Nasal Breathing, Breathing Techniques and Ultrarunning Performance with Nick Tiller, PhD | Koopcast Episode 111

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast as always i'm your humble host coach Jason Koop and on this episode of the podcast we have a KoopCast favorite coming back on the show today and that is nick tiller PhD who happens to have recorded the longest KoopCast on record but more importantly one of the most beneficial and the most downloaded podcast that is KoopCast number 27 which is nutrition for trail and ultra trail and ultra marathon training and racing that was a big mouthful but i wanted to bring nick back on the podcast today very specifically to talk about one of the most asked questions that i get when i'm at races or when i'm in the social media space and that is do any of the breathing techniques that i'm starting to see be proliferated everywhere do those actually work does nasal breathing actually work do the breathe right strips actually work does any of these pattern breathing actually work do any of these devices that make it harder to breathe do those things actually work and should i be incorporating them into my training nick has an expertise in cardiovascular and cardiopulmonary

physiology as well as being an accomplished ultra runner in his own right he has his own column for the skeptical inquirer as well as the author of the skeptics guide to sports science which i encourage everybody to go and check out nick is also one of my favorite people to talk about to talk with because he brings this very practical and pragmatic view to all of these different topics and for those of you that think that we are just going to sit around and debunk all this stuff we are not we're going to take a very analytical look at it and a very practical look at it and at the end of the day say are these interventions worth it what is the science behind them and should you undertake them i hope everybody's listening up let's buckle up i'm going to get right out of the way here's my conversation with nick tiller about everything having to do with breathing and performance so how are things back in the states man yeah they're good actually very strange to be back it took a little bit of actually you know what it didn't take any time to get settled back in even though i was gone for so long i just slotted right back into my normal rhythms and my normal routine very strange having been away for so long and i just came back and plugged everything in and a wi-fi you know fired up and the car just i had to replace the battery on my car because i because that's been sitting idle for all this time as well but everything else was just absolutely seamless but strange in a way no it's good to be back how long were you out tip to tail

18 months oh wow holy crap yeah and could you actually get back sooner or were there's there's no need to so for the first six months or so no probably for the first eight to ten months i wasn't able to get back in the country wasn't allowed in and then because of the work that we were doing in the lab because it's clinical and we took on a couple of covid based projects as well we could then apply for like a like a an exemption for me to get back in the country based on the research that we're doing like it's a national interest exemption so the idea is that me coming back into the states is in the best is in the national interests but they weren't letting my partner back in with me so it meant that i would have to leave her in europe and then come back by myself which i was willing to do if it were for a couple of months but there was no indication as to how long it would be it could be for six months or a year and i decided that i wasn't prepared to to come back without her so uh so fortunately you know the borders open up on the 8th of november so we were able to come back together yeah well it's perfect man you got the best setup you got brownie points with the partner and and you get to feel good because you're like recognized as like a national interest that people want you to come back in the country right we're like so notorious for keeping people out they care about the work that i'm doing well they made it pretty pretty hard and i mean this probably won't

make it to the to the final edit but when i was coming through the borders to get back in they wanted me i had to prove to them that i was still employed because i'd been gone for so long and my visa my visa was still valid but my my ds 2019 um had expired so i was basically i was this close to being put back on the plane and sent back to europe and i had to log on to the uh the airport wi-fi get into my internet banking to download my my uh statements and i had to reset my password they sent the they sent the code to the wrong uh to the wrong phone number and i was just like having this freak out in the middle of the terminal but eventually they let me in welcome back welcome back to the us we're glad you're back keep doing keep doing god's work like working on covid stuff all right i'll do my best all right man you want to get into it i wanted to start i wanted to start out with like you're back in the states and we just kind of went through a way that you could have gotten back into the states going uh through your covid research and um i think that's really cool because obviously it's a hot topic right now but one of the way that the research comes out is in some of the lay publications that that you've put out and in particular this most recent one in uh the skeptical inquirer i wanted to start out and talk a little bit about that and use that as a gateway to ultimately what is going to be answering some of the questions that i think are the most frequently

asked at least in the last six months and whenever i put this out on social media you put it on social media just before we went on people go bananas they want to know about should i be nose breathing and is this thing going to work and we're going to kind of tackle hopefully all of that over the course of the next five hours which is what you promised me for this recording right nick i'll go for the record there we go i i checked my uh i checked my uh my memory card before this you've got nine hours total so we've got to finish before then uh but but i wanted to start out with this article in particular because i think it's a good gateway for how companies and how um how how basically people are trying to fool the lay public is particularly using a conduit like covid so when you were looking at this and you were essentially looking at how you know how companies are pitching can you breathe your way out of covid essentially or can you use some of these devices to either protect yourself against covid or uh somehow lessen the symptoms give the audience a little bit of the theme of of the article and what the things that they should in particular watch out for yeah so most people will know if they're familiar with my work at all they'll know that i've been interested in pseudoscience and pseudoscience and pseudoscience manifestations in the health and

fitness industry i've been doing this for well over a decade but my kind of day-to-day job is actually as a respiratory physiologist i did my PhD in human respiratory physiology and most of the work that we do at our institute at harbour ucla is in respiratory physiology and exercise physiology and we work primarily with patients and one of the things that has become more and more apparent is that the commercial health and fitness industry has been targeting respiratory physiology more and more in recent years there's a number of different reasons for that the most obvious one as you mentioned is the covid 19 pandemic which has focused attention on respiratory health and the means either proven or not to enhance it but even and and because of that a lot of snake oil salesmen have crawled out the woodwork to exploit fear and misunderstanding um about covid about the whole pandemic to sell product and and exploiting people's fears and people's insecurities to sell product is not a new thing but it didn't take long for people to start doing that with covid but even before covid chronic respiratory diseases like asthma and copd were the leading cause of worldwide morbidity and the third leading cause of mortality and it's also become a more kind of interesting conundrum because not just of the growing because of the growing economic burden but because of the pressure pressing issue of climate change and

like worsening air quality and pollution and particularly if you're exercising outdoors in a very polluted area and this has the potential to lead to poor respiratory health so the commercial world has kind of jumped on that and they are they are trying to sell us all kinds of respiratory interventions products and practices that that make claims to to be able to manipulate one or more aspect of respiratory function and so that's kind of why i decided to to tackle this route because it brings together my work in skepticism i work in respiratory physiology and especially using the platform that i now have with skeptical inquirer where i can kind of reach a broader audience than i could do if i were just writing a scientific article and so i thought i would use the opportunity to kind of answer some of these uh currently unanswered questions so i'll put a link in the show notes to the article itself but can you just tease it a little bit and give everybody the nickel version of of of what the article goes over yeah so i'm currently working on a systematic review that will be published in a scientific journal article and it's basically called science and pseudoscience in respiratory physiology a guide for clinicians and coaches and in that we we're basically doing a systematic review on a bunch of different respiratory products so we talk about nasal dilators and nasal breathing and diaphragmatic breathing pursed lip breathing is peritial muscle trainers canned oxygen uh oxygenated beverages lung supplements

