Key benefits of breathhold training for athletes? 

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Background 
Breathholdtraining has been around for millenia and there are athletes who have used breathholds such as Emil Zatopek. Emil Zatopek won the 5000 m, 10 000m and the Marathon in the 1952 Olympics in Helsinki and has been called one of the greatest runners of all time. However, it is the research in the last few decades that have put breathhold training on the map for team sports and especially within rugby. One highly significant study was conducted by Formasier-Santos, Millet & Woorons, 2018 on a national level rugby team of 21 participants. Essentially they trained by running 40m sprints on a passive exhale breathhold every 30 seconds with increasing sets and reps over the course of 4 weeks. The improvement from pre- and post breathhold training on running sprint ability went up signficantly. Before the 4 weeks of breathtraining started the participants had to run max – speed normally (without breathholds) as many rounds they could without falling below 85% of max speed. Before the breathhold training started the team average was 9.1 rounds and after breathhold training 4 weeks later it increased to 14.9 reps. There is no need to do this type of extreme training, and certainly not start here, but it shows the significance of breathhold training. 
 
IMPORTANT NOTE: breathhold training is only for healthy people and not for those who are pregnant. People who suffer from mental and physical illnesses such as panic attacks, heartproblems, low/high bloodpressure, epilepsy, diabetes etc should not do it. Also, it should never be done in water while being alone. 
 
Why athletes should train breathholds? 
There are several key reasons why breathhold training, such as Simulated High Altitude Training improves running sprint ability. It creates an Intermittent Hypoxic (low oxygen, O2), Hypercapnic (high carbon dioxide, CO2) response which disturbs the blood acid balance and causes adaptation. 
These adaptations improve aerobic and anaerobic capacity. Also, it trains the diaphragm which is the largest breathing muscle or more correctly fascial tissue. Training the diaphragm in turn improves breathing efficiency. There are also short-term benefits in the following 10 minutes approximately after breathholds due to release of release of red blood cells from the spleen (1). These are just the physical aspects but maybe the greatest benefits come from improving the mental and emotional areas. Since the need for oxygen and the urge to breathe is the strongest survival mechanism we have it has a great impact on our mental and emotional state. Learning slowly to be uncomfortable with breathholds can therefore yield tremendous results for focus under fatigue in competition and in high pressure situations. 
 
How to start with breathhold training? 
First off, there is a test that should be done in order to determine how sensitive an athlete is to carbon dioxide. The test is called a BOLT test, from Patrick McKeown founder of Oxygen Advantage, which essentially measures the time of a comfortable breathhold on an exhale in order to find out how well the athlete tolerates carbon dioxide. Carbon dioxide tolerance is a key marker for endurance athletes. Breathing should be normal after the breathhold and involves no willpower what so ever because that is a different type of test. 
For elite athletes my experience is that most players have a BOLT score of around 20-30 seconds, while the interval ranges from 10-50 seconds. The test score determines what type level the player will start at and it will be continuously retested for progression. In addition, a MBT (Maximum Breathlessness Test) from Oxygen Advantage is conducted where a player will do a maximum breathhold where willpower comes in to play. This will be used to find the proper intensity level to train at since most of the time training will be at sub-max effort. A pulseoximeter is also a valuable tool to ensure the corretct intensity level. The oxygen saturation should be around 80%-87% (equivalent ot 4 000 - 5 000 m in altitude) to ensure it does not get too intense (2). 
 
When to train breathholds? 
Training breathholds can be done in many situations and for several purposes such as: 
 
Adaptation 
The best place to start is in pre-season for several reasons. One reason is to avoid injury and by doing sprints on a breathhold intensity will be higher than normal but load on muscle less because of fewer repetitions. 
 
Pre-Game and Substitutions 
To deliberately stress the body and mind pre-game and before substitution in team sports is important. One reason is the extra release of red blood cells that improves the oxygen capacity. 
 
Injured players 
To maintain physical fitness breathhold training is vital for injured athletes and they can start essentially on Day 1 after injury even if they have a leg injury and cannot move properly. 
 
Recovery 
Shorter breathholds raise carbon dioxide and nitric oxide levels and can help athletes recover after training and competition. 
 
 
1 The Oxygen Advantage by Patrick McKeown p. 137 
2 The Breathing Cure by Patrick McKeown page 84 
 
Tagged as: Adaptation
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