This is of particular
relevance to the Oxygen Advantage program, as our breath-hold exercises
are performed out of water . The relevance of the above stud ies suggests that ef fects similar to those
achieved with high-altitude training can be obtained at sea leve l simply by
performing a series of breath h olds. Stimulating the spleen to contract by
reducing the availability of oxy gen causes an increase in hem oglobin and
hematocrit, which in turn increases the oxygen-carrying capacity of the
blood and improves aerobic ability . The mo st appea ling aspect of breath holding is that it is feas ible for
most ind ividuals and is not as taxing on the body as high-intensity exercise. Performing just 3 to 5 breath holds of maximum duration can lead to a 2 to
4 percent increase in hemoglobin. This might not sound like much, but
where a fraction of a second can determine the dif ference b etween the
winner and the loser , every possible advantage counts.Why Oxygen  Advantage T raining Elicits an Even  Str onger
Response
In the studies in vestigating breath holds and splenic contraction s discussed,
each breath hold was performe d following an inhalation. Y ou might be
wondering why  Oxygen Advantage breath holds are performed after an
exhalation. Let me explain. Performing a breath hold aft er an exhalation lowers the oxygen
saturation of the blood to simulate the ef fects of high-altitude  training. I
have monitored the blood oxyge n saturation of thousands of in dividuals as
they pra ctice breath holds, and by far the greatest change to oxygen
saturation occurs after an exhalation. For most people, after four or five
days of practice, a drop of oxygen saturation below 94 percent can be
observed—a level comparative to the ef fects of living at an altitude of 2,500
to 4,000 meters. Gently exhaling  prior to holding the breath reduces air content in the
lungs, al lowing a quicker buildup of carbon dioxide and eliciting a stronger
response. While  this reduces the length of time for which you can hold your
breath, i ncreased carbon dioxide has been shown to improve hemoglobin
concentration by around 10 percent compared to a breath hold with normal
carbon dioxide. Higher levels of carbon dioxide in the blood can produce an even
greater c ontraction of the spleen, resulting in an increase in the release of
red blood cells and therefore the oxygenation of the blood. Increased CO 2  in the  blood also causes a rightward shift of the
oxyhemoglobin dissociation curve. As described by the Bohr Ef fect, an
increase in carbon dioxide decreases blood pH and causes ox ygen to be
of floaded from hemoglobin to the tissues, further reducing blood oxygen
saturation. Holding the breath on the exhale also capitalizes on the benefits of nitric
oxide by carrying the gas into the lungs rather than expelling it. By exhaling
and hold ing the breath, nitric ox ide is able to pool in the nasal cavity so that
when br eathing resumes, air laden with nitric oxide is inhaled into the
lungs.Incr ease Erythr opoietin (EPO) Naturally
As we have se en, erythropoietin, often known as EPO, is a hormone
secreted by the kidneys in response to reduced oxygen levels in the blood. One of the functions of EPO is s timulating the maturation of red blood cells
in th e bone mar row , thereby increasing oxygen delivery to muscles. Breath
holding is an ef f ective way of st imulating the release of EPO, a llowing you
to fuel your blood with increased levels of oxygen and enhance your sports
performance. The concentration of EPO can increase by as much as 24
percent when the body is subjected to lower oxygen levels using breath-
hold exercises. A cl ear example of the relation ship between breath holding and EPO
production can be found in those suf fering from sleep apnea. Sleep apnea is
a co ndition involving involunt ary holding of the breath after exhalation
during sleep. Depending on the  severity , the sleeper may hold their breath
from 10 to 80 seconds, and this may occur up to 70 times an h our . During
sleep apnea, the oxygen saturation of the blood with oxygen  can reduce
from no rmal lev els of around 98 percent to as low as 50 percent. These
reduced oxygen levels can cause an increase in EPO of 20 percent. Of cour se, there is quite a dif ference between the condition of sleep
apnea and the p ractice of breath holding to enhance sports p erformance. However , it is interesting to note the ef fect of breath ho lding (both
voluntary and involuntary) on the production of natural EPO. Increasing
EPO lev els allo ws the blood to  deliver greater amounts of ox ygen to the
muscles and is the natural equivalent of the illegal blood doping methods
discussed at the beginning of this chapter . The benefit of using breath
holding as a performance-enha ncing exercise is that, unlike sleep apnea,
conscious breath holding allows you to keep complete control over the
frequency and duration of each hold. And, unlike blood dopin g, the EPO
you produce using simple breathing techniques is free, ef fective, and legal. The Importa nce of Movement for Simulating High -Altitude
T rainingDuring p hysical exercise or breath holding, a shortage of air is created. An
air s hortage is b est described as a hunger or desire to breathe, varying in
intensity from mild to moderate to strong. The intensity of air shortage will
dif fer de pending on the exercise or situation. For example, while practicing
the exercises in this book, the air shortage during sitting should  be mild or
tolerable wherea s the air shortage during intense physical exercise can be
strong. A  strong air shortage du ring physical exercise is beneficial during
training as it con ditions the body to tolerate extreme demands, and is often
popular among athletes as it presents a new challenge to pit thei r willpower
and determination against. A stron g air shortage during physical exercise is more suitable for
athletes with a BOL T score of longer than 20 seconds. When your BOL T
score is shorter than 20 seconds , you must be careful not to hol d the breath
for too long as  it can cause a loss of control of your brea thing. It is
important that you are always able to resume calm breathing following a
breath hold. The shorter the BOL T score, the easier it is to lose control of
your breathing. Please n ote that when creating an intense air shortage you may develop
a he adache as your blood oxy gen saturation decreases, but this should
disappear after about 10 minutes of rest. T ry to avoid overdoing the
exercises to the point that they bring on a headache. Br eath Holding to Impr ove Respiratory Muscle Str ength
The respiratory center is located in the brainstem and continuously monitors
blood oxygen, carbon dioxide, and blood pH, using this information to
control the amount of air taken  into the body . When the body requires a
breath of fresh air , the brain sends a message to the respiratory muscles,
telling them to breathe. The diaphragm, which is the main breathing
muscle, moves downward, creating negative pressure in the chest cavity ,
resulting in an inhalation. Following inhalation, another message is sent for
the diaphragm to move back to its resting position, causing an exhalation. When the breath is held following an exhalation, the intake of oxygen is
halted w hile carbon dioxide accumulates in the blood. During this pause,
oxygen cannot enter the lungs, and carbon dioxide cannot leave thebloodstream. The respiratory center , noticing the change to blood gases,
communicates to the diaphragm  to resume breathing, and the diaphragm
contracts downward in an attempt to allow the body to breathe. However ,
breathing cannot resume while the breath is held, and the brain begins to
send increasingly frequent messages to the diaphragm, causing its spasms to
intensify . Y ou can experience this by simply holding your brea th until you
feel a strong need to breathe. At first you will feel an isolated spasm of the
diaphragm, but this will soon be followed by more intense and quicker
spasms as the body attempts to resume breathing. In essen ce, hold ing the breath until a medium to strong need for air
mobilizes the diaphragm, provides it with a workout and helps to strengthen
it. Whil e there are many products on the market aimed at increasing
respiratory muscle strength, bre ath holding may be the easiest and most
natural a s it can be employed at any time and actively directs attention to
the diaphragm. Improving respiratory muscle strength can be extremely
beneficial durin g exercise, especially when fatigue of the diap hragm may
determine exercise tolerance and endurance. Br eath Holding to Reduce Lactic Acid
Just as injury p lays a role in limiting physical performance, mental and
physical fatigue can also prevent an athlete from pushing harde r and faster . As U .S. Army g eneral Geor ge Patton wrote to his troops during W orld W ar
II: “ Fatigue makes cowards of u s all. Men in condition do not ti re.” And he
was righ t; endurance is relative to how well the body is prepa red, and the
onset of fatigue occurs when the body is pushed beyond the limits of
preparation. W orking a muscle without suf ficient fuel generates lactic acid, and
while sm all amounts can be beneficial, acting as a temporary ener gy source,
a buildup of lactic acid creates a burning or cramping sensation in the
muscle that can slow down or even halt exercise completely . Studies with athletes have dem onstrated that breath holding after an
exhalation deliberately exposes the body to higher levels of acid ity , thereby
improving tolerance and delaying the onset of fatigue during competition.In a team sport  like football, w here players are expected to m aintain
form an d concen tration during 90 minutes of intense activity , the ability to
push through or avoid fatigue can be instrumental to a team’ s success. I
recently worked  with the Galway women’ s football team, whose coach,
