Improve Respiratory Muscle Strength

There is strong evidence that breathing muscles may become exhausted during both short term high intensity exercise (MMA, Boxing) and endurance exercise (marathon running, triathlons).

Respiratory system limitations can impact exercise performance in highly trained individuals (Boutellier et al. 1992), especially at high intensities, where the increased work of breathing results in compromised exercise performance (Harms et al. 2000).

Furthermore, respiratory muscle fatigue not only decreases the ability to ventilate adequately (Lomax and McConnell 2003), but also increases limb muscle sympathetic nerve activity (MSNA) (St Croix et al. 2000), which has been shown to reduce blood flow to the peripheral muscles (Sheel et al. 2001).

Further, the dyspnoea experienced may limit an individual’s ability to continue to exercise at the required intensity (Altose et al. 1985). Eur J Appl Physiol (2005) 94: 527–540

Restricting air intake during physical exercise provides the respiratory muscles with an extra load, which in turn works the breathing muscles more intensely to strengthen them.

Effects of hypercapnic-hypoxic training on respiratory muscle strength:

The aim of the present study was to determine the effects of an 8-week hypercapnic-hypoxic (H-H or breath holding) training program on respiratory muscles strength and 100 meter crawl swimming performance.

The study was conducted on a sample of 26 elite Croatian swimmers (experimental group [EG] n=12, control group [CG] n=14). Both groups were subjected to the same swimming training programs and training sessions on a treadmill.

The experimental group was additionally subjected to hypercapnic-hypoxic training program with increased muscular activity.

The group of swimmers, who were subjected to the hypercapnic-hypoxic regimen, has significantly improved strength of their inspiratory and expiratory muscles in comparison to swimmers in the control group. The swimmers from the experimental group have improved the inspiratory muscle strength values (MIP) for 14.9% and the expiratory muscle strength values (MEP) for 1.9% in relation to the control group.

Based on the results of this study it can be assumed that the hypercapnic-hypoxic practice has significantly increased the respiratory muscle strength. Statistically significant differences can be attributed to the eight-week exposure to hypercapnia and hypoxia combined with increased muscle activity.

Such practice may have enlarged the diaphragm thickness which plays an important role in respiratory system and sports performance. Voluntary holding of breath may have resulted in involuntary contractions of intercostal muscles during the hypercapnic-hypoxic practice.

It is also assumed that above mentioned contraction occurrence has resulted in hypertrophy of intercostal muscles. According to the available literature, mobility of breastbone and costal joints and changes in lung and breast muscle elasticity are also possible changes that occur during voluntary breath holding.

Dajana KARAULA, Jan HOMOLAK, Goran LEKO. Effects of hypercapnic-hypoxic training on respiratory muscle strength and front crawl stroke performance among elite swimmers. Turkish Journal of Sport and Exercise. Year: 2016 – Volume: 18 – Issue: 1 – Pages: 17-24

Delay the Onset of Lactic Acid and Fatigue -Improve Anaerobic Capacity

The Oxygen Advantage® improves sports performance from a number of related perspectives, including specially designed breathing exercises to lower blood oxygen saturation to achieve severe hypoxemia. (SPO2 80%- 90%) At the same time, a hypercapnic response is generated to further increase hydrogen ions.

Both effects greatly disturb blood acid base balance causing the body to make adaptations to delay the onset of fatigue. These exercises while challenging are simple, safe and highly effective. They involve no device and can be applied anywhere to help improve sports performance.

Applying The Oxygen Advantage® exercises enhances the lactate concentration in the muscles to help maintain a glycolytic state. It can be traumatizing to repeatedly perform exercises at high intensities to stimulate an anaerobic state. Training at a moderate intensity with breath holding could reduce the risk of injury.

While breath holding after an inhalation has been used by athletes since the sixties, results often fail to show a lowering of blood oxygen saturation. The Oxygen Advantage® exercises involve holding the breath following an exhalation and are uniquely designed for athletes to achieve hypoxia within a few days of practice. Patrick McKeown has been teaching this approach to thousands of individuals since 2002. Please find papers below showing increased stimulation of anaerobic glycolysis and improved swimming and running performance.

1. Improved Swimming Performance. Improved Anaerobic Capacity.

Time performance was significantly improved in trials involving breath holding following an exhalation [100m: – 3.7 ± 3.7s (- 4.4 ± 4.0%); 200m: – 6.9 ± 5.0s (- 3.6 ± 2.3%); 400m: – 13.6 ± 6.1s (-3.5 ± 1.5%)] but did not change in CONTROLS. In breath holding following an exhalation, maximal lactate concentration (+ 2.35 ± 1.3 mmol.L-1 on average) and the rate of lactate accumulation in blood (+ 41.7 ± 39.4%) were higher at Post- than at Pre- in the three trials whereas they remained unchanged in CONTROLS.

