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Every month, we see another research study or social media post on breathing training. I usually click and read the points and hope that something new, or pardon the pun, inspiring was shared online. After seeing the same arguments and positions repeated, I figured I would write something practical so those who invest time in breathing can get something out of their time, and those who are not overzealous about it can feel comfortable knowing that they’re not missing out. Not taking a side is hard because nobody is happy when extreme positions are incorrect. In this post, I cover the gamut on breathing, ranging from mindfulness recovery breathing all the way to spirometry tools. Breathing is a big business now, and it seems that everyone is trying to attach themselves to this market. If you’re an athlete, sports medicine professional, coach, or a weekend warrior, this article is for you.
A Different Perspective on Respiration Adaptations
I won’t write too much about breathing, and I’ll stick firmly to the science that’s proven and accepted by the community rather than explore areas that don’t do justice to the human body. Respiration is a natural and vital component of living, and we are programmed to breathe. Simply put, respiration is an exchange of gas. It also has some secondary benefits that leverage the anatomy and biochemistry of the event. Instead of embracing the power of transporting oxygen, it seems we’ve put way too much focus on what can go wrong instead of what is likely working well. As coaches, it’s easy for us to focus on the lungs and surrounding muscle groups that control breathing, but we need to move past muscle strengthening and think big picture. I’m all for doing the basics and keeping things simple, but breathing is hardly a good example of sports training.
It’s helpful to know that these two things determine performance: oxygen levels in the body during extreme prolonged effort and the exchange of carbon dioxide. Coaches tend to focus too much on the mechanics of what they see rather than the outcome of the body—in this case extracting oxygen from the lungs and exhaling the carbon dioxide out of the bloodstream. Let’s not overthink this, as some coaches want to coach everything. As soon as you open Pandora’s box, you may not push all the problems back in if you’re not highly skilled in respiration training. Instead of worrying about a diagram of the rib cage, go through the administrative checklist to learn who has asthma or sickle cell anemia. You can do other screenings beyond reported diseases and health impairments to know if your athletes have a genuine problem or not. A conditioning test not only shows how many meters or yards they can run in a game but also ensures that their basic pulmonary function is working.
Anatomically, the diaphragm of the rib cage would be seductive to see, as many readers are fans of muscle systems. But it’s more important to look at the roots of the tree, rather than rehashing the extraction points of the lungs. In earlier articles, I outlined oxygen transfer in enough detail to reinforce the value of what the lungs are doing. But if I were to write those posts again, I would include more information on capillaries and how the circulatory system adapts to support the lungs. Tidal volume doesn’t change much at rest; it’s the maximal outputs that force a complex arborization that improves an athlete.
Instead of thinking about adaptations to lungs or the mechanics, you’ll be better off thinking about the root system. Coaches should consider what it takes to make deep, long term chronic adaptation rather than chase things that usually fall into place or put too much emphasis on altitude camps or low carbohydrate training.
Breathing Dysfunction and Athlete Performance
The Postural Restitution Institution certification tends to polarize coaches into two camps, either staunch advocates or critics of the education. I stay away from schools of thought and keep an open mind to what someone is trying to do. I believe in the organization’s intentions and have followed them since the late 1990s. Posture and body alignment are always subjects in flux, and a lot of attention has been paid to breathing over the last ten years. I’m concerned that we’ve spent too much time trying to be specialists in a topic we simply are not trained to manage. As coaches, we need to teach biofeedback of effort and reinforce breathing skills, not try to diagnose or fix an athlete. For years, I’ve spent a lot of time assessing breathing because athletes are so anxious and worried that they’ll resort back to dysfunction. I decided it was time to write an article on the topic.
I’ve been part of breathing reduction for years. Athletes go through insane amounts of trauma from their experiences on the field (broken ribs) to what happens off the field (emotional injury). The question is, how many genuinely have a limiting breathing problem that’s reducing health and performance? Observing and palpating the chest cavity have merit, but frankly, the number of people who are real experts on changing or restoring an athlete is small. If you’re not trained to do respiration rehabilitation and are not licensed to diagnose these functions, it’s not professional to assume a problem that may not exist. On the other hand, credit the out of box thinkers for worrying about something that can be taken for granted.