Don O’R iordan, was concerned  that the players were tiring during the last
15 minu tes of a game. When fa tigue sets in, muscles tire, work rate slows,
and in some resp ects there is a loss of interest and focus—a situa tion almost
guaranteed to hand victory to the other side. Breaking through the barrier of
fatigue can be as much about psychological resilience as physiological
endurance, and breath-holding exercises of fer a useful technique for
improving both. In o rder to replicate the cond itions of a game, the team’ s training
usually l asted th e length of a full match. Their training session consisted of
a warm-up and a 10-minute run followed by match practice and tactics. The
last 15 minutes included drills and interval training such as running back
and forth between cones set at dif ferent distances. T o incorporate the
Oxygen Advant age program as seamlessly as possible into this type of
session, I made only modest changes to the existing routine so that the
players could adapt to new breathing techniques while maintaining their
current form. The result not only  increased the ef fectiveness of the training,
but also the players’ endurance and performance during competition. During t he 10-minute run at the beginning of training, I instructed the
players to switch from their usual habit of breathing through their mouth to
running at a comfortable pace with their mouth closed. Every minute or so,
each pla yer exhaled and held th eir breath until they felt a me dium to stro ng
air short age. No  changes were made to the match practice portion of the
training session,  as the introduct ion of nasal breathing adds an extra load to
the body that c an initially slow down an athlete, and possibly lead to
deconditioning of leg strength. The better approach, therefore, was to
incorporate nasal breathing into the 10-minute run and the final  15 minutes
of interval training only . Since th e team had a tenden cy to experience fatigue during the
remaining 15 minutes of a gam e, introducing nasal breathing to the final
interval training  session added an increased challenge. Running flat out
from cone to cone with the mouth closed is no mean feat, and  although a
couple of the pl ayers experienced mild headaches during the first session,the t eam adapted to it easily . After a few more practice sessions , the players
had adapted well to the demands of nasal breathing, so I decided to
challenge them further by introducing breath-hold exercises. These
exercises (which can be found in the next chapter) subjected the players to
an even greater feeling of breathlessness and worked to furthe r delay the
onset of fatigue. Bicarbonate of Soda—Mor e Than Just a Cooking Ingr edient! In a  similar wa y that breath h olding delays the onset of fat igue during
sports, countless studies have shown that taking the alkaline agent
bicarbonate of soda r educes a cidity in the blood to impr ove endurance. Who wo uld have thought that a cooking ingredient found in almost every
kitchen cupboard in the W estern world could also improve sports
performance? Not only that, but it is a very helpful tool to reduce your
breathing volume and increase your BOL T score. Bicarbonate of soda is a salt that is found dissolved in many natural
mineral springs and is usually sold as baking soda, bread soda, or cooking
soda. Th is ingre dient has a wid e variety of uses ranging from  baking to
brushing your teeth to cleaning your fridge. T aken internally , bicarbonate of soda helps to maintain pH of the blood,
and it’ s also the  active ingredient in a number of over -the- counter antacid
medications. Dr . Joseph Mercola, a leading authority on natural health,
suggests taking bicarbonate of s oda for the relief of a number of ailments,
including ulcer pain, insect bites, and gum disease. The ther apeutic potential of bicarbonate of soda may soon become more
widely known, since Dr . Mark P agel from the University of Arizona Cancer
Center w as recently awarded a grant of $2 million from the National
Institutes of Health to study the ef fectiveness of bicarbonate of soda therapy
in treating breast cancer . Over the years many studies  have demonstrated the benefits of
bicarbonate of soda as a met hod to help improve sports p erformance. During high-intensity training, the availability of oxygen for working
muscles decreases, which causes an accumulation of acid, leading to muscle
fatigue. By ingesting bicarbonate of soda, you can help to maintain normalblood pH by dec reasing lactic acid buildup during anaerobic exercise. This
alkaline soda neutralizes the acid that accumulates during high-intensity
training, resulting in greater endurance and power output. Bicarbonate of soda can also ha ve positive ef fects on maximum breath-
hold time. As noted throughout this book, improved breath-hold time has
positive implica tions for breathlessness during exercise and your ability to
improve your VO 2  max. The inges tion of bicarbonate of soda prior to the
practice of breath-hold exercis es has been shown to increase maximum
breath-hold time by up to 8.6 percent. For swimmers, the addition of bicarbonate of soda has resulted in an
improvement of several seconds during test trials, as well as having
significant ef fects on resting blood pH. Researchers who have investigated
the ef fects of bicarbonate of soda on swimming performance have
concluded that the ingestion of bicarbonate of soda can act as an ef fective
buf fer during high-intensity interval swimming and could be used to
increase training intensity and overall swimming performance. These
benefits have even been appli ed to boxers, leading to impr oved punch
ef ficacy! What is consistent throughout all these studies is that the pra ctice of
ingesting bicarbonate of soda before exercise successfully neutralizes acid
buildup in the blood. In terms of fitness and performance, this means:
•  Improved endurance
•  Increased maximum breath-hold time
•  Reduced breathlessness
•  Higher average power output
All i n al l, quite an impressive array of benefits from a househo ld agent
that has no known side ef fects when taken in small doses! How to T ake Bicarbonate of Soda  
I find the following recipe beneficial for improving breathing
habits and increasing breath-ho ld time, and I use it quite often . T ry it and take note of its ef fects on your exercise performance.Y ou can take b icarbonate of soda an hour or so before
training. When you are used to taking it before training, you may
also wish to do so before a com petition. But like anything else ,
there is no point in overdoing it. As a precautionary measure,
please talk to your doctor before using this approach. ½ teaspoon bicarbonate of soda  (also known as baking soda
or bread soda)
2 tablespoons apple cider vinegar
1 . Put the bicarbonate of soda in a glass. 2 . Add the apple cider vinegar and stir for about 1 minute, or
until the soda is thoroughly dissolved. 3 . Drink the mixture. It will taste a little acidic. It’ s as simple as that. Alternativ ely , you can try drinking ordina ry soda
water from the grocery store. While traditionally used as a  mixer for
alcoholic beverages, the carbon ation of the water can provide an added
ef fect. If y ou drink so da water , please also make sure that you dri nk your
required intake of ordinary stil l water to ensure adequate hyd ration. The
color of  your urine will allow y ou to determine when you are  adequately
hydrated; drink enough plain w ater to ensure it is not too dark, but don’ t
drink so much that your urine  is completely clear throughout the day . Drinking too much water is pro bably just as bad for you as drinking too
little. It is about  getting the balance right! Until recently , water intoxication
or hyponatremi a was a little-known and even less understood medical
condition. Most people understand that it is sensible to stay hyd rated during
and after exercise, but when this advice is taken to excess a nd athletes
overdo it, dangerous side ef fects can result. Marathon runners are
particularly susceptible to drinking too much during training and
competition—whether water or sports drinks—and this excessiv e hydration
can cau se the brain to swell a s sodium levels decrease to cr itically low
levels. In a 2002 study of Boston Marathon runners, 13 percent of the
runners sampled  showed low sodium levels, putting them at risk of seriousor e ven fatal illness. In that very same marathon, twenty-eig ht-year -old
Cynthia Lucero collapsed and died. The state medical examiner ’ s of fice
concluded that the cause of death was a series of medical events  brought on
by drinking too much fluid during the event. Commenting on the tragedy ,
Dr . Arthur Siegel of McLean  Hospital advised for athletes to weigh
themselves prior to a race and write their weight on their race b ib. Then, if
runners felt unwell during the race, they could be weighed again and treated
for dehy dration if it was found  that their weight was down. If, however ,
their weight had increased, it w ould mean that they were overhydrated and
that they should retire from the race and stop drinking. Br eath Holding to Pr epar e for Ascent to High Altitude
Every year , millions of sea-le vel residents make the journey to high
altitudes for recreational skiing and climbing, or for religious, spiritual, or
other purposes. Adventurers, climbers, walkers, and sports enthusiasts have
ventured to altitudes of over 1,500 meters for the challenge and thrill of the
mountains. British adventurer Bear Grylls reached the summit of Mount Everest in
1998 at the age of twenty-three . In his book Facing Up,  Grylls describes
how he trained for his ascent o f Mount Everest by “swimming countless
lengths of the local pool—one underwater , then one on the surface, for
hours at  a time. This boosts one ’ s ability to work without oxyg en, making
the body more ef ficient.”
