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• During exercise, nasal breathing causes a reduction in

FEO2 (fraction of expired air that is oxygen (O2%)), indicating that on expiration the percentage of oxygen extracted from the air by the lungs is increased. extracted from the air by the lungs is increased.

• Morton, King, Papalia 1995 Australian Journal of Science and Medicine in Sport. 27, 51-55

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• Maximal exercise intensity that could be achieved by

healthy subjects while nasal breathing

• On average subjects could reach 90% of their max
• On average subjects could reach 90% of their max

workload while nasally breathing (at least for the short period during the test).

Thomas, S. A., Phillips, V., Mock, C., Lock, M., Cox, G. and Baxter, J. (2009) The effects of nasal breathing on exercise tolerance. In: Chartered Society of Physiotherapy Annual Congress 2009

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• 12 healthy physiotherapy students aged between 21 and

27 (8 male and 4 female) completed both runs. Nasal breathing was continued to 85% of V02 peak achieved indicating that people are capable of nose breathing at much higher intensities than they would normally chose to do.

Thomas, S. A., Phillips, V., Mock, C., Lock, M., Cox, G. and Baxter, J. (2009) The effects of nasal breathing on exercise tolerance. In: Chartered Society of Physiotherapy Annual Congress 2009

NOSE VERSUS MOUTH MOUTH

POOR NASAL FUNCTION

• Narrow nostrils - resistance to breathing will be too much

during physical exercise

• Wear nasal dilator to reduce resistance
• Wear nasal dilator to reduce resistance
• Recommended: TheTurbine Nasal dilator

RECREATIONAL ATHLETES

• Nasal breathing at all times
• If you find that your need for air is so great that you need

to open your mouth, simply slow down and allow your to open your mouth, simply slow down and allow your breathing to calm once more.

COMPETITIVE ATHLETES

• Competitive athletes
• Alternate nasal breathing with mouth breathing.
• High-intensity training helps to prevent muscle de-

conditioning and will require an athlete to periodically breathe through their mouth.

COMPETITIVE ATHLETES

• For less-than maximum intensity training, and at all other

times, nasal breathing should be employed.

• For example, competitive athletes may spend 50 percent
• For example, competitive athletes may spend 50 percent
• f their training with the mouth closed.

COMPETITIVE ATHLETES

• Also devote training to working at an all-out pace in order

to maintain muscle condition, for which brief periods of mouth breathing will be required. mouth breathing will be required.

COMPETITIVE ATHLETES

• During competition there is no need to intentionally take

bigger breaths.

• Instead, bring a feeling of relaxation to your body and
• Instead, bring a feeling of relaxation to your body and

breathe as you feel necessary.

• However, breath-holding exercises during your warm-up

can be very advantageous, as can practicing breathing recovery during your warm-down.

COMPETITIVE ATHLETES

• Competition isn’t the ideal time to focus about how well
• r poorly you are breathing, as your full concentration

should be devoted to the game. The best way to improve should be devoted to the game. The best way to improve breathing for competition is to improve your everyday breathing, and the key to this is obtaining a higher BOLT and MBT score.

Weight Lifting Weight Lifting

WEIGHT LIFTING

• In general, I would hold my breath ( breathe in, breathe
• ut, hold) execute a set, minimise breathing for 6 breaths

before normal breathing. Some sets I had to either break my breath hold or I forgot to minimise breathing. But in general, this was what I did

• the breath holds added in another "load", as you said,

especially psychologically, even though the urge to breath Is physiological. A challenge I relished.

