Fact or Fad? The Research Behind Breath Training Products for Ultimate

For how regularly we breathe, we tend to think very little about it. But the ability to breath and use oxygen is one of the most important determinants in athletic performance. Your muscles use oxygen like fuel and the harder you work, the more fuel your body needs. The way we fill up the tank is by breathing. In ultimate, it’s important to be well conditioned so that you can perform at high intensity through a long point or game. The more efficiently your body can utilize the oxygen in the air you breathe, the more likely you will perform on the ultimate field.

Are there ways that we can improve our ability to utilize oxygen?

We’ll start with the obvious and most effective one: exercise! Exercising can help increase red blood cell production, which are important molecules that transport oxygen through the body. (1) By increasing the amount of these molecules, your body can more efficiently use oxygen during exercise. Those conditioning workouts you do for ultimate will definitely help you improve your body’s ability to use oxygen.

What about altitude training?

We’ve all heard about endurance athletes training at high altitudes with the hope of improving their ability to use oxygen. At higher altitudes, the decreased air pressure effectively reduces the percentage of oxygen in the air, making it more difficult to provide your muscles with the fuel they need during exercise. Your body adapts to this by producing more red blood cells and hemoglobin, which allows you to transport more oxygen to the working muscles.

So does it work?

Seems like it (2) but there is debate (3) about what method of altitude training to use and the extent of its benefits. I’m not going to get into the weeds too much here because this isn’t exactly a readily available training method for most people.

Some advocate for using altitude training masks to mimic the benefits of altitude training. These masks are not able to create a low oxygen environment, instead, they provide resistance to breathing.  The lack of a low oxygen environment means that you do not get the physiological benefits such as increases red blood cell production, (4) but you do get some changes in the strength and endurance of the respiratory muscles. (5) The limiting factor in exercise is typically not the ability to take more air into your body. What determines how well conditioned you are is how efficiently you can use the oxygen in the air you breathe. So improving the strength of the respiratory muscles sounds good, but it isn’t helping transport oxygen to the muscles. Indeed, the evidence is fairly strong that altitude training masks do not improve measures of physical performance. (5, 6, 7, 8, 9)

What’s up with nose-only breathing during exercise?

Another strategy people use to attempt to improve their body’s ability to use oxygen is nose breathing. There are many proposed benefits to nose breathing. Some of them include (10, 11):

  • Filtration, temperature regulation, and humidification of the air 

These reported benefits have not really been the subject of studies related to athletics. One exception is the case of exercise-induced asthma, where the temperature and humidity of air are important. Practicing nasal breathing can reduce the frequency of symptoms and the likelihood of developing exercise-induced asthma. (12, 13)

  • The nose produces nitric oxide

Nitric oxide is a gas that is used in the human body to improve the flow of oxygen-rich blood to muscles. Nitric oxide is produced in the nose, so by breathing through the nose, you get more of it. (14) However, it is also true that nitric oxide is produced throughout the entire body, with most production occurring in the endothelium, or wall, of blood vessels. (15)  While nasal breathing might give us more nitric oxide, I’m not sure it is substantial when you compare it to the amount produced elsewhere in the body.

That being said, one study looked at the effects of nasal nitric oxide on subjects who were intubated, which when a tube is inserted through the mouth into the airway because the person is unable to breathe adequately on their own.  The testers took air from the patient's nose and directed it into the breathing tube, thereby giving the patient nasal nitric oxide and improving blood oxygen levels. (16)  While this supports the benefits of nasal nitric oxide, it is a bit of a jump to go from intubated patients to healthy athletes.

  • Carbon dioxide tolerance

Another suggested benefit of nasal breathing is that it can improve your tolerance to elevated levels of carbon dioxide in your blood that occur during exercise. When your body senses elevated blood carbon dioxide, you begin to breathe faster in order to expel carbon dioxide. (17) At a certain intensity of exercise, most people switch from nose breathing to mouth breathing because you generally breathe faster while mouth breathing. (18) The thought is that by nose breathing, you train yourself to be resistant to elevated carbon dioxide levels, which would theoretically make you less breathless on the ultimate field.

We know that almost any time you exercise, you elevate your blood carbon dioxide levels. we know that conditioning for ultimate helps us tolerate the elevated carbon dioxide in our blood. There doesn't seem to be any evidence to say that breathing through your nose while conditioning adds to this benefit. Any reduction in breathing rate would theoretically improve your carbon dioxide tolerance. So you could potentially breathe slowly through your mouth and achieve the same result.

When you look at the literature, there are no studies that demonstrate that breathing through your nose improves tests of physical performance when compared to mouth breathing. The strongest evidence is that nose breathers can achieve similar performance to mouth breathers, and this is with non-blinded subjects who have trained primarily by nose breathing for at least 6 months, which seems likely to create a bit of bias. (19) Some other studies have found no difference in athletic performance when comparing nose to mouth breathing. (20, 21) Do what comes naturally to you!

What about those white strips for your nose?

The last thing I want to touch on is the use of external nasal dilators, which are those little strips you put across your nose to help open your airways. Even though I’m not on the nose-only breathing train just yet, it would seem beneficial to improve the flow of air into your lungs in whatever way you can.

One review compiled studies on the use of external nasal dilators during exercise and the results were hit and miss. Most studies either showed a benefit or no effect in subjects using external nasal dilators, with 2/17 studies demonstrating a decrease in athletic performance. (22) If you want to try them, they are cheap and easy to use, but it is far from guaranteed that your performance will improve.