There is no dou bt that Grylls’ s training regimen helped his body to
acclimatize to the reduced partial pressure of oxygen he would experience
during his climb to the top of Mount Everest. Similar to  swimming
repetitive under water lengths of a pool, the exercises of t he Oxygen
Advantage program that simulate high-altitude training can be very helpful
to prepa re for an ascent to high  altitude. More important, as th ese breath-
hold exercises are performed on land, they involve no risk of drowning! Acclimatization refers to the adaptive changes that the body m akes in
order to cope with reduced oxygen levels. Most people can ascend to 2,500
meters without dif ficulty , since oxygen availability is still suf ficient at thataltitude. However , at higher elevations the oxygen saturation in the blood
significantly decreases, making physical activity dif ficult to sustain. As you ascend a bove 2,500 meters, your breathing will become heavier
to c ompensate for the reduced  availability of oxygen. Although heavier
breathing brings greater quantiti es of oxygen to the lungs, it al so increases
the loss of carbon dioxide. As discussed earlier , the loss of carbon dioxide
causes blood vessels to narrow and red blood cells to cling on to the oxygen
they carry , resulting in reduced oxygenation of tissues and or gans. Ironically , as the body breathes more intensely in an ef fort to take in more
oxygen, less is delivered. In a high-altitude environment, oxygenation is
more important than ever if altitude sickness is to be avoided. Almost half of those who attempt to trek or climb to an altitude above
4,000 meters will develop one o r two symptoms of mountain sickness after
a rapid ascent of more than 400 meters per day . Symptoms vary depending
on th e in dividual’ s physical cond ition and health and the speed of the climb. Generally , symptoms are mild to moderate and may include:
•  Headaches
•  Fatigue
•  Insomnia
•  Loss of appetite
•  Nausea or vomiting
•  Rapid pulse
•  Light-headedness
•  Shortness of breath during exertion
A faster climb tends to increase the severity of these symptoms, and
may bring about additional symptoms, including:
•  T ightening of the chest
•  Confusion
•  Coughing or coughing up blood
•  A bluish discoloration of the skin
•  Shortness of breath during rest
•  An inability to walk in a straight lineIncreasing the oxygen-carrying  capacity of the blood is the most
important factor when adjusting  to an increase in altitude, and breath-hold
training exercise s are an ideal way to prepare in the weeks be fore ascent. Spending two to three months performing 5 to 10 maximum breath holds
each day will condition the body to accept this intense feeling of
breathlessness as a familiar occurrence, potentially resulting in a reduced
response to this experience at higher altitude. Finally , any individual who is serious about his climb should have a
basic un derstanding of how his breathing influences delivery of oxygen to
tissues and or gans. I can onl y imagine the number of climbers who
intentionally make their breathing more intense to try to counteract the
feeling of breathlessness as they climb above 2,500 meters. By now you
will be acutely aware that this is exactly the wrong thing to do, and will
most likely result in more severe symptoms of altitude sicknes s. The right
thing to do woul d be to start of f with a high BOL T score, to brea the through
the nose at all times, and to alter your pace to reduce the  feeling of
breathlessness. At le ast one stud y shows that br eath-hold time is a very useful predictor
of m ountain sickness and that the lower the breath-hold time, the greater the
likelihood of developing symptoms of altitude sickness. In fact, those with a
high bre ath-hold time and a high concentration of hemoglobin in the blood
will be better able to tolerate desaturation of oxygen. Though the ideal BOL T score for each individual will va ry , it is
reasonable to suggest that a BOL T score of 40 seconds would certainly
af ford a greater protection from  conditions of high altitude than  a BOL T of
20 seconds or below . Pr event Dehydration with Nasal Br eathing
The air in mountainous regions  and at higher altitudes is cooler and drier
than air at sea level. As you ascend to higher altitudes, th e increased
sensation of breathlessness is  likely to induce the switch  to mouth
breathing. Howe ver , since one of the functions of the nose is to moisten and
warm incoming air , breathing th rough the mouth can lead to dehydration, as
considerable moisture is expended.Another factor is that during exhalation, mouth breathing is com pletely
inef fective in retaining moisture . T o verify this, gently breathe out through
your mouth onto a glass and ch eck the moisture left behind. Now do the
same th ing, except exhale through your nose. Y ou will find that the
moisture left on the glass following nasal exhalation is far less than the
moisture left from exhaling through the mouth. This loss of flui d can contribute to moderate dehydration, resulting in
dryness of the lips, mouth, a nd throat. Other symptoms arising from
dehydration include headache, f atigue, and dizziness, which at high altitude
could ea sily be confused with mountain sickness. Heavy breathers and
mouth b reathers will certainly experience a far greater loss of moisture than
those who have a normal breat hing volume and who breathe through the
nose. Remember that there are no convenience stores at high altitude, so the
more moisture you can hold on to, the less you need to carry! Finally , inhaling cold, dry air th rough the mouth can cause the  airways
to n arrow . As the airways con strict, the feeling is similar to breathing
through a narrow straw , and the result is often to breathe harder and faster
to c ompensate for the restricte d airflow . This is a common  occurrence
experienced by individuals with asthma and can cause even greater
dehydration and cooling of the airways, which may lead to even greater
respiratory problems. In the next chap ter we will lea rn exercises that simulate high-altitude
training in order to increase the oxygen-carrying capacity of yo ur blood for
better sports performance, or to prepare for an ascent to high altitude.CHAPTER 7
B r i n g  t h e  M o u n t a i n  t o  Y o u
W orld-renowned Brazilian track coach V alério Luiz de Oliveira used
breath-hold training techniques with Olympic athletes Joaquim Cruz and
Mary De cker , w ho between them set six world records in 800-meter to one-
mile distance running events in the 1970s and 1980s. De Oliv eira’ s go al was to enable athletes to maintain form at the end of
an anaerobic race of 400–800m. Another aspect was to improve
psychological preparedness by allowing the athletes to maintain composure
during a n oxygen-deprived state. One final factor was to train the runners
not to pay atte ntion to their b reathing, but instead to focus on tactical
maneuvers and running form. De Oliveira’ s techniques were a case of
getting results first and figuring out the science later , but his theories
certainly proved to be right. The method de Oliveira used with his athletes is as follows:
•   A thletes run 200 meters on a  straight course at near race pace,
holding the breath on an inhalation for the last 15 meters. •   After a partial  rest of 30 seconds, this breath hold is repeated 3
more times. •   Athletes then spend 3 minutes recovering before repeating. •  In total, the athletes perform 3 sets of 4 breath holds. According to de Oliveira, “Everybody’ s capable of holding their breath
for a very long time. But you’ve got to do three of these sets. By the finalset, you’ re going to become ver y , very tired. It’ s hard to hold yo ur breath at
that point. But if you use my drill, you will see results.”
De O liveira uses another exercis e in which his 400m and 800m runners
hold their breath for the last 30  meters, simulating the end of a race when
they will be mos t fatigued. Maintaining form during the last 30  meters of a
race like this is crucial. According to de Oliveira, “The most important
thing yo u can do in the race no m atter how exhausted you get is to maintain
your form.”
Joaquim Cruz, coached in this  way by de Oliveira, won gold in the
800m co mpetition during the 1984 Olympics in Los Angeles a nd silver at
the 1988 Olympics in Seoul. Fu rther accomplishments included bronze in
the 800 meters at the 1983 W o rld Championships and gold in the 1,500
meters during the 1987 and 1995 Pan American Games. By  the end of
1984, he  was the National Collegiate Athletic Association champion and
Olympic champ ion; undefeated in all seven of his 800m finals; had run the
second-, fourth-, fifth-, and sixth-fastest 800m times in history; and easily
ranked as number one in the world for the 800 meters in 1984. The legendary Czech athlete Emil Zátopek, described by the New Y ork
T imes  as perhaps one of the greatest distance runners ever , also incorporated
breath holding into his regular training. Zátopek was a man of small stature,
standing 5 feet 8  inches tall and  racing at 139 pounds, but he found an edge
over his  competitors by developing his own innovative training techniques,
which included interval training  and breath holding. While wal king to and
from wo rk each  day , he passed a lane lined with poplar trees. On the first
day , he held his breath until he r eached the fourth poplar . On the  second day
he h eld his brea th until he reach ed the fifth poplar , increasing the distance
of his breat h hold by one tree each day until he could hold his brea th for the
entire line of trees. On one occasion, Emil held his breath until he passed
out. Wh ile it is not necessary to practice to this extreme, it is fascinating to
note tha t one of history’ s great est runners was performing breath holding
long before it formed part of training for some present-day athletes. The dif f iculty in  presenting accounts of active athletes is that they strive
to keep their training regimens  a secret. It doesn’ t make much sense to
disclose your innovative techniques, especially when they give you an edge
over the competition. T o date, I have worked with a number of Olympic and
professional ath letes who have incorporated the breathing exercises in thisbook int o their training. Given the tiny (but highly important) dif ference in
mar gin of performance between  one elite athlete and another , I am very
much aware of the importance  of keeping training information close to
one’ s chest. However , sometimes hints and snatches of information can be gleaned
through the press, suggesting that breath holding is becoming more widely
practiced in the athletic commu nity . For example, a recent ar ticle on the
athletic website Eightlane.or g reported that Galen Rupp— the current
American record holder for the 10,000 meters and indoor 3,000  meters, and
silver medal winner at the 2012 London Olympics—had recently collapsed
during training. Rupp’ s headph ones had fallen of f and “he was unable to
hear his coach reminding him to breathe.” Reading between the lines, it
seems as if Rupp may well have been practicing breath holding during his
training sessions, with his coach setting his limits. Please note that it is
neither necessary nor safe to hold your breath in order to create such an
extreme air hunger . T o get the most benefit from the breath-ho ld exercises
in th is b ook, only hold your breath until you experience a mediu m to strong
ur ge for air . Pay attention to the intensity of the air hunger you create as you
perform each exercise, and rele ase your nose when you feel challenged. Y ou should be able to recover your breathing within 2 to 3 breaths
following a breath hold. T o the uninitiated, purposely h olding the breath may seem strange. Oxygen is necessary for life, so why subject the body to such a limitation? Just as physical  training is a very natural activity for mankin d, so too is
breath h olding. As a child, you might have held your breath any time you
swam to  pick up a coin or other object from the bottom of a  swimming
pool. A t other times, you may  have held competitions with siblings or
friends to see who could hold their breath for the longest, with  passing the
1-minute mark being an acceptable accomplishment. For the past th irteen years, thousands of children have attended my
courses to help address coughing, wheezing, and symptoms of
breathlessness a nd asthma. Children as young as four are able t o practice a
number of dif ferent breath-hold exercises, each with a specific purpose. For
example, there is a breath-hold exercise to help unblock the nose, another to
help stop a wheeze or a cough, while another is designed to improve
breathing volume by holding the breath for as long as possible.While ad ults ma y at first be wary of holding their breath, children often
take to it like ducks to water . I usually work with five or six children to a
group, ranging in age from fo ur to fifteen years. Beginners are gently
introduced to the exercises by walking a distance of 10 paces while they
hold the ir breath. After 3 or 4 re petitions, the number of paces is increased
in in crements of 5 until the child  understands the exercise and ex periences a
moderate need for air . Most chi ldren master the exercise in no  time at all,