WEIGHT LIFTING

• On smaller body parts, like arms, it is easier to control and

push through the "load", although when it comes to bigger body parts like back and legs, it gets very difficult. It is with these bigger muscle groups where I feel the 85% wall, and need to breathe in order to progress through the set need to breathe in order to progress through the set

• The readings are from an upper back workout. I would do a

set, put on my oximeter, take a snap shot, and then strap on my blood pressure cuff

FIRST SET WITH BREATH HOLDS

FIRST SET WITH BREATH HOLDS

FIRST SET WITH BREATH HOLDS

SECOND SET WITH BREATH HOLDS

SECOND SET WITH BREATH HOLDS

THIRD SET WITH BREATH HOLDS (upped weight)

THIRD SET WITH BREATH HOLDS (upped weight)

Pre Competition Preparation Preparation

Sleep

Sleep

GETTING A BETTER NIGHT’S SLEEP

• Avoid blue light – smart phone and laptop
• Sleep in a cool and airy bedroom
• Don’t eat late at night or drink alcohol
• Switch to nasal breathing permanently
• Practise breathing softly for twenty minutes before sleep-

parasympathetic NS

• Determine sleeping position

GETTING A BETTER NIGHT’S SLEEP

• Tape mouth closed-
• 3M micropore tape/LipSealTape.com
• Wear tape for twenty minutes during the day to

become comfortable with it

• If mouth naturally moist in the morning, no need for

tape

Pre-Competition Preparation

• 1. Meditation and reduced breathing 20 minutes (focus the

mind)

• 2. Perform 6 to 10 strong breath holds to create hypoxic

hypercapnic response. Complete five to ten minutes prior to hypercapnic response. Complete five to ten minutes prior to the game. (EPO and Splenic contraction)

• 3. Medium to large breaths for 30 seconds to lower acidosis

(BOLT score > 25 seconds)

• 4. Bring a feeling of intense energy throughout the body

Pre-Competition Preparation

• Nine well-trained swimmers (5 males and 4 females)

performed a 50m front crawl sprint either in normal conditions (NO) or after hyperventilation (HV) (30-second pre-exercise maximal voluntary hyperventilation). pre-exercise maximal voluntary hyperventilation).

Pre-Competition Preparation

• Average velocity for the 50 m front crawl was significantly

higher after HV.

• As a result, performance improves (27.79 s vs. 28.08).
• The number of breathing cycles recorded during each race
• The number of breathing cycles recorded during each race

was significantly lower under HV compared to NO

• The stroke rate was slightly increased under HV conditions.

(strokes per minute)

Science & Sports Volume 30, Issue 3, June 2015.

Pre-Competition Preparation

• A pre-exercise maximal voluntary hyperventilation can

significantly increase performance on the 50 m front crawl in well-trained swimmers.

Science & Sports Volume 30, Issue 3, June 2015.

Pre-Competition Preparation

• Repeated high-intensity sprints incur substantial

anaerobic metabolic challenges and create an acidic muscle milieu that is unfavorable for subsequent performance. performance.

• J Strength Cond Res. 2014 Apr;28(4):1119-26.

Pre-Competition Preparation

• This study tested the hypothesis that hyperventilation

performed during recovery intervals would attenuate performance decrement in repeated sprint pedalling.

• J Strength Cond Res. 2014 Apr;28(4):1119-26.

Pre-Competition Preparation

• Thirteen male university athletes performed 10 sets of

10-second maximal pedalling on a cycle ergometer with a 60-second recovery between sets under control (spontaneous breathing) and hyperventilation conditions. (spontaneous breathing) and hyperventilation conditions.

• J Strength Cond Res. 2014 Apr;28(4):1119-26.

Pre-Competition Preparation

• This intervention successfully increased blood pH by

0.03-0.07 but lowered PCO2 by 1.2-8.4 mm Hg throughout exercise.

• J Strength Cond Res. 2014 Apr;28(4):1119-26.

Pre-Competition Preparation

• In conclusion, hyperventilation implemented during

recovery intervals of repeated sprint pedalling attenuated performance decrements in later exercise bouts that was associated with substantial metabolic acidosis. (too much associated with substantial metabolic acidosis. (too much H+ from the cells)

• J Strength Cond Res. 2014 Apr;28(4):1119-26.

Pre-Competition Preparation

• The practical implication is that hyperventilation may

have a strategic role for enhancing training effectiveness and may give an edge in performance outcomes.

• J Strength Cond Res. 2014 Apr;28(4):1119-26.

WEEK 1 WEEK 1

WEEK 1

• Who is the client?
• Approx age?
• State of health?
• What would they like to achieve?
• Is it a team or an individual?
• The sportier the client, the greater the emphasis on

physical movement.