nutrition all of these different products and practices that are targeted at improving the respiratory health and we do a really deep dive on the literature basically leave no stone unturned you can't do that for a lay audience because they'll get bored and i get it because sometimes i get bored reading all of these hundreds of papers but what the article in skeptical inquiry does is basically it's the cliff notes of that so i talk about why respiratory physiology has become a target of commercial health and fitness some of the the ways that we can use respiratory interventions to improve health and performance and some of the many ways that respiratory products don't improve health and performance and some of the things to kind of steer clear of so i kind of split it into science and pseudoscience and some of the the mess in between and a lot of the messaging i think it's worth mentioning is kind of for uh it's for an entire audience not necessarily an athlete audience which is the primary eye that's going to be listening to this podcast yeah for sure so skeptical inquiry is as i've as i've said it's a mainstream outlet and most of their readers it might be changing with with my new column but most of the readers are not exercise scientists they're not athletes they're people who are interested in skepticism critical thinking they're science enthusiasts and it's actually just it's wonderful to be able to write for skeptical inquiry who are kind of the umbrella organization is center for inquiry because

it's these organizations that inspired me to get into critical thinking and skepticism and so to be able to to bridge the two worlds the skeptical world and the exercise science world because it's not something that they've ever really looked at before it's just a real honor to be kind of spearheading that yeah that's really cool so i think what we're going to try to do in this conversation is take a lot of that content and make it audience specific right because and we can be hyper specific with this audience because they're just a bunch of you know lunatic ultra runners that that you and i know i mean we know the audience very very well and at the end of the day they all want to know do any of these things work and should they actually use them and their training i promise we're going to try to get to those answers as best we can but it wouldn't be any fun it wouldn't be like a three-hour podcast if we just said yes no yes no because people have to learn something along the way they shouldn't just take our word for it they should know the knowledge behind why these recommendations are actually getting in one category or the other or maybe even the middle category so to start that all out with though we we we've got to go over some physiology 101 of just the cardio respiratory the cardiopulmonary system so that people have a broad understanding of how everything works and then we can tie that how does it work to do these interventions actually make any sense so you obviously are going to take the lead on this because you've done it yeah you yeah you're the expert in the room i just fumble over it i just read the

one of the books that's sitting right behind me so let's try to do a broad like freshman 101 level overview of how the system works okay so that's just very basic anatomy cardiovascular system when we when we say cardiovascular we're talking about the heart and blood vessels that are responsible for pumping blood around the body so when we talk about cardio and when you know the gym bro talks about cardio we're talking about cardiovascular exercise that really engages the heart and blood vessels the respiratory system we tend to talk about these things in isolation when we have cardiovascular and respiratory the cardiopulmonary system is how they kind of interlock so when we talk about the respiratory system we're talking specifically about the nose and mouth obviously so the nasal cavity the larynx and pharynx the trachea or the windpipe the the bronchi and the bronchiol so these are the branching tubes that carry air from the nose and mouth into the lungs the lungs and then the alveoli in the lungs and the alveoli are the small air sacs in the lungs that are responsible for actually allowing gas to diffuse in and out of the blood so the obviously the and then obviously not forgetting the respiratory muscles because these are going to come into the conversation later on the primary muscle of inspiration is the diaphragm and we have other kind of accessory and respiratory muscles like the intercostals scalenes sternocleidomastoid in the neck these muscles higher up and the major or the primary muscle of expiration is the rectus abdominis so this is the

major superficial muscle this the six-pack i guess and that's kind of primarily contracting during forced expiration and this kind of i guess this integrated system as we all know is responsible for moving air in the atmosphere into the blood and carbon dioxide or i should say oxygen into the blood and then carbon dioxide out of the blood where it's expired so that's kind of the the whistle stop kind of tour of the respiratory system and salient to what we are going to talk about when you just normally exercise how is that system stressed and does that produce an adaptation because you mentioned the meatheads in the gym right so i'm going to use them as an analogy i can go in the gym and i can do a bunch of bicep curls and i'm going to get bigger biceps i'm going to get biceps that function better i can curl faster i can curl more weight and all that other stuff if i go out and run right cardio cardiovascular cardiopulmonary type of activity does any of this anatomy that you just went through does it adapt and to what extent i guess does it adapt if you want to try to make that analogy back to the bicep curls does it adapt in that way yeah i'm glad you brought it up because this is a common area of misunderstanding and generally no it doesn't adapt it's the respiratory system is inherently unmalleable so if you use the example of the musculoskeletal system as you've said you go to the gym you do some weight training and you progressively increase the weights that you're lifting muscles

get bigger and stronger to adapt you get a bigger cross-sectional area of the muscle or you get better recruitment of muscle fibers so you get stronger if you go out running or cycling your cardiovascular system is is quite malleable that will adapt you get things like left ventricular hypertrophy you get increased capillarization which increases blood flow you might get an expansion of plasma volume increased red blood cell count you know all of these things make us more efficient at transporting oxygen around the body increased hemoglobin mass the respiratory system doesn't really adapt in the same way so you can do all the training that you like and your lung capacity your absolute lung capacity is pretty much set from the from the time that you stop growing so once you once you reach maturity physical maturity your lung capacity is pretty much set you can't change that and it's worth mentioning that some aspects of the respiratory system and we're talking specifically the respiratory muscles so the diaphragm and the abdominal muscles for the inspiratory and expiratory muscles respectively these can be trained we'll kind of talk about those later on but that's pretty much the only area of the respiratory system that is going to adapt to training and somebody who exercises regularly is probably going to have i guess if you looked very broadly it's probably going to have better lung capacity or better lung function than somebody who doesn't exercise because they've indirectly trained these respiratory muscles

to be able to contract more forcefully so they're probably able to i guess access for want of a better word more of their lung capacity but the but the absolute volume of the lungs in terms of the maximum volume of air that can move in and out of the lungs is pretty much set it's also worth very briefly mentioning that the respiratory system just like most other systems of the body can be subject to maladaptations as well so we all know that there is an increased risk of things like exercise induced asthma and exercise induced bronchoconstriction in in high level athletes particularly endurance athletes and particularly those who are training in cold and dry environments and this is because we're getting progressive inflammation of the upper airways which then causes airway damage and hypersensitivity so something like 20 percent of olympic athletes have exercise induced asthma or exercise induced bronchoconstriction whereas about 10 percent of non-athletes have the same condition so it is definitely more prevalent in in uh well-trained athletes and so those are the only ways that the respiratory system is really going to adapt to training somewhere out there somewhere out there somebody is begging me to ask you the tu e question since that seems to be the thing that most people want to bring up when they hear these statistics on how many athletes versus non-athletes uh have conditions like asthma and and whatnot we're not going to touch that we're going to try to stay on topic as much as possible but but the thing when you went through that description nick one of the things that kind of came to mind that i've seen pop up in the