and are soon in friendly competi tion with their peers to hold their breath for
as many steps as possible. I usually expect children to hold their breath for 30 paces during the
first session, increasing by 10 e xtra paces each week. Some c hildren will
make qu icker pr ogress and can learn to hold their breath for up  to 80 paces
in a s little as two or three weeks without losing breath control or
experiencing any stress. Even professional athletes would be impressed by
this feat. More important, at 80 paces, in my experience, the child’ s blocked
nose, cough, wheeze, or exercise-induced asthma will have completely
disappeared. The beauty of breath holding is that while the air shortage can be
relatively extrem e, it is entirel y under our own control and for a short
duration of time only . For premenstrual women, vegetarians, or those with a history of anemia,
it m ay b e necessary to take an iron supplement to support the production of
normal red blood cells. If, despite sustained practice of these exercises, your
BOL T score fails to increase, it may be useful to visit your doct or to have a
complete blood count. If your hemoglobin is low , speak with your doctor
about iron supplementation. In  some individuals, I have witnessed iron
supplementation making a remarkable dif ference to BOL T scores within
just a few short weeks. The fol lowing Oxygen Adva ntage breath-hold training e xercises
provide simple ways to simul ate the beneficial ef fects of h igh-altitude
training and high-intensity train ing while allowing you to exercise in your
usual wa y . Each  exercise provides both a hypoxic (lack of oxygen) and a
hypercapnic (high carbon dioxide) response. Combining these two ef fects
produces important changes in the body , such as:
•  Lowering sensitivity to carbon dioxide•  Increasing endurance
•  Reducing discomfort and fatigue from lactic acid buildup
•  Increasing the oxygen-carrying capacity of the blood
•  Improving breathing economy
•  Improving VO 2  max
By i ncorporating  these easy techniques into your routine, you w ill find
that your breath-hold ability increases quickly , and you will begin to see
results within your training and your competitive performance. Using a Pulse Oximeter
T o get the best results from breath-hold exercises, it can be helpful to use a
handheld device  called a pulse oximeter that measures how loaded the
blood is with ox ygen. Convenient and noninvasive, using a pulse oximeter
simply i nvolves placing a probe on your fingertip to measure the oxygen
saturation (SpO 2 ) of your blood. A pulse oximeter can be purchased rather
cheaply , but my advice is to purchase a better -known brand such as
NONIN, as they tend to be more responsive. One of the main  benefits of
using a pulse oximeter is that it can be very motivating to witn ess the drop
in oxyge n satura tion as you prac tice breath holds, reinforcing the success of
the exercise. In addition, the device can help to ensure that you don’ t
overdo the exercises by lowering your SpO 2  below 80 percent. Normal oxygen saturation at sea level varies between 95 and 99 percent
(as we have seen), while the benefits from breath holding occur when the
SpO 2  l eve l is  dropped to below 94 percent. In the beginning, you may not
notice m uch of a decrease to your oxygen saturation while performing
breath holds. However , with practice and the ability to tolerate a stronger air
shortage, the drop to oxygen sat uration will become evident in as little as a
few days. The ef fects of breath holding de pend on two factors—oxygen saturation
during training and the length of the exposure to reduced oxygen—but slow
and steady is the way to go, just as it is whenever you start a new exercise
program. T o get the most out of breath-hold exercises, it helps to startgently , h olding the breath until you feel a medium air hunger during the
first two or thre e breath holds b efore gradually increasing the duration and
intensity . This way , you will fe el in control and be able to practice more
ef fectively . As your BOL T score increases, you will find it easier to manage
the sensation of air hunger , and your blood oxygen saturation will start to
drop below 94 percent. Simulate High-Altitude T raining While W alking
W e beg in by introducing a simple walking exercise that ena bles you to
achieve similar benefits to those experienced during intense physical
training in as litt le as 10 to 15 m inutes. The beauty of this exercise is that it
can be performed anywhere and at any time, even if an injury is preventing
you from  engaging in normal training. Similar to any intense physical
exercise, it is important to practice at least two hours after eating. Just as it
is not advisable to go for a jog directly after eating, it is also best to practice
breathing exercises on an empty stomach. Not only would it be
uncomfortable to  perform breath holds too soon after a meal, bu t the benefit
of the exercise would be much reduced as the process of digestion increases
breathing. During this exercise you will be practicing breath holds as you walk. For the first 2 to  3 breath holds,  in order to gently acclimatize your body to
lower levels of oxygen, it’ s important to hold your breath only until you feel
a medium hunger for air . For the  remaining breath holds, challenge yourself
by aiming to ac hieve a relatively strong need for air . Due to a delay in the
pulse tra nsit tim e, it is commo n for the decrease in oxygen saturation to
take plac e not during the breath hold, but soon after it. Therefore, to get the
most fro m the exercise, minimize breathing for about 15 seconds following
the breath hold by taking short breaths in and out through the nose. If you
have a pulse ox imeter , you might enjoy observing the decre ase to your
oxygen saturation as you do this—ef fectively simulating h igh-altitude
training and bringing the mountain to you.•   W alk and hold:  Aft er a minute of continuous walking, gently
exhale a nd pinch your nose to  hold your breath. If you feel
uncomfortable pinching your nose while walking in public, you
can simply hold your breath without holding your nose. Continue to walk while holding your breath until you feel a
medium to strong air shortage. Release your nose, inhale
through it, and minimize your breathing by taking very short
breaths for about 15 seconds. Then allow your breathing to
return to normal. •   Continue walking for 30 seconds and r epeat:  Continue
walking for around 30 seconds while breathing through your
nose, the n gently exhale and pin ch your nose with your fingers. W alk w hile holding the breath until you feel a medium to
strong h unger for air . Release your nose and minimize your
breathing by taking short breath s in and out through your nose
for a bout 15 se conds. Then allow your breathing to revert to
normal.•   Repeat br eath holds 8 to 10 tim es:  While continuing to walk,
perform a breath hold every minute or so in order to create a
medium to strong need for air . Minimize your breathing for 15
seconds following each breath hold. Repeat for a total of 8 to
10 breath holds during your walk. This exercise will take about 12 minutes to complete and is highly
ef fective at teaching your body to do more with less. At first yo u may only
be able to hold your breath for 20 or 30 paces before you feel a strong air
shortage (or less if you have ast hma or are out of breath). As the number of
paces per breath hold increases, the air shortage you experience will
progress from easy to moderate to strong. As you feel an increased hunger
for air , the breathing muscles in your abdomen or neck will begin to
contract or spasm. An added ef fect of the contractions is to p rovide your
diaphragm with a workout, thereby strengthening your main breathing
muscle. During the longer breath holds, as you feel your breathing muscles
spasm, f ocus on  relaxing your b ody . Allow your muscles to go soft as you
hold your breath. Relaxing the body in this way allows a longer breath hold
with less stress. W ith repetition, as the weeks go by , you will find yourself being able to
hold your breath for 80 to 100 paces. Y our ability to hold your breath will
increase with practice and without stressing your body . Do not overdo it. Ideally , your breathing should re cover easily and become calm w ithin 3 or 4
breaths. While this exercise is a challenge, it should not be stressful. If you notice any side ef fects, such as an elevated or stronger than
normal p ulse for  a prolonged pe riod after completing breath holding, then it
is b est to refra in from performing the stronger breath holds. Instead,
concentrate on breathing lightly  both during rest and physical exercise to
bring benefit to your health and sports. Breath holding can also be incorporated into a jog, run, or bike ride. While you may not be able to h old your breath for as many paces during a
jog as you can during a walk, the quality of the exercise will be better
because of the greater accumulation of carbon dioxide in the blood. Breath holding during training  adds an extra load that would only
otherwise be experienced during maximum intensity exercise.Here is a breath-hold exercise to try while jogging or running:
•   Run and hold:  T en  to fifteen minutes into your run, when your
body has warmed up and is sw eating, gently exhale and hold
your br eath until you experience a medium to strong air
shortage. The length of the breath hold may range from 10 to
40 p aces and w ill depend on your running speed and BOL T
score. •   Br eak f or 1 minute and r epe at:  Following the breath hold,
continue to jog or run with nasal breathing for about 1 minute,
until your breathing has partially recovered. •   Repeat br eath holds 8 to 10 times:  Rep eat the brea th hold 8 to
10 t imes during your run, follo wed each time by a minute of
nasal breathing. The breath holds should be challenging but
should also allow breathing to  recover to normal within a
couple of breaths.If you find this exercise in any way stressful, or have dif ficulty
recovering your  breathing after a breath hold, then refrain from doing the
exercise until your BOL T score has increased to at least 20 seconds. Br eath Holding During Cycling
A similar practice can be employed as you ride your bicycle:
•   A fter your bo dy has warmed up, exhale and hold your breath
for 5 to 15 pedal rotations. •   Resume nasal breathing while continuing to cycle for about 1
minute. •  Repeat this exercise 8 to 10 times throughout your ride. Br eath Holding During Swimming
Swimming is the only sport in which breathing volume is controlled, as the
face is immersed in the water and the weight of the body on the water
restricts breathing even further . Breathing through the mouth is probably the
best opt ion during swimming,  as nasal breathing may result in water
inhalation. T o incor porate reduced breathing during swimming, you will need to
increase the number of strokes between breaths. Y ou can do this in gradual
increments, incr easing the number of strokes between breaths fr om 3 to 5 to
7 over a series of lengths. This exercise was employed by former Olympic
swimmer and triathlete Sheila T aormina, who achieved the fastest 1.5 km
swim during the Sydney Gam es in 2000. In my correspon dence with
T aormina, she explained how reduced breathing was used to create a
training ef fect so that the swimmer would be challenged to do more with
less. However , unlike some spo rts, such as underwater hockey , the breath
hold is never pushed to an absol ute maximum, in order to ensure the safety
of the swimmer .In addition to the hematological benefits from breath-hold training, it
has been found that breath ho lds also improve swimming coordination. After breath-hold training, swimmers have shown increases in VO 2  peak as
well as an increase in the distance traveled with each swimm ing stroke. During t he front crawl it is necessary to turn the head sideway s every few
strokes in order to take a breath. However , each time a swim mer takes a
breath, hydrodynamic drag take s place, which ultimately wastes ener gy and
reduces performance. One of the benefits of having a high BOL T score is
that bre athing becomes more ef ficient, meaning that less air is required
during a  swim. Reducing the number of breaths minimizes drag , helping to
conserve ener gy for improved performance. The same training has also been  applied to underwater hockey players,
who perform their sport below t he surface of the water in a swimming pool. The obje ct of the game is to pass a weighted puck along the bottom of the
pool using an underwater hoc key stick, scoring points in th e opposing
team’ s g oal. As play takes place underwater , it is advantageous, if not
essential, that players are able to hold their breath for long periods of time. Part of the train ing of underwater hockey players includes prolonged and
repeated breath holds and con trolled breathing, which lead to a higher
tolerance for carbon dioxide and an increase in breath-hold time. Researchers inv estigating the ef fects of short repeated breath holds on
underwater hockey players found that these exercise s reduced
breathlessness and produced a higher concentration of carbon dioxide in the
blood. I n addition, lactate values were found to be lower in underwater