WEEK 1

• What form of physical exercise do they partake in?
• OA can be applied during walking, running, cycling, rowing or any

sport.

• Are they recreational or competitive?
• Are they recreational or competitive?
• How do they warm up?
• Do they meditate?
• Incorporate the OA into their existing routine for best effect. But first

teach them the basic program so they understand the exercises.

WEEK 1

• Paper tape
• Pulse oximeter- explain how it works.
• Measures peripheral oxygen saturation (Spo2) to give a close

approximation of the saturation of arterial blood with oxygen (Sao2). What percentage of Hb is loaded with O2.

• Two lights- red light and infrared light.
• Oxygenated hemoglobin absorbs more infrared light and allows more

red light to pass through. Deoxygenated hemoglobin allows more infrared light to pass through and absorbs more red light.

WEEK 1

• Client intake form (provided in folder- marketing images and more)
• How to recognise poor functional breathing
• Benefits of functional breathing
• Briefly talk about the Bohr effect, nasal breathing, sleep, asthma,
• Briefly talk about the Bohr effect, nasal breathing, sleep, asthma,

reduced breathlessness, improved focus and concentration.

• Discuss the benefits of strong breath holding. Explain how oxygen is

carried in the blood and hypercapnic/hypoxic training.

• Benefits: Delayed lactic acid and fatigue, improved resilience,

improved respiratory muscle strength.

WEEK 1

• Measure BOLT score and give feedback
• Measure MBT score and give feedback
• Ex 2: Breathe Light- 5 minutes
• Ex 2: Breathe Light- 5 minutes
• Ex 3: Preparation of simulation of altitude
• Ex 4: Simulation of altitude training- 5 reps
• Tape mouth at night. Lipsealtape.com

WEEK 1

• In assessing functional breathing, BOLT score although not

perfect provides good feedback.

• Also observe athletes breathing during rest:

Fast or slow Fast or slow Regular or interspersed with sighs Pause if any at the end of exhalation Upper chest or diaphragm Amplitudes of the breath

WEEK 1 HOMEWORK

• Breathe Light 15 minutes during the day and 15 minutes

before sleep. (sets of 5 minutes with rest of one minute between each)

• Incorporate nasal breathing and breath holding during warm
• Incorporate nasal breathing and breath holding during warm

up.

• 5 reps of breath holding by two times daily (not after eating)
• Nose breathing during physical exercise as much as possible.

WEEK 2 WEEK 2

WEEK 2

• Check progress. Observe athletes breathe.
• Recap on functional breathing and dysfunctional breathing
• Measure BOLT score
• Measure MBT
• Ex 2: Breathe Light- 5 minutes
• Ex 3: Preparation of simulation of altitude
• Ex 4: Simulation of altitude training- 5 reps
• Ex 6: walking, jogging 5 minutes
• Ex 10: Shark fit

WEEK 2 HOMEWORK

• Breathe Light 15 minutes during the day and 15 minutes

before sleep

• Incorporate nasal breathing and breath holding during warm

up up

• (Ex 4 or Ex 10) 5 reps of breath holding by two sets daily (not

after eating)

• Nose breathing during physical exercise as much as possible.

WEEK 3 WEEK 3

WEEK 3 onwards

• Check progress. Observe athletes breathe
• Recap on functional breathing and dysfunctional breathing
• Measure BOLT score
• Measure MBT
• Do entire 11 exercise workout
• (main addition is breathe light and simulation altitude training

advanced)

• Introduce pre competition preparation (also for presentations)

WEEK 3 HOMEWORK

• 40- 60 minutes of combination of exercises throughout the

day

• Jogging/running with mouth closed
• Walking/jogging/running 5 to 10 reps of strong breath holds
• Walking/jogging/running 5 to 10 reps of strong breath holds

daily

• Breathe light for 15 minutes before sleep
• Be aware of nasal breathing and breathe light
• Incorporate into existing training