literature a little bit more recently is this is is this phrase is this phraseology overbuilt for purpose and i once again i'm not an expert in the room but i i i can intuitively understand why we would describe particularly the respiratory system as being this way i'm wondering if you can kind of like shed some light on what that actually means because like i said it's come out in some very specific pieces of research and i think it's a great way to explain that concept that you just went through okay so when we talk about the respiratory system being overbuilt for purpose we can kind of explain it with a really simple example if you were to get somebody to do what we call a maximum voluntary ventilation test then uh so so very simply you would get somebody to breathe in and out of a mouthpiece for 12 seconds and if you give them a bit of coaching give you give them some instructions and essentially what you want them to do is to breathe as hard and as far so as deeply and as rapidly as they possibly can for 12 seconds and then we extrapolate the result for a minute so we get the maximum voluntary ventilation over a minute we can't actually get them to do it for a minute because because they'd uh they'd hyperventilate and then they'd they'd go hypocapnic so they'd expel all the carbon dioxide and they'd probably they'd probably collapse in front of you so we can't do that from an ethical perspective so what we do is we get it we do them we do the test over 12 seconds and then we extrapolate extrapolate the result over a minute and the the typical result for a for a test like that

could be in somebody who's you know fit and well trained i'm going to pick a number off the top of my head might be 250 liters per minute so they so they're going to move 250 liters of air in and out of the lungs in in one minute of that kind of um breathing with using that kind of breathing pattern if you were to get them to exercise maximally that they're not going to they're not going to max out their envelope they're probably only only going to hit about 200 liters per minute and that's if they're really well trained most people don't hit 200 liters per minute it's going to be maybe 180 190 liters per minute but the point is your capacity to ventilate the lungs is never really going to be encroached upon by the amount of ventilation that you're going to need during maximal exercise even a vo2 max test so when we talk about the the respiratory system being overbuilt for for purpose that's kind of what we're talking about in terms of maximal ventilatory capacity is never is never going to be exceeded now there are exceptions to that um which i can talk about very briefly if you like but it doesn't mean delving a little bit into the respiratory mechanics which is which is not super simple should we give it a go well we can give it a go or because we're going to talk about the devices in a second if it's a good place to splice it in there you can bring it in there it's your your call well i suppose let's briefly touch on it because if there are respiratory physiologists who end up listening to this they're going to tell me off for not for kind of misrepresenting so in most cases the respiratory

system is overbuilt for capacity but sometimes what happens is particularly in people who are very well trained we get something called expiratory flow limitation and this basically occurs when people are ventilating very very hard and because the the the respiratory muscles are contracting quite forcefully and because of that we're getting very big pressure changes in the airways okay so the respiratory muscles are contracting really hard to move air really hard and fast out of the lungs we're getting big pressure changes in the airways and these pressure changes can cause the smooth muscle in the airways to constrict very very slightly okay this is what we call thoracic gas compression so the actual external pressure the external load on the rib cage causes the the airway smooth muscle to just constrict now if you were kind of you know watering your plants you know at the weekend and you've got water gushing out of the hose and then you were to constrict the hose slightly then the water is going to start to trickle out and it's exactly the same thing air is in in areas can be considered just a it's you know it's just not the fluid yeah so when we think of it in terms of fluid dynamics exactly the same thing if you constrict the the airway smooth muscle we we get a what we call bronchoconstriction and that's going to cause some kind of limitation to to expiratory flow when that happens the respiratory system can be considered not overbuilt for capacity it's actually a kind of

inherent flaw in the respiratory system and in people with kind of respiratory disease like copd they have diseased and damaged airways that very easily collapse under very very modest pressures so they get really really high levels of expiratory flow limitation what we see in athletes because they have healthy airways we see a much kind of more modest constriction of the airways but in in people with copd the airways collapse and that's why they they have all these kind of distressing respiratory symptoms i think that that distinction is important to bring out because we we always have to be mindful that once again we're talking to an athletic population and sometimes information trickles into the athletic population from a diseased population that may or may not be relevant and i think here here's one of those examples right here where we see that constriction in athletes but it's just not to the same degree as we do in a diseased population sure and and that kind of idea of you know not extrapolating extrapolating data from patient populations to healthy subjects is going to come back when we talk about some of these interventions because some of these things may be really beneficial for patients but actually may have negligible effects in a healthy athletic person with healthy respiratory function so i think that that's going to kind of come full circle i think okay so we're going to generally divide this next section into kind of two categories that are going to have some overlap now that i'm thinking about it right now the devices and then the techniques and by the

devices i mean some sort of strength training analogy right device that's meant to improve the strength of your cardio respiratory system right the muscles that you just went through and the interventions being all of the breathing techniques that we have started to see in the marketplace purse lip breathing nose breathing holding your breath like doing you know counted counted breaths like there's any kind of number of things that i'm sure that you have have run into i'll ask you this is there a logical order to that that you think we should go through one versus the other not particularly but i i would quite like to start with the question that you pose to me on social media let's do it let's get the background story first though okay no that's fine because i think that's a great place to start and it actually allows us to approach the question in a very logical and systematic way and bring in all of these other aspects into answering the question because there is actually a very clear answer to the question but but we need to kind of take people by the hand and lead them lead them through the science if you like there's a full story there's a few of them i don't know if you're tagged in all of them then hold on let me make sure we get the right ones here i only got one oh okay um well okay you go you go over that one and since that's the only one i've got like five or six in my feed that i can choose from okay so so the one that that uh that we started off with was at least from my perspective was is there some kind of a performance

benefit to nasal breathing so breathing through the nose as opposed to breathing through the mouth and i think this is a good place to start because as i said there's there's actually a fairly decisive answer but there's we've got to approach it in a logical and systematic way so when we talk about nose breathing and it's really trendy at the moment getting people to breathe predominantly through the nose exclusively through the nose nasal breathing during exercise even to the point where it's being sold as a product you know it's being wrapped up as a product and sold and people are making money off it a lot of there's a lot of false claims surrounding it as well but the first the first kind of question um relating to that is what is the premise what is the potential benefit what is the mechanism by which there could be any advantage to breathing through the nose and there are two potential ones the first one is that nasal breathing as opposed to oral nasal breathing or breathing through the mouth only can increase the uptake of nitric oxide into the lungs so nitric oxide is a kind of it's a bronchodilator it it sort of evokes a relaxation of the airway smooth muscle and helps the airways to relax and expand a little bit and there are there's loads of research looking at nitric oxide breathing through external gas mixtures so actually somebody breathing nitric oxide through an

external mixture and then looking at the effects of that that's not what we're talking about the nasal cavity produces two to three times more nitric oxide than the mouth or the trachea and so the proponents of nasal breathing postulate that actually if we get people to breathe in through the nose more readily more frequently particularly during exercise it's going to help to open up the airways that's kind of what we hear the most the second major premise of nasal breathing is that breathing through the nose helps to warm and humidify the air which promotes gas exchange in the lungs so that there is research showing that if we're breathing through the nose we do get more nitric oxide in to the lungs okay so that is true and the nasal cavity does produce more nitric oxide than either the mouth or the or the air the upper airway the trachea and there are studies in patients primarily in patients showing that certain individuals people with obstructive lung disease people who who are on mechanical ventilation when physiologic concentrations of nitric oxide are actually introduced into the um into the breath it can actually help to um reduce respiratory symptoms it can help to um reduce or at least partially mitigate pulmonary hypertension and it can have certain beneficial effects for patient populations so breathing in through the nose and actually kind of practicing nasal breathing at rest