Under these conditions, there was also an increased lactate concentration, revealing a greater glycolytic activity as compared to the same exercise performed with normal breathing. Such results, already reported in terrestrial activities, were original in swimming. Conversely, in studies in which swimmers applied hypoventilation at high lung volume (i.e. inhale-hold), that is the classical technique used since the 1970’s, no hypoxic effect occurred and lactate concentration was not different or even lower than exercise with normal breathing.

Increased Lactate max reflects an improved anaerobic capacity and may be due to a greater ability to tolerate high concentrations of lactate and high level of acidosis, as reported after high-intensity training.

Woorons X, Mucci P, Richalet JP, Pichon A. Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance. Med Sci Sports Exerc. 2016 Jun;48(6):1119-28

2. Delayed Appearance of Blood Lactate

Five male subject performed 16 by 4 min cycling bouts alternating with 16 min rest periods. Breathing frequency was voluntarily controlled starting 10 s before each 3rd min of exercise and maintained throughout the rest of the exercise period. Four different breathing patterns at each exercise intensity were used: normal breathing (NB), breathing every 4 s, breathing every 8 s, and maximal Reduced Frequency Breathing.

Except for the NB trials, subjects held their breath at functional residual capacity during each breathing interval. The researchers concluded: results might indicate that reduced breathing frequency inhibited lactate removal from working muscles during exercise.

Yamamoto Y, Takei Y, Mutoh Y, Miyashita M. Delayed appearance of blood lactate with reduced frequency breathing during exercise. Eur J Appl Physiol Occup physiol. 1988;57(4):462-6.

3. Exposing the body to Increased Acidosis to Improve Buffering Capacity

Repeated prolonged expirations carried out down to residual volume during a submaximal exercise led to a drop of SaO2 down to 87% and was also accompanied by a marked hypercapnia. The severe arterial desaturation was caused by a PAO2 decrement, a widened PAO2 − PaO2 and a right shift of ODC.

We also reported a greater ˙VO2 and fh during PE than NB70 may be caused by the greater activity of the respiratory muscles and the adrenergic system. Finally, the prolonged expiration led to a greater blood acidosis, mainly hypercapnic and possibly also linked to a greater muscle acidosis.

Xavier Woorons, Pascal Mollard, Aur´elien Pichon, Alain Duvallet,Jean-Paul Richalet, Christine Lamberto. Prolonged expiration down to residual volume leads to severe arterial hypoxemia in athletes during submaximal exercise. Respiratory Physiology & Neurobiology 158 (2007) 75–82

4. Blood acidosis was reduced and the oxidative stress no more occurred

Repeated epochs of breath-holding were superimposed to the regular training cycling program of triathletes to reproduce the adaptative responses to hypoxia, already described in elite breath-hold divers [Respir. Physiol. Neurobiol. 133 (2002) 121].

After training, the duration of static apnea significantly lengthened and the associated bradycardia was accentuated; we also noted a reduction of the post-apnea decrease in venous blood pH and increase in lactic acid concentration, and the suppression of the post-apnea oxidative stress (increased concentration of thiobarbituric acid reactive substances).

After dynamic apnea, the blood acidosis was reduced and the oxidative stress no more occurred. These results suggest that the practice of breath-holding improves the tolerance to hypoxemia independently from any genetic factor.

Joulia F, Steinberg JG, Faucher M, Jamin T, Ulmer C, Kipson N, Jammes Y.Breath-hold training of humans reduces oxidative stress and blood acidosis after static and dynamic apnea. Respir Physiol Neurobiol. 2003 Aug 14;137(1):19-27.

5. Reduced oxidative stress and blood lactic acidosis in trained breath-hold human divers

We hypothesized that the repetition of brief epochs of hypoxemia in elite human breath-hold divers could induce an adaptation of their metabolic responses, resulting in reduced blood acidosis and oxidative stress.

Trained divers who had a 7-10 year experience in breath-hold diving, and were able to sustain apnea up to 440 sec at rest, were compared to control individuals who sustained apnea for 145 sec at the most. The subjects sustained apnea at rest (static apnea), and then, performed two 1-min dynamic forearm exercises whether they breathed (control exercise) or sustained apnea (dynamic apnea).

In divers, the changes in lactic acid, TBARS, RAA, and GSH concentrations were markedly reduced after static and dynamic apnea, as well as after control exercise. Thus, human subjects involved in a long duration training programme of breath-hold diving have reduced post-apnea as well as post-exercise blood acidosis and oxidative stress, mimicking the responses of diving animals.

