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Respiratory training: A neglected but significant
training modality

Respiratory training is the deliberate modification of how we usually breathe throughout
the day by implementing specific exercises and techniques to eventually improve oxygen
uptake, lung function, and overall well-being, as well as enhance athletic performance.
Respiratory training aims to strengthen the diaphragm, which is the primary muscle of
respiration as well as the inspiratory rib cage muscles. This will eventually increase lung
capacity and optimize oxygen delivery to the body’s tissues, including muscles, at rest and
during exercise.
Respiratory training can be applied through various techniques based on the ultimate
goal and what best suits the individual. The most popular type of respiratory training is
diaphragmatic breathing. It can be performed in a supine position, sitting or standing, based on
the practice level of the individual. When you first learn the diaphragmatic breathing technique,
you are recommended to practice it lying down on your back. Bend your knees and support your
head using a pillow or a folded towel to relax your neck and shoulder muscles. Place one hand
on your upper chest and the other on your belly, just below your ribcage, to be able to feel your
diaphragm as it moves up and down. Breathe in slowly through your nose so that your stomach
pushes out, causing your hand to rise. The hand that lies on your chest should remain as still as
possible. To exhale, purse your lips as if you are going to whistle or gently blow on a hot drink.
Exhale slowly and gently through your pursed lips by tightening your abdominals so that your
stomach moves in.
Two other common forms of respiratory training include inspiratory muscle training (IMT)
and yogic breathing. IMT involves breathing exercises using a pressure threshold device to
strengthen the inspiratory muscles, such as the external intercostals. It’s a form of resistance
training for these muscles since it strengthens them, improving stamina and reducing breathing
fatigue. It is performed sitting or standing, where the individual puts on a nose clip, holds the
IMT device by the handle grip, and places the mouthpiece in the mouth. They breathe out as far
as they can and take a fast, forceful breath through their mouth, trying to take in as much air as
they can while expanding their chest. They then breathe out slowly with minimal effort while
letting their shoulders relax. Yogic breathing, also referred to as pranayama, is mainly practiced
through the guidance of a certified yoga instructor. It involves breath control via patterns and
variations in respiration rate, with specific instructions regarding the number of breaths over a
certain period of time. Some variations of yogic breathing include alternate nostril, paced, and
box breathing.
Respiratory training is mainly used by people suffering from breathing problems such as
asthma and chronic obstructive pulmonary disease (COPD). COPD is a group of respiratory
diseases that cause airflow obstruction and breathing-related problems, such as dyspnea. It
includes emphysema and chronic bronchitis and is the fourth leading cause of death in the US.
However, respiratory training is also regularly used by athletes who wish to improve their sports
performance by strengthening their breathing muscles, thus improving breathing stamina and
strength, and eventually endurance during aerobic exercise.
The benefits of respiratory training are due to a combination of physiological
mechanisms. Two of the main mechanisms are increased oxygen delivery and improved tissue
oxygenation. Respiratory training allows increased amounts of oxygen to enter the bloodstream
through the lungs, enhancing oxygen delivery to the body’s tissues and organs, such as the
working muscles. The improved tissue oxygenation is crucial for the proper functioning of cells.
It promotes metabolic processes which require oxygen to be attained and result in the
production of energy, which is valuable for accomplishing vital cellular functions. The increased
cellular energy produced is in the form of adenosine triphosphate (ATP). ATP is the primary
energy source for cells and derives from this increased metabolic function attained through
respiratory training. Another vital mechanism through which respiratory training works is wound
healing. Adequate oxygen levels are necessary for tissue repair and regeneration as well as
angiogenesis (the growth of new blood vessels) in the injured area.
Regarding mechanisms around lung mechanics per se, respiratory training alleviates the
strain on the respiratory system by strengthening inspiratory muscles, better-controlling breath,
and eventually making breathing easier. Therefore, it reduces the effort required to breathe
(work of breathing) and improves oxygen exchange in the lungs. This is particularly helpful
when oxygen demand increases, as happens in pulmonary diseases and/or during exercise.
Especially when the intensity of exercise increases, the breathing volume or ventilation must
also rise to cope with the oxygen demand. The inspiratory muscles must contract more
forcefully and rapidly to keep pace with the substantial increase in metabolism, and this process
can be attained through respiratory training.
Each of the proposed mechanisms above can lead to several benefits that respiratory
training may offer an individual who regularly practices it. One of the most important benefits
associated with the first two mechanisms described above is the reduction of lung disease
symptoms, such as shortness of breath (at rest and during exercise), whizzing, chest tightness,
and lack of energy, among others. Therefore, people suffering from pulmonary diseases can
have a much better quality of life by participating and enjoying all aspects of life. By improving
lung health-related symptoms, respiratory training can vastly enhance sleep quality. Many
people with compromised lung function face sleeping-related breathing disorders, with sleep
apnea being the most common. Engaging in respiratory training techniques can significantly
decrease these symptoms, resulting in better sleep and reduced daytime fatigue.
Nevertheless, as already mentioned, respiratory training can also lead to improved
physical performance, which most athletes long for. Elevated oxygen uptake can increase the
amount of lung capacity a person is able to use per breath (tidal volume) as well as the oxygen
delivered to the working muscles during exercise, thus improving cardiovascular endurance
during exercise or sports activities, such as running and cycling. Lung capacity and
cardiovascular endurance are also assessed through the active test performed by the PNOĒ
metabolic analyzer. Their respective metrics in the PNOĒ active reports are expressed as
aerobic health and respiratory capability, respectively. Respiratory training can further enhance
athletic performance by contributing to the recovery process after exercise. More specifically, it
helps reduce muscle soreness, accelerate tissue repair, and promote faster recovery between
workouts. This increased recovery capacity is also assessed and depicted in the PNOĒ active
Respiratory training also strengthens the inspiratory muscles and improves breath
control at rest and during exercise. Therefore, it helps improve breathing and posture as well as
breathing and stability, metrics provided in the PNOĒ resting and active metabolic reports,
respectively. As a result, musculoskeletal problems, especially in the spine, arising from not
breathing properly, thus not properly activating the deep core muscles, especially during
exercise, can be avoided. Lastly, respiratory training can improve brain oxygenation, leading to
enhanced cognitive performance, improved concentration, and mental clarity, at rest and during
exercise. These are also metrics assessed through the PNOĒ metabolic analyzer (the breathing
& cognition metrics in both the resting and active metabolic reports).
Overall, respiratory training is the deliberate modification of how we usually breathe by
implementing specific exercises and techniques. Its benefits are due to a combination of
mechanisms, including increased oxygen delivery, improved tissue oxygenation, increased
energy (ATP) levels, and enhanced respiratory muscle strength. These mechanisms work
together to reduce lung disease symptoms and improve sleep quality, sports performance,
recovery, and brain function.

