instructor. She is also an approved NPCP CEC Provider and the creator of the Pilates for Rotational Sports workshop, which blends performance training, injury prevention, and functional movement education for both athletes and instructors.