Introduction: Various breathing exercises promote relaxation, reduce blood pressure and heart rate. However, findings from existing literature indicated that some of these exercises have more effect on systolic blood pressure (SBP), some on diastolic blood pressure (DBP) and some lower blood pressure only but not heart rate (HR). Some studies reported no immediate effect on SBP, DBP and Heart rate following breathing exercise.  It is unclear whether combining different breathing exercises at a time have an immediate positive effect on SBP, DBP, HR and peripheral oxygen saturation (SPO2) at rest and after exercise and whether the combination has more effect than individual techniques. Aim: The purpose of this study was to investigate immediate effect of combining 4-7-8, Box and Pursed lip breathing patterns at a time on SBP, DBP, HR and SPO2 at rest and after exercise. Method: Following ethical approval (ref: SHREC/2024/4721) by the Health Research Ethics Committee, Kano State Ministry of Health, Kano Nigeria, eighty healthy young adults (18 – 25 years) with normal BMI (Mean ± SE: 20.72 ± 0.19) were recruited into the study. HR, SBP, DBP and SPO2 of the participants were recorded at rest and after one session of combined 4-7-8, box and pursed lip breathing patterns. The participants were then divided into two groups, intervention and control groups,  both performed five minutes of fast walking (using a treadmill speed of 4-mph). At the end of this exercise, the intervention group performed the same pattern of combined breathing exercise as described above. HR, SBP, DBP and SPO2 of the participants from the two groups were recorded at exactly one-minute after fast walking. IBM SPSS version 26 was used for data analysis, paired t-test was used to compare the baseline variables recorded before and after breathing exercise while independent t-test was used to compare variables between the two groups recorded after exercise. Results: A significant decrease in resting HR, SBP and DBP was recorded after one session of combined 4-7-8, box and pursed lip breathing patterns (Mean ± SE: HR 82.26 ± 1.33 – 79.05 ± 1.40, p=0.001; SBP 114.42 ±1.24 – 109.94 ± 1.14, p=0.001; DBP 80.44 ± 1.06 – 76.51 ±1.03, p=0.01). No significant change in SPO2 was observed (p=0.35). Independent t-test revealed significantly lower HR, SBP and DBP (82.04 ± 1.39, 117.18 ± 1.36 and 80.11 ±1.16) in the intervention group than in the control group (89.61 ±1.38, 124.21 ± 1.35 and 84.07 ± 1.28). The decline in HR was significantly higher with the combine pattern than with individual technique (Mean ± SE: Combine, 7.58 ± 1.08; individual, 4.90 ± 0.83; p=0.02). Conclusion: One session of combined 4-7-8, box and Pursed lip breathing caused immediate decrease in HR, SBP and DBP at rest and after exercise. Furthermore, the combine pattern was more effective in lowering heart rate after exercise than individual technique.