WEEK 3 HOMEWORK

• People are time poor. Compliance is always an issue.
• Convey the benefits
• Must enjoy the exercises
• Must experience positive effects
• Minimum dose for maximum effectiveness
• Supports: lipsealtape, The Turbine, Pulse Oximeter,

Buteyko Belt, Sports Mask

PROGRAM PROGRAM

PROGRAM

BOLT Score of Less Than 10 Seconds

• Measure your BOLT score each morning after waking;
• Breathe through the nose both day and night (tape);
• Swallow or hold the breath any time you feel a sigh coming;
• Swallow or hold the breath any time you feel a sigh coming;
• Practice the many small breath holds (Ex 1) -10 minutes by 6 times

per day;

• Small paces (Ex 3): Exhale through your nose, pinch your nose with

your fingers, and walk while holding the breath for 5 to 10 paces. Rest for 1 minute and repeat 10 times. (three sets per day)

PROGRAM

BOLT Score of Less Than 10 Seconds

• Engage in 10 to 15 minutes of slow walking each day with

mouth closed. If need to breathe through mouth, slow down or stop;

• When BOLT score increases to 15 seconds, Breathe Light

(Ex2). 1 hour per day (six by 10-minute sets);

• As your BOLT score increases, it will become a lot easier to

engage in physical exercise. Your expected progress is to increase your BOLT score to 25 seconds within 6 to 8 weeks.

PROGRAM

BOLT Score of Less Than 20 Seconds

• Measure your BOLT score each morning after waking;
• Breathe through the nose at all times. Wear paper tape at night;
• Regularly observe your breathing throughout the day;
• Regularly observe your breathing throughout the day;
• Breathe Light (Ex2) for 10 minutes by 2 times daily;
• Warm up (Ex 4 or Ex10) for 10 minutes prior to exercise by walking

and breath holding every minute or so;

• Practice Breathe walking (Ex 5) for between 30 and 60 minutes per

day.

PROGRAM

Oxygen Advantage Program for a BOLT Score of 20 to 30 seconds

• Measure your BOLT score each morning after waking;
• Breathe through the nose both day and at night, including

wearing tape;

• Breathe Light (Ex2) for 10 minutes, 2 times per day;
• Warm up (Ex 4 or Ex10) for 10 minutes prior to exercise by

walking and breath holding every minute or so;

PROGRAM

Oxygen Advantage Program for a BOLT Score of 20 to 30 seconds

• Breathe Light to Breathe Right during a fast walk or jog

for 30 to 60 minutes;

• Simulate High-Altitude Training during walking or jogging

by practicing 8 to 10 breath holds;

• After physical exercise, practice the Breathing Recovery

exercise.

PROGRAM

BOLT Score of 30 Seconds or More

• Measure your BOLT score each morning after waking;
• Breathe through the nose both day and at night, including

wearing tape during sleep;

• Warm up (Ex 4 or Ex10) for 10 minutes prior to exercise by

walking and breath holding every minute or so;

• Breathe Light during the run ;
• Continue with running and nasal breathing for 20 minutes;

PROGRAM

BOLT Score of 30 Seconds or More

• Midway through the run, practice breath holds;
• Intersperse breath holds every few minutes throughout

the run; the run;

• After physical exercise, Breathing Recovery exercise;
• Practice one session of Advanced Simulation of High

Altitude every other day;

• Breathe Light (Ex2) for 15 minutes before sleep.

BPD & INJURY BPD & INJURY

• BPDs known as hyperventilation syndrome and rapid

breathing alters the body’s pH producing respiratory alkalosis; which results in an array of symptoms including headache, dizziness, chest pain, trouble sleeping, headache, dizziness, chest pain, trouble sleeping, breathlessness, light sensitivities, exhaustion, and cramps.

The International Journal of Sports Physical Therapy | Volume 11, Number 5 | October 2016

• An athlete with an abnormal breathing pattern during

physical activity may experience premature breathlessness or muscle fatigue, resulting in decreased performance. performance.