can potentially be beneficial for patients okay there isn't any research to show that it's going to be also beneficial in somebody with healthy respiratory function and again this is where we need to distinguish between patients and people with healthy function if you have healthy baseline function then there isn't an awful lot to be gained by nasal breathing okay so the next question is is it even plausible to breathe exclusively through the nose during exercise right because this is getting us a little bit closer to okay is it beneficial to nasal breathing during exercise and again this has been studied if if you get a normal individual somebody who's athletically trained or recreationally active and you get them to do an incremental exercise test to volitional fatigue like a vo2 max test and you ask them to just breathe through the nose and you actually enforce it they're not going to like you very much but they'll probably hit about 80 percent of their normal vo2 max okay so there's going to be about a 20 percent reduction in exercise capacity there are also studies showing that it is trainable right so if you're willing to put the time and the effort into training somebody for at least six months we're talking about a six month intervention to get somebody habituated to nasal breathing then studies show and there's there's a nice case study actually in a in an elite triathlete when when it showed that they over a prolonged period

of time they became habituated to nasal breathing only then you can get people to exercise at a really high intensity and even maximally without compromising exercise performance so they can breathe exclusively through the nose without compromising vo2 max so that's the second part of the question the final part of the question is is there any benefit to breathing through the nose we've shown that it may benefit patients at rest and it's at least feasible to train somebody to become habituated to nasal breathing does it provide any performance advantage as opposed to just oral nasal breathing or just breathing through the mouth and the answer is no and it's been studied fairly extensively in a whole bunch of different papers and a systematic review that was published a couple of years ago actually found that there was generally if you look at all if you collate the findings from all of the papers together it doesn't improve vo2 max it doesn't improve ventilation there might be some small effect on breathing efficiency but again in somebody who's already healthy so who's already got healthy lung function it's not going to make any difference and actually the perceptions of respiratory discomfort seem to be worse if you force somebody to breathe through the nose there's lots of anecdotal reports of air hunger it's this kind of this idea of unsatisfied inspiration because people can't get enough airing through the nose

so um so generally for somebody who who is athletically inclined it's not going to improve your performance and for somebody who's a who's a patient if it's going to exacerbate these respiratory sensations it's not going to be appropriate for them anyway so at best it might be par with copious amounts of training months six months maybe of training and at worst there's a 20 reduction in vo2 max and you're uncomfortable but here's here's where here's a practical piece that i hear from the kind of from the from the community and particularly like the ultra endurance community is that the 20 reduction in vo2 max is not that meaningful because we're running at such a low percentage of our vo2 max as well and the nasal breathing while it might have a physiological detriment has a like a psychological centering quality to it where you're going through an effort and you're hurting a lot and you just need to kind of focus on your breath and all of those meditative types of aspects that we can that we continue to hear and i know that's that's that research is not very very well formed but for the people out there that say hey listen i do i do nasal breathing when i'm out there on my on my run if you're not exercising at a high intensity yeah i mean maybe that maybe that decrement is not that is not that big of a deal i still wouldn't look at it as a

performance enhancer though certainly it's not a performance enhancer at best there's there's going to be some kind of perceptual advantage to doing it and if somebody feels more comfortable doing it and that's great and it does kind of lead us smoothly into this discussion of breathing techniques because almost all of these different breathing techniques whether it's diaphragmatic buteyko purslip breathing yoga breathing whatever it happens to be they all involve breathing in through the nose so if when you're running if if you're able to breathe in through the nose and out through the mouth and you're comfortable doing that and that's how you feel most comfortable breathing then who am i to tell you otherwise and the the first question i always get when people find out that i'm a respiratory physiologist they'll ask me what's the most efficient way to breathe what's the correct way to breathe and i always come back to them with however you're breathing there is there is a reason for it now there is technically there is a more efficient and a less efficient breathing pattern and and there is a kind of more efficient way to breathe i guess generally what we don't want to do is is to see people panting because that just um increases the dead space in the in the airway we want people to be kind of expanding the lungs and trying to take bigger breaths generally speaking but if somebody's not doing that then there's usually a reason yeah maybe they've got a respiratory muscle weakness or or it's offloading the respiratory strain from you know some other area so there's always a reason why people breathe the way that they do it's not to say that we should just accept the way that people breathe it's

always got to be subject to close to scrutiny but there's no right or wrong way to breathe necessarily there's a reason why you breathe the way that you do so if you're happy and comfortable going out and breathing this way during your runs and it's not uh compromising performance and it's not making you uncomfortable then by all means do it i'm so glad that you mentioned the vo2 max analogy because that's the analogy that i always use for people it's like if you have ever done one of those tests there is no way you want to exclusively breathe through you if you've ever done one and you've ever had that experience there's no way that you would want to put that handicap on yourself and for whatever reason the people who have actually done those tests that's when they actually get it they're like okay i totally i totally understand i've got the mask on i don't want another kind of limiting thing when i'm doing this when i'm doing this maximal test and people normally transition from nasal to or nasal breathing at about 35 it's somewhere between 35 and 50 liters per minute that's the kind of the natural point at which people switch from breathing exclusively through the nose and that's that's a very low exercise intensity that's kind of we're talking about a slow jog so most people could go out and they could jog very slowly breathing in and out through the nose comfortably but your natural inclination is to switch at anything above a moderate intensity yeah okay we're going to go on to the next one which is which is imt right and you are you mentioned some of these techniques earlier and i think actually the first the first kind of technique to to go through is really just pursed lip breathing

because people understand that the most and then we can kind of go through some of the more i don't know advanced or i guess lesser known ones of those so we've already gone through nasal breathing right and we've seen we've we've we can recognize that it's a performance limiter it takes a long time to train probably not worth your while if you're comfortable doing it and it gives you some sort of centering quality at a low intensity there's probably no detriment at those very low intensities but let's move on to to pursed lip breathing take the audience through first off what that is right and then how where do we see that come up in the medical community and then is there a translation to the athletic community okay so pursed lip breathing specifically and in when we look at the literature on this and there's a lot of it i mean we did we did some keyword searches for our systematic review which is kind of in in the latter stages of um so knit close to a final draft and there is something like 15 000 different papers that come up with these keyword searches yeah there's a lot of research and but that encompasses you know pursed lip breathing diaphragmatic breathing yoga uh meditative breathing uh buteyko inspiratory muscle training um any kind of intervention that claims to improve the way that you breathe and pursed lip breathing specifically is probably the most popular one and it's the one that's used more often in like pulmonary rehabilitation for cbd patients

and basically involves taking a deep breath in through the nose usually there isn't a breath hold in some you know in diaphragmatic breathing and some of the other interventions there might be a short breath hold then there's a long slow exhalation out through the mouth and in pursed lips breathing specifically you would breathe out through pursed or puckered lips so this is not going to work well for people who are just listening but but if you're watching it you would generally take a deep breath in and then breathe out if you would purse your lips together almost as if you're kind of whistling or whistling badly or learning to whistle and and that actually we'll talk about the the the respiratory mechanics of what that actually does in a minute but you would take this long slow exhalation through pursed or puckered lips and then you do the whole thing again the emphasis in pursed lip breathing is to well there's a couple of things we want to slow down the breathing rate so the respiratory frequency needs to drop there's there's no kind of specific guide as to you know how many breaths per minute you should be taking but again this is usually aimed at patients who tend to breathe very very quickly and they tend to breathe very in kind of very shallow terms as well and this is is partly what contributes to their to their breathlessness so in respiratory patients what we want to do is get them breathing more slowly but more deeply so we're taking a deep breath in we're expanding the rib cage we you know you can if you want to use the diaphragm you can preferentially engage the diaphragm with diaphragmatic breathing but that takes some