Later in this article, I cover assessment. As we talk about dysfunctions, we need to ask, what is the likelihood someone is actually suffering a breathing disorder? The probability is very low. While athletes may not be perfect mechanical breathers, they’re unlikely to have a limiting problem or impairment. I do understand the nature of physiological issues, such as exercise-induced asthma and exercise-induced bronchoconstriction. Add in bronchial hyper-responsiveness or even sleep apnea, breathing impairments are common, but they’re not solved by activating muscle groups or blowing up a balloon. While we can manage the symptoms slightly with changes in exercise, it’s likely we’ll find the answer in pharmacology and navigating the doping restrictions of medications.
Can Breathing Exercises Increase Aerobic Capacity?
From the research, we know it’s possible to improve breathing performance using supportive exercises with non-athletic populations. I don’t disagree with the possibilities of an athlete improving with specific breathing exercises; I question how many of them have improved due to using external devices rather than a conscious effort from instructional exercises. I’m very skeptical about artificially strengthening the inspiratory muscles. Most of the research results come from inspiratory muscle training (IMT), not general core muscles that we commonly know. In my experience, a change requires very little isolation work; a good holistic approach to training usually enables natural adaptations to work on their own. The market for IMT devices is still going strong, and at times athletes may benefit from using them, but the majority of elite athletes are unlikely to see any benefits at all. Though I’m cautious about recommending artificial devices, I do keep an open mind.
Current research demonstrates that specific IMT training works for some in disease populations who can’t exercise, and those in endurance settings can make small gains if they have an injury restriction. One IMT study with patients who underwent bypass surgery found that simple exercise provided all the needed benefits if the activity was intense enough. This makes me even more skeptical. IMT does not appear to help aerobic capacity with healthy athletes, and we have known this for a while.Inspiratory muscle training does not seem to improve aerobic capacity with healthy athletes, says @spikesonly. #IMT Click To Tweet
I find that the devices are fine for return to play, but are not effective unless an athlete is experiencing a real need. Again, for twenty years, we’ve seen very little evidence outside of a few fluke studies, and not with well-trained endurance athletes showing impressive performance changes. Usually, the more fit the athlete, the more ability they have to recruit the specific muscles from training. I also believe that many endurance athletes who participate in violent power exercises, who don’t have coordination issues at high speeds with their respiratory muscles, are fine and don’t respond greatly to extra breathing work. If an athlete is struggling to have their respiration mechanics keep up with their physiology, then an intervention makes sense. I’ve seen a few examples where an athlete stopped below their physiological limits because of severe mechanical breathing issues other than asthma and similar disorders.
If you’re an endurance athlete, it’s worth experimenting, provided you also look at the spirometry values from season to season. I also recommend it as a way to assess an athlete specifically, and that comes from direct measures and conditioning tests. I don’t care if an athlete can blow up a home swimming pool—their ability to cope with duress during heavy loads often separates who tests well and who performs well. Both isolation testing and fitness are needed to succeed. The only way to really know if IMT works is to assess, and often the hardest working athletes are already maxed out. Remember, lungs usually are not what holds an athlete back; it’s the biochemical limitations of removing the waste products, not taking in oxygen. VO2Max testing is kind of a misnomer, as it’s really about finding the tipping point of how the body is functioning rather than an absolute measure of oxygen utilization.
Does Breath Work Help Recovery?