hockey players compared to untrained individuals, meaning th at the pain
from lac tic acid buildup was reduced. These athletes clearly have a high
tolerance for carbon dioxide, most likely explained by their experience with
prolonged breath holding for their sport. As we have already seen, reduced
sensitivity to carbon dioxide translates into reduced breathlessness during
exercise as less breathing is re quired to eliminate excess carbon dioxide. This allows greater physical exertion with lighter breathing—enabling your
body to do more with less. Advanced Simulation of High-Altitude T rainingNormal oxygen saturation at sea  level varies between 95 and 99 percent. T o
receive any benefit from hypoxic (reduced oxygen) training, oxygen
saturation levels  must drop below 94 percent (and ideally to  below 90
percent). The ef fect of this m ethod depends on two factors: oxygen
saturation durin g training, and the length of the exposure to reduced
oxygen. Lowering oxyge n saturation below 90 percent for a duration of 1 to 2
minutes can significantly incre ase the production of EPO, and this can
easily be achieved by using this exercise. Before y ou con sider doing this exercise, please get the a ll clear fr om
your physician. T his exercise is only suitable for those who have good
physical fitness,  perfect health, a BOL T score of longer than 30 seconds,
and are accustom ed to performing intense physical exercise. In other words,
if you wish to try this exercise , you must be familiar with experiencing
strong air shortages. Please refrain from doing this exercise if any of the
following statements apply to you:
•   Y ou are in any doubt about your capabilities to perform inten se
physical exercise. •  Y ou are unwell. •  Y our BOL T score is shorter than 30 seconds. •  Y ou are not currently in a regular physical training program. This advanced exercise aims to readjust the composition of your blood
and alt er levels of oxygen and carbon dioxide. After months of
experimenting, I have developed this exercise to lower the oxygen
saturation of arterial blood and to maintain this decrease over a number of
seconds. I have practiced this e xercise hundreds of times and include the
following guide lines to help you to perform it correctly and to be aware of
potential side ef fects:•   T o regulate the decrease in ox ygen saturation to below 94
percent and to ensure that it does not go below 80 percent, it is
important to use a higher -quality pulse oximeter during this
exercise. •   This exerci se should be p racticed on a relatively empty
stomach, at least three hours after eating. •   The f irst brea th hold is between 40 and 60 paces, or until yo u
feel a medium to strong need for air . •   After  the first breath hold, subsequent holds are performe d
every 5 to 10 paces. •   Follow ing eac h breath hold, either exhale through your nose or
take a sip of air in through your nose before the next breath
hold. •   A “si p of air” means taking  a tiny breath in, the purpose of
which is  to relieve tension rathe r than take in air . It is about 10percent of a normal breath. •   Contractions  of the diaphr agm will strengthen as the a ir
shortage progres ses. T ry to bring a feeling of relaxation to your
body as the air shortage increases. •   W ith  each successive brea th hold, oxygen saturation will
continue to decrease. •   Continue to observe the puls e oximeter , ensuring that you do
not go below 80 percent SpO 2 . •  Challenge but do not stress yourself. •   If the air shor tage is too great , take a slightly lar ger breath and
continue to relax. •  Perform this exercise for 1 to 2 minutes. The obj ective of the exercise is to generate a reasonably strong air
shortage in order to lower oxygen saturation and to maintain it at a lower
level for a period of between 30 seconds and 2 minutes. Please note that it is not advis able or even necessary to low er your
oxygen saturatio n below 80 pe rcent. Maintaining an oxygen saturation of
less than  91 percent for approximately 24 seconds can result in an increase
of E PO of up to 24 percent, while maintaining this saturation for 136
seconds can result in an increase of EPO of up to 36 percent. Putting the Oxygen Advantage Pr ogram to the T estFrance i s well known for its glo bal cycling events. It is not
only the  home of the T our de France but also to such legendary
mountains as Mont V entoux and Col le da Madone, which lure
cyclists from around the world to conquer their slopes. The
thriving French amateur road racing culture is steeped in
folklore, setting such intense challenges that some athletes are
unable to compete more than a few seasons due to injury ,
fatigue, or burnout. Nick Ma rshall i s an Australian cyclist who started racing in
the Paris region. A father of two and a businessman, Nick had
trouble j uggling the demands of work and family with what he
felt w ere “old-school training m ethods.” Seeking a better way to
train, Nick started using advanced yoga breathing and then the
Oxygen Advant age principles to develop more power while
reducing his overall training lo ad. Initially , Nick had a BOL T
score of  just 25 seconds (common even among elite athletes) ,
but through the nasal breathing, Breathing Light to Breathe
Right, and simulating high-altitude training, his BOL T score
now regularly reaches 60 seconds. The primary Oxygen Advantage exercise Nick used was a
daily 30-minute routine combining the following:
1. Breathe Light to Breathe Right for 15 minutes. 2. S imula te High -Altitude T raining while walking with breath
holds of 60 to 80 paces. 3. Rest for 3 to 4 minutes. 4. Do 1 set of Advanced S imulation of High-Altitude
T raining to reduce arterial bl ood oxygen saturation to
around 81 to 84 percent. The ap plication of Oxygen Advantage techniques has
resulted in a drop in lap time along with a reduction in weight
and the improvement of Nick’ s o verall health. On his bike, Nickhas seen an im provement in VO 2  max and lactate buf fering
during hard ef forts, and a redu ced heart rate at rest. (Lactate
buf fering refers to the body’ s a bility to of fset or neutralize the
ef fects o f lactic acid during inte nse exercise.) A big benefit for
Nick is the ability to reduce the  training hours spent on his bike
while st ill steadily improving his fitness—a clear sign that he
has become more ef ficient as an athlete. Oxygen Advantage T raining: Short- and Long-T erm Benefits
Oxygen Advantage training involves temporarily subjecting the body to
reduced oxygen saturation. This is usually achieved by living or training at
high altitudes, but breath-hold exercises can easily bring abo ut the same
result. Performing just 5 maximum breath holds can significantly increase
the c oncentratio n of oxygen-carrying red blood cells in the bloo d, but often
levels w ill return to normal within 10 minutes following the final breath
hold. Do es this mean that brea th-hold training is only beneficial directly
before a competition? The answer is no. Several research studies have
shown that permanent improvements to oxygen-carrying capacity can be
achieved by regularly exposing the body to reduced concentrations of
oxygen. If you incorporate th e Oxygen Advantage program  into your
normal training and practice nasal breathing during rest and day-to-day
activity , you will begin to see real physiological changes that will enable
you to raise your game and increase your endurance over both th e short and
long term. The benefits of genuine and sim ulated high-altitude training have been
studied in many dif ferent ways,  and the results repeatedly show that long-
term exposure to reduced oxygen concentration brings about advantageous
changes for individuals looking to improve their physical performance. Breath-hold dive rs have been fo und to show a 5 percent higher resting
hemoglobin mass than untrained divers, suggesting that long-term breath
holding has a tangible ef fect on performance. In addition, experienced
breath-hold divers demonstrate a stronger spleen contraction in  response tobreath-hold exer cises, leading to a greater release of red blood c ells into the
blood supply , improving their oxygen delivery . In ch apter 1, I mentioned Don Gordon, who has reached new he ights in
his c ycling performance by app lying the Oxygen Advantage program. In a
recent e- mail, he  informed me t hat his hematocrit was 52 perce nt (up from
47 percent)—high enough to provide increased aerobic performance while
still remaining within the upper normal range. As I  have note d before, it is not possible or practical for e veryone
wishing to benefit from the ef fects of hypoxic training to live at high
altitude, but fortunately benefic ial results can be obtained with less drastic
alterations to your lifestyle and training routine. The adage “use it or lose it” can be applied to all forms of training;
form, fi tness, and endurance can only be maintained through constant
repetition and practice. The sam e is true for your breathing. First you must
learn how to breathe ef ficiently and correctly day and night, during rest and
activity . Only then should you a pply Oxygen Advantage techniques to your
training routine and sporting competition. By practicing these exercises
regularly , you will benefit from all the advantages of high-altitude training,
increase your VO 2  max, and move beyond your previous limits. T o fully utilize the power of Oxygen Advantage reduced b reathing
exercises, it is im portant to bring a feeling of relaxation to your body as you
exercise, and encourage your breathing volume to reduce. Exercise at a
pace in which y our breathing is regular and controlled, and you experience
a feeling of air  shortage. T o generate greater intensity and bring about
positive physiological changes from hypoxic training, incorporate breath
holds into your p hysical training. Y our BOL T score will provide continuous
feedback on your breathing volume during rest and physical exercise. If
your BOL T score decreases, it means your breathing is heavie r than your
metabolic requirements. This will have negative implications for both
performance and health. Return  to the earlier exercises and concentrate on
retraining your breathing habits  until you are able to improve your BOL T
score to more than 30 seconds. When y ou first begin these exer cises, your breath-hold time and BOL T
score may be short, but with regular training and a commitment to theprogram, both these measureme nts can be increased over a short period of
time. A number of res earch papers have come to conclusions that support my
findings, studyin g athletes and n onathletes alike to see the ef fects of breath-
hold exercises on an individual’ s tolerance of carbon dioxide. These studies
have fou nd that breath-hold tim e can be increased as a result o f short-term
and long -term practice. For example, a study measuring the breath-hold
time of volunteers practicing breath-hold exercises with their faces
immersed in water found that th e length of breath holds increas ed by up to
an impressive 43 percent over a series of exercises. Another study found
that breath-hold  divers with 7 to 10 years of experience were a ble to hold
their breath for u p to 440 second s, compared to up to 145 seconds achieved
by inexperienced  individuals. Similarly , the duration of breath-hold time for
triathletes was found to be sign ificantly lengthe ned following a three-month
breath-hold program. Earlier on, we investigated the ef fects of a reduced sensitivity
(ventilatory response) to carbon  dioxide, finding that it resulted in better
sports p erformance, reduced bre athlessness, and improved VO 2  max. Y our
BOL T s core allows you to measure this sensitivity and provid es a useful
method for tracking your progre ss, providing you with both a goal to strive
for ( attaining a B OL T score of 40 seconds) and positive reinfor cement that
you are making real changes to your body’ s capabilities as you watch your
score in crease. All the exercises in this book aim to increase your BOL T
score and improve your body’ s tolerance for CO 2 , and you will be able to
notice im provements to your well-being and performance rig ht from the
very first time you practice.CHAPTER 8
F i n d i n g  t h e  Z o n e
C onsidered the greatest moment in twentieth-century boxing, the 1974
“Rumble in the Jungle” pitted undefeated world heavyweight champion
Geor ge Foreman against former  champion Muhammad Ali. The event was
or ganized by boxing promoter Don King and sponsored by t he King of
Zaire with the promise of a major purse to the winner . No one thought Ali had much of  a chance of beating Foreman. After all,
Foreman was both younger an d lar ger than Ali and was considered the
strongest fighter  of his generati on—no previous opponent had lasted more
than thre e rounds with him. But Ali had more than just speed and strength
—he use d psych ology and tactics to his advantage. During the early rounds
of the fight Ali toyed with Fore man by frequently leaning on th e ropes and
covering himself up, leading Foreman to throw inef fective body punches
and tire himself  out. By the seventh round, Ali turned to taunting, goading
the wea ry Forem an with jibes l ike “They told me you could punch!” and
“That all you got, Geor ge?”