practice and then you're taking this this long slow breath out so we're slowing down respiratory rate we're increasing the tidal volume so that's the amount of air moving in and out of the lungs with each breath and this helps to study show that actually increases oxygen saturation so respiratory patients often have lower than normal oxygen saturation it might be below 90 percent if they have severe copd it might be you know 85 percent or something and this kind this method of breathing can actually increase oxygen saturation it can reduce respiratory symptoms reduce breathlessness it can actually if it's if it's done during low intensity exercise it can actually improve exercise capacity again in patients and the other key thing that pursed lip breathing does which isn't necessarily a factor in these other breathing methods is that that that uh motion of breathing out through pursed lips actually creates a positive back pressure in the airway and that helps to open up the airways it sort of increases what we call positive end expiratory pressure by creating that back pressure it helps to prevent the airways from collapsing during the expiration which is something that happens quite often in people that have copd so to the next part of your question do any of these things actually benefit somebody who's healthy probably not the reason being is that somebody who has healthy respiratory function they're not going

to have lower than normal saturation rates okay they're not going to have distressing respiratory symptoms at baseline anyway they're not going to need to enact these things during exercise because as i've said their baseline function is already by definition if they're healthy their baseline function is already normal if they're athletic it's probably going to be above normal anyway so all of these things that would benefit a patient and have been documented to to improve patients well-being and reduce their respiratory symptoms it probably isn't going to have the same effect in a healthy person and when we look at some of the other types of breathing techniques and i i i kind of lump them into the same category like a caveman you know because it's not my area of expertise but i look at all of them and there's some sort of timing associated with them right breathe in for this amount of time hold it for that amount of time breathe out and you can change the pattern and you know two four two and four four four and what kind of whatever it is is is is there a broad statement that you can make with any of those other ones where it's just simply the timing that you're trying to manipulate and some of these actually have become quite popular not only in endurance sports but also in like yoga and and even in mixed martial arts both of both you and i are mixed martial arts fans you see coaches in the corner that that will take their athletes uh in between rounds through some of these things is there anything that we can say about the timed breathing basket of stuff whether you want to mention any of those techniques by name or you

want to kind of just lump them all into the same thing like i do yeah absolutely so there is there is a really important takeaway for people who are not patients who who are lucky enough to not be patients who want to improve their respiratory function because this kind of breathing pattern or breath training where you take a breath in and then you take this long slow exhalation and sometimes there's a breath hold on the inspiration there's a lot of research now showing that this can help to control the autonomic nervous system so when you when you take a breath in where there's a short breath hold and then there's a long slow exhalation it actually stimulates the vagus nerve which is associated with parasympathetic function and it can help to you know this i know you're interested in heart rate variability but this is how you can increase your heart rate variability it can help to reduce anxiety it can help to reduce stress it reduces arousal and there are fmri studies so functional fm mri studies showing that actually when you engage in these kind of deep slow meditative breathing strategies it actually stimulates different areas of the brain you actually get different brain regions are being stimulated and and associated with parasympathetic drive and that is what causes the kind of the feelings of reduced arousal reduced anxiety and it's been shown to help in depression and this kind of thing as well so from a meditation type perspective these kind of breathing techniques can be really really beneficial for somebody who

has healthy respiratory function but um whether it whether that directly translates to improved performance or just indirectly um you know it's something that you can try but there's a kind of growing body of research in that area i think it's i think it's fascinating yeah the hrv stuff is actually really fascinating as well i recently i don't know if you know this nick but i recently had marker altini on the on the podcast and i i had this on my list of stuff to ask him but i don't think it actually came up i'm always stunned at the the the the short amount of time between cause and effect like you can be taking your heart rate variability you can be measuring it and you can kind of see see it in real time and change your breathing pattern and it changes almost instantly now my my question to that once i see that is yes you can see that but is it material to anything right because you can always get an outcome if you you know force the issue but is it material to improvement relaxation performance like where what's the actual translational point there and that's i think is we don't know a whole lot of that well acutely you know if you were monitoring your heart rate or your heart rate variability and you were to hold your breath or take a deep breath in and then a long slow breath out part of that is going to be due to the changes on the pulmonary vasculature and the the change in the the pressure dynamics as you take a breath in and you take a breath out that's why your heart rate seems to change very very quickly in from you know in an acute perspective but in the long term if you were to do these kinds of breathing exercises for at least

five maybe ten minutes that's when you're going to get the change in the autonomic function and i think this is one of the the the really key areas where we get the overlapping of the plausible and the implausible claims because it's absolutely plausible to say the deep slow breathing and meditative breathing diaphragmatic breathing maybe with some kind of basic breath hold of five to ten seconds if you find it comfortable yeah there's research showing that it can help to reduce arousal and stress and anxiety and these kinds of things by manipulating the autonomic nervous system but then at the other end of the spectrum other people claim that it can promote healing and that it can help to cure disease and this breath work has you know some kind of link with an internal life energy and that's when we get into the the superstition and the quite frankly the harmful pseudoscience when people think that they can heal themselves just by breathing and we've got to make we've got to draw a very clear line in the sand between the plausible and the implausible claims because in my opinion the implausible claims just undermine the very plausible claims and it does it does a disservice to everyone well also the implausible claims uh prevent people from seeking treatment that could actually fix whatever they're trying to be fixed from right could or whatever's actually ailing them that's the bigger or a a a one of the bigger things uh in addition to that if they're seeking treatment which there is already a standardized well

known treatment for you know and they're and they're foregoing that treatment with something that's just total horseshit that's when people get into trouble well it's a slippery slope and i know we're not here to talk about cupping but you know as an just as an example you know that the british the british cupping society say that cupping is great for reducing stress and for relieving muscle soreness and you can also use it to treat asthmatic symptoms well hang on there's two very different things don't try and treat you know an asthma attack with cupping because it's going to lead to you know disastrous results here i think let me let me try to steer the train back on track stay before you i'll bring you back here um here's what people are going to want to know though like they can people will want to use breath work to enhance their life quality right it helps them reduce stress they use it in a meditative capacity i have a lot of athletes that use the apps and things like that and they love them and it feels like i do as well yeah yeah i think they're fantastic yeah i've i love the headspace app when i used it i i stopped using i should probably pick it back up maybe that'll be my new year's resolution or something like that but anyway um but and they recognize that they can control those things acutely and there's some improvement in some aspect of their quality of life but from a performance standpoint is there anything within the literature or even on the mechanistic side of things where we can say some of this breath work in an athletic context is going to make a difference