Joulia F, Steinberg JG, Wolff F, Gavarry O, Jammes Y. Reduced oxidative stress and blood lactic acidosis in trained breath-hold human divers. Respir Physiol Neurobiol. 2002 Oct ;133(1-2):121-30.

6.Improved Sprint Ability in Swimming through enhanced anaerobic glycolysis

Repeated-sprint training in hypoxia has been shown as an efficient method for improving repeated sprint ability in team-sport players but has not been investigated in swimming.

Repeated sprint training in hypoxia induced by voluntary hypoventilation at low lung volume improved repeated sprint ability in swimming, probably through enhanced anaerobic glycolysis. This innovative method allows inducing benefits normally associated with hypoxia during swim training in normoxia.

Trincat L, Woorons X, Millet GP. Repeated Sprint Training in Hypoxia Induced by Voluntary Hypoventilation in Swimming. Int J Sports Physiol Perform. 2016 Jun 13.

7. Lower muscle oxygenation and higher blood lactate concentration: role of hypoxia and hypercapnia

This study demonstrated that exercise with voluntary hypoventilation induced a lower tissue oxygenation and a higher [La] than exercise with normal breathing. This was caused by a severe arterial O2 desaturation induced by both hypoxic and hypercapnic effects.

Eight men performed three series of 5-min exercise on a cycle ergometer at 65% of normoxic maximal O(2) consumption in four conditions: (1) voluntary hypoventilation (VH) in normoxia (VH(0.21)), (2) VH in hyperoxia (inducing hypercapnia) (inspired oxygen fraction [F(I)O(2)] = 0.29; VH(0.29)), (3) normal breathing (NB) in hypoxia (F(I)O(2) = 0.157; NB(0.157)), (4) NB in normoxia (NB(0.21)).

Using near-infrared spectroscopy, changes in concentration of oxy-(Delta[O(2)Hb]) and deoxyhemoglobin (Delta[HHb]) were measured in the vastus lateralis muscle. Delta[O(2)Hb – HHb] and Delta[O(2)Hb + HHb] were calculated and used as oxygenation index and change in regional blood volume, respectively. Earlobe blood samples were taken throughout the exercise.

Both VH(0.21) and NB(0.157) induced a severe and similar hypoxemia (arterial oxygen saturation [SaO(2)] < 88%) whereas SaO(2) remained above 94% and was not different between VH(0.29) and NB(0.21). Arterialized O(2) and CO(2) pressures as well as P50 were higher and pH lower in VH(0.21) than in NB(0.157), and in VH(0.29) than in NB(0.21). Delta[O(2)Hb] and Delta[O(2)Hb – HHb] were lower and Delta[HHb] higher at the end of each series in both VH(0.21) and NB(0.157) than in NB(0.21) and VH(0.29). There was no difference in Delta[O(2)Hb + HHb] between testing conditions. [La] in VH(0.21) was greater than both in NB(0.21) and VH(0.29) but not different from NB(0.157).

Woorons X, Bourdillon N, Vandewalle H, Lamberto C, Mollard P, Richalet JP, Pichon A Exercise with hypoventilation induces lower muscle oxygenation and higher blood lactate concentration: role of hypoxia and hypercapnia. European Journal of Applied Physiology. 2010 Sep;110(2):367-77.

8. Intermittent breath holding provokes consistent changes in muscle oxygenation, leading to lower tissue oxygenation

This study examined the effect of intermittent breath holding (IBH) on physiological response, including oxygenation in working muscle, to moderate-intensity exercise.

Thirteen men performed bicycle exercise for 5 min at 65% of peak oxygen uptake with normal breathing (NB) and with IBH. Muscle oxygenation, concentration changes of oxyhemoglobin (ΔOxy-Hb), deoxyhemoglobin (ΔDeoxy-Hb) and total hemoglobin (ΔTotal-Hb), in the right vastus lateralis were continuously monitored using near-infrared spectroscopy (NIRS). Finger capillary blood samples were taken after exercise for analyzing blood lactate concentration (BLa).

NIRS parameters showed acute changes to each BH episode in the IBH condition (Total-Hb and ΔOxy-Hb decreased, ΔDeoxy-Hb increased). Accordingly, in the IBH condition, ΔOxy-Hb was lower (P<0.05) and ΔDeoxy-Hb was higher (P<0.05) compared to that in the NB condition, whereas there was no difference in ΔTotal-Hb in the both conditions. BLa levels were greater (P<0.05) in the IBH condition compare to the NB condition.

These results suggest that IBH during moderate-intensity exercise provokes consistent changes in muscle oxygenation, leading to lower tissue oxygenation. Our data also indicate that exercise with IBH induces higher BLa.