In th e ei ghth round Ali saw his m oment and took it, landing a strong left
hook and hard right. Foreman, weakened by fatigue and distraction,
stumbled to the canvas, and though he managed to get up at the count of
nine, the referee called the bout to an end. Muhammad Ali, a master in
psychology , won the title by a knockout. V ery few people could have exp ected this outcome. Both fighters were
equally motivate d to win, but while Foreman was at that time the stronger
combatant, Ali’ s constant barrage of taunts played a significant role in
undermining Foreman’ s mental strength, causing his concentration to lapse
and allowing him to lose his tem per—the opportunity Ali need ed to strike.By pulli ng his opponent out of t he zone, Ali created an opening for himself,
overcoming all odds. And that’ s all it takes—just one distraction can
dramatically alte r the outcome o f any event. Often athletes are deprived of
success not because of lack of skill, fitness, or stamina, but by their own
thoughts. When looking back on a disapp ointing performance, most athletes will
comment that their head “just w asn’ t in it.” T raining the mind to be in the
flow is just as vital as training th e body . As any athlete knows, one thought
is al l it takes to divert attention from the task at hand, ruinin g the shot,
penalty , race, or putt. But while in the flow , distracting thoughts do not
enter . T he shouts of opposing spectators are not heard, a mistake made
during the game is not ruminat ed on, and thoughts of past mistakes or of
future go als do not arise. There is no fear of losing. There is no expectation
of winni ng. Y ou are not anxious about actions or reactions from opponents
but ef fortlessly perform to the best of your ability . Nothing e lse matters. Y ou are  present , using the full concentration of your mind in a state of
undivided attention. “Going with the flow” is a concept popularized by Mihaly
Csikszentmihalyi, former head of the department of psycho logy at the
University of Chicago. Csikszentmihalyi described “flow” as the experience
of “bein g completely involved in an activity for its own sake. Self-
consciousness falls away . T ime flies. Every action, movement, and thought
follows inevitab ly from the previous one, like playing jazz. Y our whole
being is  involve d, and you’re us ing your skills to the utmost.” This mental
state is also so metimes descri bed as being in the zone or the present
moment. Flow is a state of concentration that allows for complete imme rsion in
the situation at hand. Being in the flow means that no boundaries exist
between you and the activity in which you are involved. The player and the
game be come one. The ego—which is the fictitious story that we create
about ourselves—is left behind. Conscious thinking ceases, and the athlete
acts spo ntaneously . Any sense of self-consciousness is set aside, allowing
full conc entration and focus to be obtained. While in the flow , instinct and
intuition take over and the right action happens automatically , without the
need for conscious thought.When in  the flow you do not t hink about how good you are,  or how
useless y ou are,  or what the spectators think of you, or what you are going
to do  tom orrow , or what your ha ir looks like. The usual repetiti ve nonsense
generated by the active W estern mind ceases. Concentration—the ability to
focus unhindere d by distracting thoughts—is at its highest. In such a state
of inten se concentration, your complete attention can be devoted to the
game. Being i n the flow allows for a still, quiet mind, undistracted by
conscious thoug hts. It is a state that involves the use of the entire brain
rather th an just the logical proc esses of the left brain. Being in the flow is
the v ery antithesis of W estern e ducation, whose sole purpose is to develop
and nurture the analytical, reasoning, and logical brain. Y ou will  no doubt have experienced the feeling of an activity ta king up
all your attention and focus to the point where you for get everything else
around y ou. Wh en you are truly  engaged in creative endeavors like sports,
writing, painting, music, and drama, many hours can pass by unnoticed. The dan cer and the dance become one. The painter and the paint ing become
one. The runner and the race become one. During training practice, an athlete will perform the same action over
and over again, making precise adjustments to create the perfect sequence,
whether it is marking an opponent during a game, taking a golf swing,
knowing when to overtake duri ng a race, or taking a penalty kick. In the
same w ay , a martial arts expert develops controlled and flawless
movements through years of constant repetition and refining. Each time a
movement is replicated, the bra in stores information and develops muscle
memory , eventually allowing the task to be performed without conscious
ef fort. In  essenc e, the body kno ws what to do—the mind simp ly needs to
get out of the way . There is no room  for thought in fast-paced activities;
thoughts serve only as distractions. An athlete at peak performan ce does not
think. Instead, instinct kicks in, muscle memory ensures spontaneous
movement, and 100 percent of e ner gy is directed toward the task  at hand. In
the zone , the athlete finds that his or her reactions and move ments flow
without conscio us thought. Intuition takes over and the right ac tion occurs
naturally . During the 1988 Monaco Grand Prix, A yrton Senna managed to stay
ahead of  his competitors with ease, including a teammate driving a similarcar .