either from a performance perspective or even i mean we can even dive into like the arousal and being able to control anxiety and effort and things like that is there is there anything that makes that link from this type of breath practice into the performance side sure and and yes it's a short answer you've already mentioned one aspect in terms of reducing anxiety and i think that is a key one because a lot of people do get very anxious and it negatively affects their performance right so if you can find strategies to relieve that anxiety and that and reduce that arousal through breath work you know then that's absolutely a positive thing and uh it reminds me actually you know they people always make this big fuss about how marijuana is is um is on the water banned substance list and they're talking about well marijuana is not a performance answer i'm like if you have adhd it is a performance answer if you get if you get pre-composition nerves it absolutely is going to help you to focus and perform more effectively and it just kind of links in with this if you have anxiety before a race then doing some breath work and taking some deep slow breaths and focusing on that is absolutely going to help if you have an inefficient breathing pattern so if you're it doesn't happen very often because most people generally tend to change their breathing pattern their breathing strategy to make sure that they're meeting their ventilatory demands but occasionally i don't know how often you've seen this but if i'm at a race or if i'm attending a competition and i can literally hear some runners

and they're breathing at twice the speed at twice the frequency of other people and they sound like a sound like a choo-choo train coming along you know and their breath is very very shallow and very very fast and a couple of times you know pre-covid because if somebody's breathing like that i'm not getting close to them now but but but pre-covid i would sometimes if i had the opportunity to i would mention to them look that's probably not a very efficient way to breathe so actually doing some breath work to try and slow your breathing down and and expand your rib cage expand your tidal volume is probably going to be more efficient in terms of not utilizing so much of this dead space in the airways so that that's that's another way that we can use these strategies to improve performance can i pause you on that one really quick not to interrupt your train of thought how do people not know that this has always befuddled me because i've been in the same situation situation you have been running beside somebody in a marathon or a trail race and i'm like how do you not hear yourself and understand that you're going and you're not going that hard like i don't understand how that even happens like i can't even give them the counsel to course correct that because it's it's so befuddling to me i don't know i think a lot of people are just very very naive to how their body works and some people are new to the sport and don't know they don't know what's normal um they don't know what a normal you know method of breathing is they haven't spent enough time around other athletes to know that they're doing it wrong uh sometimes people just get into a rhythm and get into a habit you

know you see an older person doing it in their 50s or 60s maybe they've been breathing that way since since day one and they've got a lifetime of you know reinforcing this inefficient breathing strategy behind them and it's just it's going to take too much time and too much effort for them to correct and um and in those cases maybe maybe it's not worth trying to correct because you might do more harm than good see that's what people are going to want to know right it's like a how do i know if i don't know well you can have somebody listen to you right and they they can tell you if it's normal or not if they're a good friend in particular but then the second thing is is it worth course correcting and in some cases it might not be because it's like too hard to unwind at that point yeah each individual it has to be each individual case has to be addressed as an individual case and so if if somebody you you can't just tell by listening to somebody if they're breathing inefficiently ideally you try and get them into a lab try and get them to see a specialist who can hook them up to some gear and look at the ventilation rates look at the breathing frequency look at the ventilatory equivalents and see how that's affecting them kind of metabolic function because you know when i when i was working i spent a year working with a british kayaking squad and again there was one athlete who when he was out on the water you could just hear him a mile off because he was breathing twice as loud and twice as quickly as ever as everyone else when we actually got him into the lab it didn't seem to be affecting his cardiometabolic function you know he's on on paper

his breathing pattern was very inefficient and it's something that i picked up on when he was out on the water but it actually wasn't negatively impacting on his on his physiology so actually it would be probably more do more harm than good trying to correct it at that point but um in some cases people do breathe very inefficiently and it does affect their their metabolic functions so that's something that needs to be corrected what's the ballpark or do you know the prevalency rate of that i i don't know off the top of my head it's pretty pretty from just anecdotally it's pretty rare and i spent a lot of time around athletes over the over the last couple you know decade and a half and um i've only seen it on in a handful of instances so i think it's pretty rare but uh you know if you're listening to this and you're you know next time you go out for a run just be mindful of and it links into the meditation and the mindfulness just just be mindful of how you're breathing if you're breathing very fast and very rapidly that's probably not a very efficient way to breathe it's not necessarily it's not doing any harm but it could be that it it might be optimized and it might be worth looking into okay so i interrupted your train of thought with my ramble here continue that's fine it's important to to to follow these sidetracks when they come up yeah the last thing i was going to mention was in spiritual muscle training right and i don't know if you were going to come on to this more no let's do it let's do it now organic okay so the the kind of the last aspect i guess to mention among all of this is in spiritual muscle training and this is when we

actually use some kind of handheld in spiritual muscle training device to train the in spiritual muscles or train the respiratory muscles and generally we pleased to know the research is very favorable for using respiratory muscle training devices not just in patients but in athletic populations as well um where's the best place to start i suppose well first off like people are going to know these by their brand names and there's there's a few of them there's arrow fit iron lung power breathe what else is out there you probably know the space a little bit better than i do those those three main ones those are the three ones but there's something you stick in your mouth right and it's providing the training the training mask that used to be called the altitude mask because it doesn't replicate altitude at all and then they were forced to train it to like the the respiratory mask or something like that but it's a it's a device i guess right it's got it's got a technical name to it but there are all these devices that are providing some sort of resistance to your breath it's an inspiratory resistive device the only one that i'm going to talk about is power breathe because the vast majority of the scientific research has been done with power breathe and then all of these other products basically try to hitch a free ride on the research that's been done on power breathe so they say look in spiritual muscle training does this this and this i'm like no hang on power breathe does this this and this your product may work in the exact same way but the

research hasn't been done in these other products so i'm only going to talk about power breathe because that's the research that i know so i guess the analogy to to extend the analogy that you used earlier is if you were to go to the gym and train one of your skeletal muscles to make it bigger and stronger you could go and you could um you could strengthen your quads by doing squats okay and just like in an ultramarathon just like your your leg muscles are going to fatigue your respiratory muscles can fatigue as well okay because after you know several hours of ventilating the lungs and moving air in and out out of the lungs the diaphragm is going to start getting tired it's going to experience some kind of contractile fatigue so if you were to get somebody to do a maximal strength test on their quads before an ultramarathon and then you got them to replicate the test after the ultramarathon their ability to reduce force is going to have diminished considerably right all of all of his research yeah exactly yeah our good friend keys research he mille's research and he's actually he's taking it to the next level because he's looked at involuntary muscle contractions as well using transcranial magnetic stimulation so it takes the kind of the the voluntary aspect out of the equation it's all involuntary so he's actually looking at the the very contractile properties of the muscle in its purest form but the same studies have been done with the respiratory muscles if you've got somebody to do a maximal breath in against a an occluded mouthpiece before an ultramarathon and they did the same thing

after the ultramarathon the amount of pressure that they can generate against the occluded mouthpiece is going to have dropped off and the only one study that's been done on on this using nerve stimulation has come from geese lab of course and what they found was that exactly the same thing when when you actually artificially stimulate the inspiratory muscles using a magnetic stimulator it shows that the actual contractile properties of the muscle have actually changed pre to post race so the ability to contract the muscles has actually diminished now this can have at least two or three different effects on a runner the first thing is that if the the ability for the inspiratory muscles to contract is diminished it means you're not going to be able to ventilate the lungs as effectively okay so your ability to maximally ventilate the lungs is going to be diminished that's not such a big deal for ultramarathon runners because you don't generally get anywhere close to your maximum voluntary ventilation anyway we're not working so hard that you're going to be encroaching on your ability to maximally ventilate the lungs so that's not such a big deal but the other thing that happens when the inspiratory muscles start to fatigue is something that we call a metaboreflex and this is basically when the muscle fatigues it starts to redirect cardiac output it redirects blood flow away from the limb locomotor muscles to the muscles that are fatiguing so when the diaphragm fatigues it steals the cardiac output it steals the blood flow away from the limb locomotor muscles in this case the legs