Kume D, Akahoshi S, Song J, Yamagata T, Wakimoto T, Nagao M, Matsueda S, Nagao N. Intermittent breath holding during moderate bicycle exercise provokes consistent changes in muscle oxygenation and greater blood lactate response. J Sports Med Phys Fitness. 2013 Jun;53(3):327-35.

9. Voluntary Reduced exercise induced blood acidosis

This study investigated the effects of training with voluntary hypoventilation (VH) at low pulmonary volumes. Two groups of moderately trained runners, one using hypoventilation (HYPO, n = 7) and one control group (CONT, n = 8), were constituted.

In each session, HYPO ran 24 min at 70% of maximal O2 consumption (˙VO2max) with a breath holding at functional residual capacity whereas CONT breathed normally. A ˙VO2max and a time to exhaustion test (TE) were performed before (PRE) and after (POST) the training period.

The results of this study demonstrate that VH training did not improve endurance performance but could modify the glycolytic metabolism. The reduced exercise-induced blood acidosis in HYPO could be due to an improvement in muscle buffer capacity. This phenomenon may have a significant positive impact on anaerobic performance.

Xavier Woorons,, Pascal Mollard a, Aur´elien Pichon a, Alain Duvallet, Jean-Paul Richalet, Christine Lamberto. Effects of a 4-week training with voluntary hypoventilation carried out at low pulmonary volumes. Respiratory Physiology & Neurobiology 160 (2008) 123–130

10. Hypoventilation at low lung volume improved repeated sprint ability in swimming

Repeated-sprint training in hypoxia (RSH) has been shown as an efficient method for improving repeated sprint ability (RSA) in team-sport players but has not been investigated in swimming. We assessed whether RSH with arterial desaturation induced by voluntary hypoventilation at low lung volume (VHL) could improve RSA to a greater extent than the same training performed under normal breathing (NB) conditions.

16 competitive swimmers completed six sessions of repeated sprints (two sets of 16×15 m with 30 s send-off) either with VHL (RSH-VHL, n=8) or with NB (RSN, n=8). Before (pre-) and after (post-) training, performance was evaluated through an RSA test (25m all-out sprints with 35 s send-off) until exhaustion.

From pre- to post-, the number of sprints was significantly increased in RSH-VHL (7.1 ± 2.1 vs 9.6 ± 2.5; p<0.01) but not in RSN (8.0 ± 3.1 vs 8.7 ± 3.7; p=0.38). Maximal blood lactate concentration ([La]max) was higher at post- compared to pre- in RSH-VHL (11.5 ± 3.9 vs 7.9 ± 3.7 mmol.l-1; p=0.04) but was unchanged in RSN (10.2 ± 2.0 vs 9.0 ± 3.5 mmol.l-1; p=0.34). There was a strong correlation between the increases in the number of sprints and in [La]max in RSH-VHL only (R=0.93; p<0.01).

Repeated sprint training in hypoxia induced by voluntary hypoventilation at low lung volume improved repeated sprint ability in swimming, probably through enhanced anaerobic glycolysis. This innovative method allows inducing benefits normally associated with hypoxia during swim training in normoxia.

Trincat L, Woorons X, Millet GP. Repeated Sprint Training in Hypoxia Induced by Voluntary Hypoventilation in Swimming. Int J Sports Physiol Perform. 2016 Jun 13.

11. Voluntary Hypoventilation during exercise augments electromyography (EMG) activity

It has been reported that exercise under hypoxic conditions induces reduced muscle oxygenation, which could be related to enhanced activity on electromyography (EMG).

Although it has been demonstrated that exercise under conditions of voluntary hypoventilation (VH) evokes muscle deoxygenation, it is unclear whether VH during exercise impacts EMG. Seven men performed bicycle exercise for 5 min at 65 % of peak oxygen uptake with normal breathing (NB) and VH.

Muscle oxygenation; concentration changes in oxyhemoglobin (Oxy-Hb), deoxyhemoglobin (Deoxy-Hb) and total hemoglobin (Total-Hb); and surface EMG in the vastus lateralis muscle were simultaneously measured.

In the VH condition, Oxy-Hb was significantly lower and Deoxy-Hb was significantly higher compared to those in the NB condition (P < 0.05 for both), whereas there was no significant difference in Total-Hb between the two conditions.

We observed significantly higher values (P < 0.05) on integrated EMG during exercise under VH conditions compared to those under NB conditions. This study suggests that VH during exercise augments EMG activity.

Kume D, Akahoshi S, Yamagata T, Wakimoto T, Nagao N. Does voluntary hypoventilation during exercise impact EMG activity? Springerplus. 2016 Feb 24;5:149