_OceanofPDF.com_The_Oxygen_Advantage_-_Patrick_McKeown.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        This is of particular
relevance to the Oxygen Advantage program, as our breath-hold exercises
are performed out of water. The relevance of the above stud ies suggests that ef fects similar to those
achieved with high-altitude training can be obtained at sea leve l simply by
performing a series of breath h olds. Stimulating the spleen to contract by
reducing the availability of oxy gen causes an increase in hem oglobin and
hematocrit, which in turn increases the oxygen-carrying capacity of the
blood and improves aerobic ability. The mo st appea ling aspect of breath holding is that it is feas ible for
most ind ividuals and is not as taxing on the body as high-intensity exercise. Performing just 3 to 5 breath holds of maximum duration can lead to a 2 to
4 percent increase in hemoglobin. This might not sound like much, but
where a fraction of a second can determine the dif ference b etween the
winner and the loser, every possible advantage counts. Why Oxygen  Advantage T raining Elicits an Even  Str onger
Response
In the studies in vestigating breath holds and splenic contraction s discussed,
each breath hold was performe d following an inhalation. Y ou might be
wondering why  Oxygen Advantage breath holds are performed after an
exhalation. Let me explain. Performing a breath hold aft er an exhalation lowers the oxygen
saturation of the blood to simulate the ef fects of high-altitude  training. I
have monitored the blood oxyge n saturation of thousands of in dividuals as
they pra ctice breath holds, and by far the greatest change to oxygen
saturation occurs after an exhalation. For most people, after four or five
days of practice, a drop of oxygen saturation below 94 percent can be
observed—a level comparative to the ef fects of living at an altitude of 2,500
to 4,000 meters. Gently exhaling  prior to holding the breath reduces air content in the
lungs, al lowing a quicker buildup of carbon dioxide and eliciting a stronger
response. While  this reduces the length of time for which you can hold your
breath, i ncreased carbon dioxide has been shown to improve hemoglobin
concentration by around 10 percent compared to a breath hold with normal
carbon dioxide. Higher levels of carbon dioxide in the blood can produce an even
greater c ontraction of the spleen, resulting in an increase in the release of
red blood cells and therefore the oxygenation of the blood. Increased CO 2  in the  blood also causes a rightward shift of the
oxyhemoglobin dissociation curve. As described by the Bohr Ef fect, an
increase in carbon dioxide decreases blood pH and causes ox ygen to be
of floaded from hemoglobin to the tissues, further reducing blood oxygen
saturation. Holding the breath on the exhale also capitalizes on the benefits of nitric
oxide by carrying the gas into the lungs rather than expelling it. By exhaling
and hold ing the breath, nitric ox ide is able to pool in the nasal cavity so that
when br eathing resumes, air laden with nitric oxide is inhaled into the
lungs. Incr ease Erythr opoietin (EPO) Naturally
As we have se en, erythropoietin, often known as EPO, is a hormone
secreted by the kidneys in response to reduced oxygen levels in the blood. One of the functions of EPO is s timulating the maturation of red blood cells
in th e bone mar row, thereby increasing oxygen delivery to muscles. Breath
holding is an ef f ective way of st imulating the release of EPO, a llowing you
to fuel your blood with increased levels of oxygen and enhance your sports
performance. The concentration of EPO can increase by as much as 24
percent when the body is subjected to lower oxygen levels using breath-
hold exercises. A cl ear example of the relation ship between breath holding and EPO
production can be found in those suf fering from sleep apnea. Sleep apnea is
a co ndition involving involunt ary holding of the breath after exhalation
during sleep. Depending on the  severity, the sleeper may hold their breath
from 10 to 80 seconds, and this may occur up to 70 times an h our. During
sleep apnea, the oxygen saturation of the blood with oxygen  can reduce
from no rmal lev els of around 98 percent to as low as 50 percent. These
reduced oxygen levels can cause an increase in EPO of 20 percent. Of cour se, there is quite a dif ference between the condition of sleep
apnea and the p ractice of breath holding to enhance sports p erformance. However, it is interesting to note the ef fect of breath ho lding (both
voluntary and involuntary) on the production of natural EPO. Increasing
EPO lev els allo ws the blood to  deliver greater amounts of ox ygen to the
muscles and is the natural equivalent of the illegal blood doping methods
discussed at the beginning of this chapter. The benefit of using breath
holding as a performance-enha ncing exercise is that, unlike sleep apnea,
conscious breath holding allows you to keep complete control over the
frequency and duration of each hold. And, unlike blood dopin g, the EPO
you produce using simple breathing techniques is free, ef fective, and legal. The Importa nce of Movement for Simulating High -Altitude
T rainingDuring p hysical exercise or breath holding, a shortage of air is created. An
air s hortage is b est described as a hunger or desire to breathe, varying in
intensity from mild to moderate to strong. The intensity of air shortage will
dif fer de pending on the exercise or situation. For example, while practicing
the exercises in this book, the air shortage during sitting should  be mild or
tolerable wherea s the air shortage during intense physical exercise can be
strong. A  strong air shortage du ring physical exercise is beneficial during
training as it con ditions the body to tolerate extreme demands, and is often
popular among athletes as it presents a new challenge to pit thei r willpower
and determination against. A stron g air shortage during physical exercise is more suitable for
athletes with a BOL T score of longer than 20 seconds. When your BOL T
score is shorter than 20 seconds, you must be careful not to hol d the breath
for too long as  it can cause a loss of control of your brea thing. It is
important that you are always able to resume calm breathing following a
breath hold. The shorter the BOL T score, the easier it is to lose control of
your breathing. Please n ote that when creating an intense air shortage you may develop
a he adache as your blood oxy gen saturation decreases, but this should
disappear after about 10 minutes of rest. T ry to avoid overdoing the
exercises to the point that they bring on a headache. Br eath Holding to Impr ove Respiratory Muscle Str ength
The respiratory center is located in the brainstem and continuously monitors
blood oxygen, carbon dioxide, and blood pH, using this information to
control the amount of air taken  into the body. When the body requires a
breath of fresh air, the brain sends a message to the respiratory muscles,
telling them to breathe. The diaphragm, which is the main breathing
muscle, moves downward, creating negative pressure in the chest cavity,
resulting in an inhalation. Following inhalation, another message is sent for
the diaphragm to move back to its resting position, causing an exhalation. When the breath is held following an exhalation, the intake of oxygen is
halted w hile carbon dioxide accumulates in the blood. During this pause,
oxygen cannot enter the lungs, and carbon dioxide cannot leave thebloodstream. The respiratory center, noticing the change to blood gases,
communicates to the diaphragm  to resume breathing, and the diaphragm
contracts downward in an attempt to allow the body to breathe. However,
breathing cannot resume while the breath is held, and the brain begins to
send increasingly frequent messages to the diaphragm, causing its spasms to
intensify. Y ou can experience this by simply holding your brea th until you
feel a strong need to breathe. At first you will feel an isolated spasm of the
diaphragm, but this will soon be followed by more intense and quicker
spasms as the body attempts to resume breathing. In essen ce, hold ing the breath until a medium to strong need for air
mobilizes the diaphragm, provides it with a workout and helps to strengthen
it. Whil e there are many products on the market aimed at increasing
respiratory muscle strength, bre ath holding may be the easiest and most
natural a s it can be employed at any time and actively directs attention to
the diaphragm. Improving respiratory muscle strength can be extremely
beneficial durin g exercise, especially when fatigue of the diap hragm may
determine exercise tolerance and endurance. Br eath Holding to Reduce Lactic Acid
Just as injury p lays a role in limiting physical performance, mental and
physical fatigue can also prevent an athlete from pushing harde r and faster. As U. S. Army g eneral Geor ge Patton wrote to his troops during W orld W ar
II: “ Fatigue makes cowards of u s all. Men in condition do not ti re. ” And he
was righ t; endurance is relative to how well the body is prepa red, and the
onset of fatigue occurs when the body is pushed beyond the limits of
preparation. W orking a muscle without suf ficient fuel generates lactic acid, and
while sm all amounts can be beneficial, acting as a temporary ener gy source,
a buildup of lactic acid creates a burning or cramping sensation in the
muscle that can slow down or even halt exercise completely. Studies with athletes have dem onstrated that breath holding after an
exhalation deliberately exposes the body to higher levels of acid ity, thereby
improving tolerance and delaying the onset of fatigue during competition. In a team sport  like football, w here players are expected to m aintain
form an d concen tration during 90 minutes of intense activity, the ability to
push through or avoid fatigue can be instrumental to a team’ s success. I
recently worked  with the Galway women’ s football team, whose coach,
Don O’R iordan, was concerned  that the players were tiring during the last
15 minu tes of a game. When fa tigue sets in, muscles tire, work rate slows,
and in some resp ects there is a loss of interest and focus—a situa tion almost
guaranteed to hand victory to the other side. Breaking through the barrier of
fatigue can be as much about psychological resilience as physiological
endurance, and breath-holding exercises of fer a useful technique for
improving both. In o rder to replicate the cond itions of a game, the team’ s training
usually l asted th e length of a full match. Their training session consisted of
a warm-up and a 10-minute run followed by match practice and tactics. The
last 15 minutes included drills and interval training such as running back
and forth between cones set at dif ferent distances. T o incorporate the
Oxygen Advant age program as seamlessly as possible into this type of
session, I made only modest changes to the existing routine so that the
players could adapt to new breathing techniques while maintaining their
current form. The result not only  increased the ef fectiveness of the training,
but also the players’ endurance and performance during competition. During t he 10-minute run at the beginning of training, I instructed the
players to switch from their usual habit of breathing through their mouth to
running at a comfortable pace with their mouth closed. Every minute or so,
each pla yer exhaled and held th eir breath until they felt a me dium to stro ng
air short age. No  changes were made to the match practice portion of the
training session,  as the introduct ion of nasal breathing adds an extra load to
the body that c an initially slow down an athlete, and possibly lead to
deconditioning of leg strength. The better approach, therefore, was to
incorporate nasal breathing into the 10-minute run and the final  15 minutes
of interval training only. Since th e team had a tenden cy to experience fatigue during the
remaining 15 minutes of a gam e, introducing nasal breathing to the final
interval training  session added an increased challenge. Running flat out
from cone to cone with the mouth closed is no mean feat, and  although a
couple of the pl ayers experienced mild headaches during the first session,the t eam adapted to it easily. After a few more practice sessions, the players
had adapted well to the demands of nasal breathing, so I decided to
challenge them further by introducing breath-hold exercises. These
exercises (which can be found in the next chapter) subjected the players to