and it causes them to fatigue prematurely so it's not just in respiratory muscle fatigue that we get but that metaboreflex causes the limb locomotor muscles to fatigue before they would otherwise fatigue and that can obviously impact performance in the obvious way so one of the ways that the research has shown that we can try and get around this in terms of providing a protective effect is to train the inspiratory muscles with one of these inspiratory resistive loading devices like power breathe so i don't know if you have you ever tried these devices if you ever worked with people that yeah that have tried a an imt protocol what's the kind of typical protocol that you would use well we've done i mean we've had them do everything right we've had an exercise with it we've had them do like maximal uh like maximal exhalation work with it uh in almost kind of like an interval fashion right very short you know intervals that are interspersed with like five or ten minutes of recovery so we've done all that stuff both in the lab and in the field i've worked with a lot of athletes who have done really low intensity exercise against an inspiratory resistive loader but the the most common kind of strategy is to do kind of 30 breaths a day at least you know maybe once twice a day and then the idea is just like you would increase the resistance if you're doing a resistance training program in the gym you increase the resistance of the inspiratory trainer so that you're progressively

breathing against a greater load so the inspiratory muscles are being progressively trained well the study shows that you know with a you know something like a 12-week intervention you can significantly increase the pressure generating capacity of the inspiratory muscles so if before you could generate 150 centimeters of water before the training program after you know 8 to 12 weeks of training you might be able to increase it to 170 180 centimeters of water and by increasing your ability to generate pressure with the inspiratory muscles you're providing a protective effect against inspiratory muscle fatigue and when and the studies generally show that you get you don't completely eliminate fatigue but you mitigate it okay you prolong the amount of time it takes for the inspiratory muscles to fatigue or you get a lesser effect you get lesser fatigue in trained muscles and does that actually show up in a performance benefit yes so it would do so if there are studies that have been done if you pre-fatigue the inspiratory muscles it shows that it negatively impacts on performance okay so time to exhaustion is reduced and then if you take somebody through an inspiratory muscle training program that it actually provides a protective effect against the the kind of the negative outcomes of inspiratory muscle fatigue it's not a miracle cure and it's not and it's not gonna you know it's not gonna get you from an amateur athlete to an

olympic medalist but in terms of the accessible tangible ways to train the respiratory system this is one of the few ways that that seems to actually work and we get respiratory muscle fatigue in almost all sports it used to be some of the early research you know we we thought that it was just in high intensity short duration very high intensity exercise like when you when you hit exhaustion within eight to 12 minutes because that's what that's where most of the research was done but there's more than enough research now showing that your respiratory muscles fatigue during marathon during ultra marathon i published a review paper just a couple of years ago uh collating the research that's been done looking at the prevalence of respiratory muscle fatigue following marathon and ultra marathon and you know that the muscles seem to um show some somewhere between a 15 and 25 percent decrease in pressure generating capacity following any given race so if you can do something to offset that then it should improve your ability to perform and what seems to be the most efficacious protocol passive protocol or an active one like low intensity exercise or the one that you mentioned where it's just you're doing a you're basically doing sets and reps right yeah the one that's been studied i don't think that there is a an optimum strategy that's been identified in the literature the one that's been studied the most is what power breathe recommend so it's 30 breaths a day uh at least once or twice a day over a period

of at least eight to 12 weeks with a with a progressive increase in the resistance and there's there's a lot of there's a lot of crappy research in this area but there's a lot of really good research as well and the good research has actually done sham studies so they get a group of individuals to do in spirituary muscle training and then another group to do sham in spirituary muscle training so they're going through the motions of using an inspiratory resistive device and they're breathing in against resistance but the resistance is is low enough so that they think they're doing something but not high enough to really stimulate any adaptation in the respiratory muscles and there's you know usually if the protocol is right there's a difference between the two groups so would you view this i don't want to put words in your mouth but i'm trying to like synopsize it it it seems like a low effort intervention that has that has some tangible benefit that athletes could reap from it yeah almost the only caveat to that is that the main benefit seems to be in prolonging the time to respiratory muscle fatigue and at least in part offsetting this metaba reflex the the kind of the the respiratory steel but the the major caveat is that nobody has yet demonstrated that this metaba reflex occurs during ultramarathon so it it might be that the metaba reflex only occurs

during really high intensity exercise if you're working at a relatively lower exercise intensity for a very long period of time it might be that you don't get the same redirection of cardiac output so that's the kind of the the main caveat that that is yet to be explored we know that the respiratory muscles fatigue following ultramarathon and we know that training with uh with a with an respiratory muscle trainer seems to prolong the time it takes to for these muscles to fatigue also seems to be a perceptual improvement as well so people seem to be more breathless as well but um but beyond that you know we we can't really uh uh stake our uh flag in the sand you know and and just for the record i don't earn commission on power breathe on the sale of power breathe devices and i don't have any stocks and shares in power breathe but it's one of the very few devices thankfully where the research actually seems to support the claims that are being made and it's so rare for that to happen i don't mind talking about it well most of the time it's an oversell like we've talked about this before both on and offline there's usually a thread of truth right and that thread gets blown up into a rope or to a steel cable or like something way bigger than a thread you know and and and i hear i think if you look at the research i always come to the conclusion that yeah if you want to put in the effort it's a low it's a low effort intervention that could result and some performance benefit that you that we can't put a pin on we can't say is it we could

probably say it's like between one and ten percent right it's probably the bucket that we could put it in it's not 50 it's not going to put you on the freaking olympic podium if you can't make the olympic team but maybe you know improves your UTMB time by 20 minutes or something something like that yeah if nothing else it's probably going to improve your your perceptions of the respiratory discomfort and as you've said you know the vast majority of products when you look at the claims and the evidence there is this huge disparity between the claims and the supporting evidence and power breed seems to be one of those devices where the claims that they make seem to be tempered they seem to be fairly modest and moderate and based on the literature and you know why because the product was developed by a scientist product was developed by a very well respected very well renowned respiratory physiologist called alison mcconnell if you're a respiratory physiologist you'll know who she is and um this was all off the back of research that she did in the early part of her career so there's no the disparity between the claims and the evidence is much much smaller here and there there's a lot of other sports that have adopted this as well um that and when yeah and when i think when i see when i see things that kind of meet all those criteria that's when it becomes interesting to me when the gap between what is claimed and what is actually going on is not very big i get people got to sell stuff like mark the marketing team's got to come in at some point it's just how much gloss do they put on the do they put all the research but when you see that in combination