One muse to this article was the embarrassing social media surge about how athletes can recover better between bouts by putting their hands on their knees or hands behind their heads. I was thrilled that we had research investigating posture and recovery, but disappointed that the researchers cherry-picked nasal breathing using a nose clip. Sure, some coaches may have recommended an athlete recover from heavy training that way by raising their arms up, but we’re missing the big picture. Watch any modern sport except for endurance events and ask if the athletes are going all out for four straight minutes. A middle distance runner sometimes will collapse and lie on the ground supine, breathing on their back, not caring about the next day or their parasympathetic reactivation. Bending over in team sports may or may not be a sign of toughness or psychological advantage, but seeing the court and not one’s feet could be. For the most part, anything can be sold to an athlete so they feel powerful, including bent over breathing like a wolf. The real issue is the actual long term benefit of posture during training, and if anything really increases the success rate.
Most coaches will fixate on recovery through stress management after training. Maybe it’s not the real load that provides the actual training for athletes but the life around it. Paced breathing is known to help manage stress and physiological strain, but does coaching it to the point of breaking down the mechanics to the individual muscle groups make a difference? I don’t believe so, as the evidence does not support this notion.
As for breathing interventions, specifically guided breathing rather than coaching the mechanics, the research is very supportive. The question is, what is the value or impact for training outcomes? Improving HRV (heart rate variability) is great, but what is its long term worth regarding speed, conditioning, or power? Lowering residual stress hormones is enticing, but for real tangible benefits, coaches want to see results that speak to them, such as athletes who test faster and fitter.Focused breathwork makes a difference, and the sleep data we collected showed impressive trends during heavy training and travel, says @spikesonly. Click To Tweet
Paced breathing and sleep work, we know that. But how can we keep an athlete interested in spending time managing stress with mindfulness training and breathing exercises every day? I don’t have an answer, though I do value some of the work from Eric Renaghan, who uses relaxation techniques with his athletes. Using steam with essential botanical oils helps athletes get comfortable and calm. I know there are other options available for autogenic training. Still, I find the techniques above are the most practical and safe way to take breathing to the next level without making it a chore (other than using air filters). Focused breathwork makes a difference, and the sleep data we collected showed impressive trends during heavy training and travel.
What About Evaluation and Objective Testing?
Athletes who struggle during training and competition should see a medical professional with a sport background—a medical doctor or a professional working in a hospital setting. I say this firmly because I see way too many athletes, or parents of athletes, explaining a “diagnosis” by a coach rather than a trained medical professional. A coach or trainer may have suspicions, but they can’t form a diagnosis from a brief exchange of symptoms. An athlete needs testing—formal appraisal—to determine if they have breathing dysfunctions or disorders. I’ve seen more psychological collateral damage to athletes who are afraid to breathe. Anxiety is a huge problem in today’s modern world, and having to worry about how you are breathing doesn’t help the cause.
Spirometry tests and gas measures of oxygen and carbon dioxide transfer are available now. You don’t need to be a genius to administer the tests or even interpret the results, but you need to do your homework if you’re adding this battery to your athlete assessments. Assessing athlete respiratory function is a good idea that could screen some issues if used wisely. The main goal of breathing tests, other than quantifying core respiration metrics, is to create sophisticated and reasonable monitoring strategies in case a problem emerges later or to see if an athlete might benefit from an intervention. If you’re pushing training—not just conditioning but all modalities—an athlete should improve their respiratory strength at maximal intensity without specific breathing training. In fact, a fitter athlete with great training will gain confidence from their perspiration that could help reduce the anxiousness of competition. For healthy athletes, knowing they are normal (or better than normal) is far more useful than making assumptions from an eyeball test.
The Most Important Intervention Is You
Many coaches and sports medicine professionals are chasing their tails with breathing exercises. When a real problem occurs, I recommend referring out and working with a specialist. A modern strength coach is more educated and more skilled than ever before, but I’m worried that the foundational components of training are lost in the attempt to cover the bases. It seems the Johnny Parker adage of “going an inch wide and a mile deep” has been replaced with a “jack of all trades and a master of none.” Breathing will take care of itself; you only need to know when a situation should be elevated to a professional. An athlete who trains properly and receives emotional support from coaches and loved ones will have more resilience and better breathing when it counts. Focusing too much on the frosting and not baking the cake leaves athletes ill-prepared for competition.