Scientific sources

Ambrosino N. Inspiratory muscle training in stable COPD patients: enough is enough? Eur
Respir J. 2018;51(1):1702285
Basso-Vanelli RP, Di Lorenzo VAP, Labadessa IG, Regueiro EMG, Jamami M, Gomes ELFD,
Costa D. Effects of inspiratory muscle training and calisthenics-and-breathing exercises in
COPD with and without respiratory muscle weakness. Respir Care. 2016;61(1):50-60
Bostanci O, Mayda H, Yilmaz C, Kabadayi M, Yilmaz AK, Ӧzdal M. Inspiratory muscle training
improves pulmonary functions and respiratory muscle strength in healthy male smokers. Respir
Physiol Neurobiol. 2019;264:28-32
de Medeiros AIC, Fuzari HKB, Rattesa C, Brandão DC, de Melo Marinho PÉ. Inspiratory muscle
training improves respiratory muscle strength, functional capacity and quality of life in patients
with chronic kidney disease: a systematic review. J Physiother. 2017;63(2):76-83
HajGhanbari B, Yamabayashi G, Buna TR, Coelho JD, Freedman KD, Morton TA, Palmer SA,
Toy MA, Walsh C, Sheel AW, Reid DW. Effects of respiratory muscle training on performance in
athletes: a systematic review with meta-analyses. J Strength Cond Res. 2013;27(6):1643-1663
Illi SK, Held U, Frank I, Spengler CM. Effect of respiratory muscle training on exercise
performance in healthy individuals: a systematic review and meta-analysis. Sports Med.
Walterspracher S, Pietsch F, Walker DJ, Röcker K, Kabitz H-J. Activation of respiratory muscles
during respiratory muscle training. Respir Physiol Neurobiol. 2018;247:126-132

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Susan Edwards

Wow Metabolic

Our Story

My name is Susan Edwards FMP, HHP. I am the owner of a thriving wellness center in Brea, Ca. For over 10 years I have worked with clients who have chronic pain, weight gain, low energy and inflammation. My clients were getting some pain relief and having short term recovery. However, I knew I could do more for them. I realized they need a more individualized ” Down to the Root” approach for Optimal Health. I have now added Functional Medicine Programs and Metabolic Testing with PNOE the GOLD Standard in Metabolic Testing . Since adding these programs my team and I are able to get to the Root of our clients issues. This has enabled them to have long term Pain Relief, Reduce Weight, recover their Energy and lower their Inflammation. It is Awesome to see our clients now living their lives with Joy and Vitality. 

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