with different different sports adopting it and then the athletes genuinely without getting paid are adopting it as well i think that that's the right combination to start to to start to pay attention yeah and i think more often than not when when you have products who that or manufacturers who invest all of their capital in sponsorship because they're they're trying to subsidize the fact that they don't have any legitimate scientific research they don't have any evidence to support their claims so instead they sponsor athletes and they focus on visibility and the exposure effect and they're trying you know they're trying to bypass that all you know science thing and um and at least with powerbury that that doesn't seem to be the case they don't think they need to because they've got this this good body of research uh so at least that's that's one example where that's happening i've never heard anybody phrase it like that they're subsidizing a lack of research just through money and through attention that they can get through sponsorships i've never heard anybody put it like that i think that's brilliant well they they're not held accountable for the claims that they make the vast majority of manufacturers can say and do whatever they like so they can make whatever claims they want they don't have to provide any evidence because most athletes and most coaches aren't demanding the evidence it's supply and demand right if you're not demanding the evidence they're not going to supply you with any evidence and and so for the um you know most of the time the claims are being made and there's no supporting

evidence and so they will use clever marketing rhetoric and they will they will engage in logical fallacies and athlete sponsorship to to try and sweep under the carpet the fact that there's actually no scientific legitimacy to the claims that they're making okay so since we're on this rant right now we will keep it in the we'll kind of keep it in the breathing techniques and breathing apparatuses where are the worst offenders like where should the athletes like just run away don't look twice this is not worth your it's not even worth your attention more more over your money well especially now with this new world that we find ourselves in which is saturated with big business and social media and bad science and fake news and particularly with the pandemic the pandemic has really is brought out the worst a lot of people it's brought out the best in some people and the worst in others so i would say anytime you see any respiratory intervention that claims to boost your immune system that claims to protect you from covid that claims to help um you know cleanse your lungs i would just run as far as you can in the other direction you know and especially now with social media a lot of manufacturers can use social media to say and do things and make claims that they would never be able to do from a legal perspective you know on their own websites or in interviews and so forth but um they can do it a lot a lot more subtly on social media by by um you know using accounts that are not necessarily directly linked to theirs and the worst one that i saw recently was a picture of a guy using an

respiratory training device and it was in his mouth and underneath the picture it said protect yourself from covid 19 boost your immune system and strengthen your lungs to protect yourself from covid uh click this link you know and as i wrote in the skeptical inquire article none of these interventions are going to do any such thing okay there's there are very clear and and tried and tested ways to protect yourself from covid that is get vaccinated this is not controversial it's get vaccinated get boosted wear a freaking face mask and keep your distance from other people strengthening your lungs and improving your lung capacity is not going to help you if you have healthy baseline function to begin with and improving your lung function further is not going to help having said that you know being physically physically active and you know um not being obese and not having um you know type 2 diabetes that is the result of you know poor lifestyle choices all of these things can be corrected to some extent um but yeah anytime that there is any claim to boosting immune function or protecting you from covid there is no there is no respiratory intervention that can do that so i would just look in the other direction yeah there i mean there were a lot of other companies that ran afoul that as well they were just trying to use the pandemic to to make money and shame on them they're going to be the losers after this whole thing is said and done because they now have no confidence

that's neither here nor there i'm trying to keep the train back on the tracks again let's try to summarize it nick right so the breathing techniques that we went over those are they're probably not going to directly improve your exercise capacity and or performance they might have a second order effect on calming centering focusing something else that could potentially downstream affect your performance nobody's kind of kind of denying that whether or not you adopt those techniques or not is a highly personal choice there also might be some advantage to an imt device and the one that's been studied almost exclusively or at least the most is the power breed device where you can mitigate some of the respiratory fatigue that's going on by undertaking one of those interventions what else to the nickel version do we want to add or add caveats to two very brief things the first thing is that breathing interventions will be very beneficial for athletes who also have respiratory disorders because there are some of them so there are a lot of athletes who have asthma uh far fewer athletes who have copd but they are out there maybe they're listening and in that context then doing some kind of breath training or breathing intervention can be very beneficial but for people who as standard have healthy baseline function you hit the nail on the head the other the only other thing that we didn't mention

was uh nasal dilators so i don't want to get into a whole thing about that now but um but there's a lot of research on nasal dilators and essentially they again they as you can probably guess they don't improve athletic performance they might be able to improve your ability to nasal breathe during exercise so if you've decided for whatever reason that you want to nasal breathe during exercise or maximal exercise using an external nasal dilator like the tape that goes across the nose or an internal nasal dilator that goes actually in the nostrils it might actually um help you to breathe nasally if that's what you want to do but studies show that it doesn't enhance performance in in any meaningful way nobody's going to get on the olympic podium if they're not already on the olympic podium through a breathe right strip no and some athletes swear by you know i remember paul aracliff paul aracliff a very famous british a marathon runner and there's a american triathlete forget her name who's who every picture she's wearing these devices you know it's probably placebo effect if you perceive that you're breathing more comfortably you know the studies show that it does actually help to improve nasal patency so so if you know if you were to take a sniff again this isn't going to work for people who aren't watching the video but if you if you sniff in you'll see that the that the nasal uh the nasal wings actually collapse inwards anytime you take a sharp breath in through the nose and during high intensity exercise that can cause some people some discomfort so the nasal relators can actually help to prop open the nasal

the nasal wings and stop them from collapsing during inspiration but it doesn't improve performance it may help you from a perceptual perspective if that's what you're into i'm glad that we at least had some winners though right or some kind of like plausible winners i think a lot of times people like see these podcasts and like ah they're just gonna shit all over everything but we go through it in a rational fashion i i just i hate it when people call me like a debunker you know i'm just a debunker yeah i'm just a naysayer i just shit all over everything and you know that's not that's not the case i just i point my nose in the direction of the science and if the science shows that something's going to be beneficial hey i'm all for it the as as it goes the vast majority of these products don't work in the way that it's claimed or at least we've got to do we've got to make more of an effort to distinguish the plausible from the from the implausible claims because there's a lot of good that can be taken from some of these products but but there's a lot of bad that needs to be removed as well so um yeah it's i think it's a nice it makes a nice change when there are some positive takeaways from some of these products as well yeah man i appreciate it we appreciate you i know that you're a fan favorite nick i always appreciate you coming on i've always appreciated your counsel man uh we're gonna let you go for now i know you've got really important covet research to go over but i'll have links to the show notes to your column and uh skeptical inquires or anything else that you want to mention where people can reach out to you on social follow me on twitter at nbtiller and you can check out some of the work that i'm doing and in all different facets at my website nbtiller.com sweet but that was fun thanks for having me

yeah thanks nick appreciate it all right folks there you have it there you go thanks again to nick for coming back on the podcast i'm gonna have him back again because inevitably when i have these things people start to ask questions and he is always a very good sport about it i'm also glad that nick is finally finally finally back in the us and we can correspond on roughly the same time zone and not have to worry about this transatlantic time difference like we had to earlier so thank you thank you thank you nick for your time once again thank you to all the listeners out there i know a lot of you are interested in nick's book i'll have a link to that in the show notes as well as my own book you guys bought all of the copies of my hardback book that i had initially ordered and they're not going to be available again until the end of february so thank you guys for the overwhelming support on that i promise i will have more in stock but in the meantime i am more than happy to personalize a paperback copy for you the website that you can get that is just my website jasoncoop.com forward slash book you can enter in a personal note send it off as a gift send it to yourself i'm happy happy happy to personalize those for you and as i mentioned earlier i really appreciate the support that is it for today you guys and as always we will see you out on the trails