Breathing Pattern Assessment · Client Intake
Breathing Pattern Assessment
Before completing this form, do the BOLT test below. It takes 60 seconds and is the single most informative measure of your breathing function. Then work through each section — it takes around 8–10 minutes in total.
Sections: 6 Time: 8–10 minutes BOLT test: Do first
🫁 BOLT Test — Do This Before Filling in the Form
1
Sit quietly for 2 minutes. Breathe normally through your nose.
2
Take a normal breath IN through your nose.
3
Take a normal breath OUT through your nose. Then pinch your nose closed.
4
Count seconds until you feel the FIRST definite urge to breathe. Release nose and breathe normally. Note that number.
This is not a maximum breath hold. Stop at the first urge — the moment you feel air hunger. If you gasped when you released, you held too long. Repeat after 2 minutes rest. Enter your score in Section 2 below.
1 Client Details
2 BOLT Score & Breathing Metrics
Enter your BOLT score to see interpretation.
Resting Breathing Rate
Nasal vs Mouth Breathing
3 Overbreathing & Dysfunction Symptoms
Respiratory Patterns
Physical Symptoms
Cognitive & Emotional
4 Current Practice & History
Relevant History
5 Stress & HPA Axis Context
Very lowModerateVery high
1
2
3
4
5
6
7
8
9
10
6 Movement & Breath-Movement Preference

These questions help identify which breath-movement practice is most likely to suit your nervous system, energy level, and preferences — so the protocol recommendation fits how you actually move, not just how you breathe.

How Intensity Affects You
Movement Preferences
Slow, mindful movement
Breathing leads, body follows. Stillness is as important as movement. I prefer to feel what I'm doing rather than push harder.
Qi gong · Tai chi · Yin yoga · Feldenkrais · Walking meditation
Flowing whole-body movement
Sequences that flow from one position to another. Body control and awareness matter more than fitness. I enjoy the skill element.
Yoga · Animal movements · Pilates · Ginástica Natural · Mobility work
Functional strength and conditioning
I want to be strong and capable. Kettlebells, bodyweight, resistance training. Breath training to support performance not replace it.
Kettlebell · Calisthenics · CrossFit-style · Functional fitness
Endurance and cardiovascular
Running, cycling, swimming, sport. I want to go further and recover faster. Breathing efficiency is the limiter I want to address.
Running · Cycling · Swimming · Triathlon · Team sports
Currently limited — starting from low base
Energy, pain, or health limitations mean I need to start very gently. Small consistent practice matters more than intensity right now.
Gentle walking · Seated breath practice · Chair yoga · Light stretching
Existing Experience