The International Journal of Sports Physical Therapy | Volume 11, Number 5 | October 2016

• Normal breathing mechanics play a key role in posture

and spinal stabilization. Breathing Pattern Disorders (BPD) have been shown to contribute to pain and motor control deficits, which can result in dysfunctional control deficits, which can result in dysfunctional movement patterns.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• Correction or re-education of BPDs can result in new

neural connections and restoration of normal motor control patterns in the CNS.

The International Journal of Sports Physical Therapy | Volume 11, Number 5 | October 2016

• “If breathing is not normalized, no other movement

pattern can be.”

The International Journal of Sports Physical Therapy | Volume 11, Number 5 | October 2016

BPD ARE MULTIDIMENSIONAL MULTIDIMENSIONAL

• Thoracic

breathing can have an acute effect

• n

respiratory chemistry, specifically a decrease in the level

• f carbon dioxide (CO ) in the bloodstream. This causes

the pH of the blood to increase, and a state of respiratory the pH of the blood to increase, and a state of respiratory alkalosis results. Respiratory alkalosis can trigger changes in physiological, psychological, and neuronal states within the body that may negatively affect health, performance, and the musculoskeletal system.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• Method to assess this biochemical aspect of respiratory

function is capnography. Capnography measures average CO partial pressure at the end of exhalation, known as end tidal CO (etCO ) and has good concurrent validity when tidal CO (etCO ) and has good concurrent validity when compared to arterial CO2 measures.

• Normal ranges are between 35-40 mmHg, while values of

<35mmHg were suggestive of a BPD.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• Breath-holding

ability is an aspect

• f

breathing functionality that is commonly disturbed in individuals with dysfunctional breathing. Times of <20 seconds are proposed to indicate the presence of BPD and to proposed to indicate the presence of BPD and to correlate with resting CO2 levels.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

THE STUDY THE STUDY

• 34 healthy men and women
• Resting etCO

and resting RR were the most sensitive measures of BPD with over 70% of subjects having measures of BPD with over 70% of subjects having disordered results.

• Between 50 to 60% of participants had abnormal scores

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

Variables Mean ± SD MIN MAX

FMS Score 14.71 ± 1.84 12.00 19.00 Rest etCO (mmHg) 33.70 ± 2.74 27.70 39.33 Active etCO (mmHg) 34.28 ± 2.44 29.37 40.17 Rest RR (breaths/min) 18.39 ± 3.41 12.25 25.2

TM

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

Rest RR (breaths/min) 18.39 ± 3.41 12.25 25.2 Active RR (breaths/min) 24.30 ± 3.06 17.65 30.64 BHT (sec) 19.22 ± 5.05 10.57 34.13 NQ 9.24 ± 6.43 0.00 27.00

FMS™, Functional Movement Screen™ ; etCO , end-tidal carbon dioxide;

RR, respiratory rate; BHT, breath-hold time; NQ, Nijmegen Questionnaire

• The Functional Movement Screen (FMS) has been

shown to accurately predict injury in individuals who demonstrate poor movement patterns.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• Subjects who scored higher on the NQ, had a lower

etCO during the FMS™ test and a higher RR.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• Individuals with a high RR during the FMS™ had lower

etCO measurements.

• Resting etCO measurements were significantly different
• Resting etCO measurements were significantly different

between diaphragmatic (mean=35.47 mmHg) and thoracic breathers (mean=32.14 mmHg)

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• Individuals with a less efficient breathing pattern scored

worse on the FMS™ compared to those subjects who had normal breathing patterns. Resting etCO was positively correlated with FMS™ scores. positively correlated with FMS™ scores.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• The results from this study show that a relationship exists

between elements of BPD and functional movement.

• Both biomechanical and biochemical measures of BPD
• Both biomechanical and biochemical measures of BPD

had a significant association with FMS™ scores.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• Furthermore, 87.5% of individuals who were in the Pass

group on the FMS™ were classified as diaphragmatic

• breathers. These results demonstrate the importance of

diaphragmatic breathing on functional movement. diaphragmatic breathing on functional movement.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014

• A higher etCO

level, indicating efficient respiratory function, was positively correlated with a higher FMS™ score.

The International Journal of Sports Physical Therapy | Volume 9, Number 1 | February 2014