So what should you do?

Keep it simple! Conditioning is the best thing you can do to improve your ability to transport oxygen from the air to your working muscles. While things like nose breathing or altitude training masks might make changes to the way you breathe, they have yet to demonstrate consistent ability to improve athletic performance.

There are a lot of products and techniques out there based on the conclusion of a single study or theory. Don't buy into fads promising magical results. When you are deciding whether to include one of these products in your training program, remember it is the sum of the evidence that matters. Here the evidence tells us that completing your conditioning workouts will give you the performance improvements you’re looking for!

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Sources for this post are listed below. 

1) Mairbäurl, H. (2013). Red blood cells in sports: effects of exercise and training on oxygen supply by red blood cells. Frontiers in physiology4, 332.  
2) Park HY, Hwang H, Park J, Lee S, Lim K. The effects of altitude/hypoxic training on oxygen delivery capacity of the blood and aerobic exercise capacity in elite athletes–a meta-analysis. Journal of exercise nutrition & biochemistry. 2016 Mar 31;20(1):15.
3) Lundby, Carsten, Gregoire P. Millet, Jose A. Calbet, Peter Bärtsch, and Andrew W. Subudhi (2012). Does ‘altitude training’ increase exercise performance in elite athletes? Br J Sports Med 46, no. 11: 792-795.
4) Porcari JP, Probst L, Forrester K, Doberstein S, Foster C, Cress ML, Schmidt K. Effect of wearing the elevation training mask on aerobic capacity, lung function, and hematological variables. Journal of sports science & medicine. 2016 Jun;15(2):379.
5) Williams JS, Wongsathikun JA, Boon SM, Acevedo EO. Inspiratory muscle training fails to improve endurance capacity in athletes. Medicine and Science in Sports and Exercise. 2002 Jul;34(7):1194-8.
6) Warren BG, Spaniol F, Bonnette R. The effects of an Elevation Training Mask on VO2max of male reserve officers training corps cadets. ─░nternational Journal of Exercise Science. 2017;10(1):37-43.
7) Sellers JH, Monaghan TP, Schnaiter JA, Jacobson BH, Pope ZK. Efficacy of a ventilatory training mask to improve anaerobic and aerobic capacity in reserve officers' training corps cadets. The Journal of Strength & Conditioning Research. 2016 Apr 1;30(4):1155-60.
8) Sperlich B, Fricke H, De Marées M, Linville JW, Mester J. Does respiratory muscle training increase physical performance?. Military medicine. 2009 Sep 1;174(9):977-82.
9) Sonetti DA, Wetter TJ, Pegelow DF, Dempsey JA. Effects of respiratory muscle training versus placebo on endurance exercise performance. Respiration physiology. 2001 Sep 1;127(2-3):185-99.
10) Dietz C, Van Dyke M. Utilizing Breathing to Further Enhance Training & Performance. Vandykestrength.com. http://vandykestrength.com/pages/utiliz_breath_train. Published 2019. Accessed May 16, 2019.
11) Lawrence G. Breathing Is Believing: The Importance of Nasal Breathing. Gaiam. https://www.gaiam.com/blogs/discover/breathing-is-believing-the-importance-of-nasal-breathing. Published 2019. Accessed May 16, 2019.
12) Izuhara Y, Matsumoto H, Nagasaki T, Kanemitsu Y, Murase K, Ito I, Oguma T, Muro S, Asai K, Tabara Y, Takahashi K. Mouth breathing, another risk factor for asthma: the Nagahama Study. Allergy. 2016 Jul;71(7):1031-6.
13) Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF. The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. American Review of Respiratory Disease. 1978 Jul;118(1):65-73.
14) Lundberg JO, Weitzberg E. Nasal nitric oxide in man. Thorax. 1999 Oct 1;54(10):947-52.
15) Chen K, Pittman RN, Popel AS. Nitric oxide in the vasculature: where does it come from and where does it go? A quantitative perspective. Antioxidants & redox signaling. 2008 Jul 1;10(7):1185-98.
16) Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta physiologica scandinavica. 1996 Dec;158(4):343-7.
17) Jack S, Rossiter HB, Pearson MG, Ward SA, Warburton CJ, Whipp BJ. Ventilatory responses to inhaled carbon dioxide, hypoxia, and exercise in idiopathic hyperventilation. American journal of respiratory and critical care medicine. 2004 Jul 15;170(2):118-25.
18) Niinimaa VP, Cole P, Mintz S, Shephard RJ. The switching point from nasal to oronasal breathing. Respiration physiology. 1980 Oct 1;42(1):61-71.
19) Tong TK, Fu FH, Chow BC. Nostril dilatation increases capacity to sustain moderate exercise under nasal breathing condition. Journal of sports medicine and physical fitness. 2001 Dec 1;41(4):470.
20) M. Dallam G, R. McClaran S, G. Cox D, P. Foust C. Effect of Nasal Versus Oral Breathing on Vo2max and Physiological Economy in Recreational Runners Following an Extended Period Spent Using Nasally Restricted Breathing. International Journal of Kinesiology and Sports Science. 2018;6(2):22.
21) Recinto C, Efthemeou T, Boffelli PT, Navalta JW. Effects of Nasal or Oral Breathing on Anaerobic Power Output and Metabolic Responses. International journal of exercise science. 2017;10(4):506.
22) Dinardi RR, de Andrade CR, da Cunha Ibiapina C. External nasal dilators: definition, background, and current uses. International journal of general medicine. 2014;7:491.

 

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