The difference between thoracic breathing (chest breathing) and abdominal breathing is generally in the different breathing effects. Thoracic breathing, also known as ribbed breathing, transverse breathing, and shoulder breathing, relies on lateral expansion of the ribs for inhalation, utilizing the external intercostal muscles to lift the ribs as well as expand the thorax, and lifting the shoulders during inhalation, with the breath inhaled shallowly. Thoracic breathing is seen in some female healthy adults, but is also common in patients with severe chronic airway disease and abdominal disorders. Abdominal breathing, accomplished by increasing the activity of the diaphragm and decreasing the movement of the chest cavity, is the primary form of breathing in healthy people, especially adult males and children. Abdominal breathing uses the diaphragm to rise and fall to expand the upper and lower volume of the chest cavity and improve ventilation. Chest breathing is generally adequate for daily life, while abdominal breathing can be adapted to more intense exercise, more forceful speech as well as singing and stage performance.