an even greater feeling of breathlessness and worked to furthe r delay the
onset of fatigue. Bicarbonate of Soda—Mor e Than Just a Cooking Ingr edient. In a  similar wa y that breath h olding delays the onset of fat igue during
sports, countless studies have shown that taking the alkaline agent
bicarbonate of soda r educes a cidity in the blood to impr ove endurance. Who wo uld have thought that a cooking ingredient found in almost every
kitchen cupboard in the W estern world could also improve sports
performance. Not only that, but it is a very helpful tool to reduce your
breathing volume and increase your BOL T score. Bicarbonate of soda is a salt that is found dissolved in many natural
mineral springs and is usually sold as baking soda, bread soda, or cooking
soda. Th is ingre dient has a wid e variety of uses ranging from  baking to
brushing your teeth to cleaning your fridge. T aken internally, bicarbonate of soda helps to maintain pH of the blood,
and it’ s also the  active ingredient in a number of over -the- counter antacid
medications. Dr. Joseph Mercola, a leading authority on natural health,
suggests taking bicarbonate of s oda for the relief of a number of ailments,
including ulcer pain, insect bites, and gum disease. The ther apeutic potential of bicarbonate of soda may soon become more
widely known, since Dr. Mark P agel from the University of Arizona Cancer
Center w as recently awarded a grant of $2 million from the National
Institutes of Health to study the ef fectiveness of bicarbonate of soda therapy
in treating breast cancer. Over the years many studies  have demonstrated the benefits of
bicarbonate of soda as a met hod to help improve sports p erformance. During high-intensity training, the availability of oxygen for working
muscles decreases, which causes an accumulation of acid, leading to muscle
fatigue. By ingesting bicarbonate of soda, you can help to maintain normalblood pH by dec reasing lactic acid buildup during anaerobic exercise. This
alkaline soda neutralizes the acid that accumulates during high-intensity
training, resulting in greater endurance and power output. Bicarbonate of soda can also ha ve positive ef fects on maximum breath-
hold time. As noted throughout this book, improved breath-hold time has
positive implica tions for breathlessness during exercise and your ability to
improve your VO 2  max. The inges tion of bicarbonate of soda prior to the
practice of breath-hold exercis es has been shown to increase maximum
breath-hold time by up to 8. 6 percent. For swimmers, the addition of bicarbonate of soda has resulted in an
improvement of several seconds during test trials, as well as having
significant ef fects on resting blood pH. Researchers who have investigated
the ef fects of bicarbonate of soda on swimming performance have
concluded that the ingestion of bicarbonate of soda can act as an ef fective
buf fer during high-intensity interval swimming and could be used to
increase training intensity and overall swimming performance. These
benefits have even been appli ed to boxers, leading to impr oved punch
ef ficacy. What is consistent throughout all these studies is that the pra ctice of
ingesting bicarbonate of soda before exercise successfully neutralizes acid
buildup in the blood. In terms of fitness and performance, this means:
•  Improved endurance
•  Increased maximum breath-hold time
•  Reduced breathlessness
•  Higher average power output
All i n al l, quite an impressive array of benefits from a househo ld agent
that has no known side ef fects when taken in small doses. How to T ake Bicarbonate of Soda  
I find the following recipe beneficial for improving breathing
habits and increasing breath-ho ld time, and I use it quite often. T ry it and take note of its ef fects on your exercise performance. Y ou can take b icarbonate of soda an hour or so before
training. When you are used to taking it before training, you may
also wish to do so before a com petition. But like anything else,
there is no point in overdoing it. As a precautionary measure,
please talk to your doctor before using this approach. ½ teaspoon bicarbonate of soda  (also known as baking soda
or bread soda)
2 tablespoons apple cider vinegar
1. Put the bicarbonate of soda in a glass. 2. Add the apple cider vinegar and stir for about 1 minute, or
until the soda is thoroughly dissolved. 3. Drink the mixture. It will taste a little acidic. It’ s as simple as that. Alternativ ely, you can try drinking ordina ry soda
water from the grocery store. While traditionally used as a  mixer for
alcoholic beverages, the carbon ation of the water can provide an added
ef fect. If y ou drink so da water, please also make sure that you dri nk your
required intake of ordinary stil l water to ensure adequate hyd ration. The
color of  your urine will allow y ou to determine when you are  adequately
hydrated; drink enough plain w ater to ensure it is not too dark, but don’ t
drink so much that your urine  is completely clear throughout the day. Drinking too much water is pro bably just as bad for you as drinking too
little. It is about  getting the balance right. Until recently, water intoxication
or hyponatremi a was a little-known and even less understood medical
condition. Most people understand that it is sensible to stay hyd rated during
and after exercise, but when this advice is taken to excess a nd athletes
overdo it, dangerous side ef fects can result. Marathon runners are
particularly susceptible to drinking too much during training and
competition—whether water or sports drinks—and this excessiv e hydration
can cau se the brain to swell a s sodium levels decrease to cr itically low
levels. In a 2002 study of Boston Marathon runners, 13 percent of the
runners sampled  showed low sodium levels, putting them at risk of seriousor e ven fatal illness. In that very same marathon, twenty-eig ht-year -old
Cynthia Lucero collapsed and died. The state medical examiner ’ s of fice
concluded that the cause of death was a series of medical events  brought on
by drinking too much fluid during the event. Commenting on the tragedy,
Dr. Arthur Siegel of McLean  Hospital advised for athletes to weigh
themselves prior to a race and write their weight on their race b ib. Then, if
runners felt unwell during the race, they could be weighed again and treated
for dehy dration if it was found  that their weight was down. If, however,
their weight had increased, it w ould mean that they were overhydrated and
that they should retire from the race and stop drinking. Br eath Holding to Pr epar e for Ascent to High Altitude
Every year, millions of sea-le vel residents make the journey to high
altitudes for recreational skiing and climbing, or for religious, spiritual, or
other purposes. Adventurers, climbers, walkers, and sports enthusiasts have
ventured to altitudes of over 1,500 meters for the challenge and thrill of the
mountains. British adventurer Bear Grylls reached the summit of Mount Everest in
1998 at the age of twenty-three. In his book Facing Up,  Grylls describes
how he trained for his ascent o f Mount Everest by “swimming countless
lengths of the local pool—one underwater, then one on the surface, for
hours at  a time. This boosts one ’ s ability to work without oxyg en, making
the body more ef ficient. ”
There is no dou bt that Grylls’ s training regimen helped his body to
acclimatize to the reduced partial pressure of oxygen he would experience
during his climb to the top of Mount Everest. Similar to  swimming
repetitive under water lengths of a pool, the exercises of t he Oxygen
Advantage program that simulate high-altitude training can be very helpful
to prepa re for an ascent to high  altitude. More important, as th ese breath-
hold exercises are performed on land, they involve no risk of drowning. Acclimatization refers to the adaptive changes that the body m akes in
order to cope with reduced oxygen levels. Most people can ascend to 2,500
meters without dif ficulty, since oxygen availability is still suf ficient at thataltitude. However, at higher elevations the oxygen saturation in the blood
significantly decreases, making physical activity dif ficult to sustain. As you ascend a bove 2,500 meters, your breathing will become heavier
to c ompensate for the reduced  availability of oxygen. Although heavier
breathing brings greater quantiti es of oxygen to the lungs, it al so increases
the loss of carbon dioxide. As discussed earlier, the loss of carbon dioxide
causes blood vessels to narrow and red blood cells to cling on to the oxygen
they carry, resulting in reduced oxygenation of tissues and or gans. Ironically, as the body breathes more intensely in an ef fort to take in more
oxygen, less is delivered. In a high-altitude environment, oxygenation is
more important than ever if altitude sickness is to be avoided. Almost half of those who attempt to trek or climb to an altitude above
4,000 meters will develop one o r two symptoms of mountain sickness after
a rapid ascent of more than 400 meters per day. Symptoms vary depending
on th e in dividual’ s physical cond ition and health and the speed of the climb. Generally, symptoms are mild to moderate and may include:
•  Headaches
•  Fatigue
•  Insomnia
•  Loss of appetite
•  Nausea or vomiting
•  Rapid pulse
•  Light-headedness
•  Shortness of breath during exertion
A faster climb tends to increase the severity of these symptoms, and
may bring about additional symptoms, including:
•  T ightening of the chest
•  Confusion
•  Coughing or coughing up blood
•  A bluish discoloration of the skin
•  Shortness of breath during rest
•  An inability to walk in a straight lineIncreasing the oxygen-carrying  capacity of the blood is the most
important factor when adjusting  to an increase in altitude, and breath-hold
training exercise s are an ideal way to prepare in the weeks be fore ascent. Spending two to three months performing 5 to 10 maximum breath holds
each day will condition the body to accept this intense feeling of
breathlessness as a familiar occurrence, potentially resulting in a reduced
response to this experience at higher altitude. Finally, any individual who is serious about his climb should have a
basic un derstanding of how his breathing influences delivery of oxygen to
tissues and or gans. I can onl y imagine the number of climbers who
intentionally make their breathing more intense to try to counteract the
feeling of breathlessness as they climb above 2,500 meters. By now you
will be acutely aware that this is exactly the wrong thing to do, and will
most likely result in more severe symptoms of altitude sicknes s. The right
thing to do woul d be to start of f with a high BOL T score, to brea the through
the nose at all times, and to alter your pace to reduce the  feeling of
breathlessness. At le ast one stud y shows that br eath-hold time is a very useful predictor
of m ountain sickness and that the lower the breath-hold time, the greater the
likelihood of developing symptoms of altitude sickness. In fact, those with a
high bre ath-hold time and a high concentration of hemoglobin in the blood
will be better able to tolerate desaturation of oxygen. Though the ideal BOL T score for each individual will va ry, it is
reasonable to suggest that a BOL T score of 40 seconds would certainly
af ford a greater protection from  conditions of high altitude than  a BOL T of
20 seconds or below. Pr event Dehydration with Nasal Br eathing
The air in mountainous regions  and at higher altitudes is cooler and drier
than air at sea level. As you ascend to higher altitudes, th e increased
sensation of breathlessness is  likely to induce the switch  to mouth
breathing. Howe ver, since one of the functions of the nose is to moisten and
warm incoming air, breathing th rough the mouth can lead to dehydration, as
considerable moisture is expended. Another factor is that during exhalation, mouth breathing is com pletely
inef fective in retaining moisture. T o verify this, gently breathe out through
your mouth onto a glass and ch eck the moisture left behind. Now do the
same th ing, except exhale through your nose. Y ou will find that the
moisture left on the glass following nasal exhalation is far less than the
moisture left from exhaling through the mouth. This loss of flui d can contribute to moderate dehydration, resulting in
dryness of the lips, mouth, a nd throat. Other symptoms arising from
dehydration include headache, f atigue, and dizziness, which at high altitude
could ea sily be confused with mountain sickness. Heavy breathers and
mouth b reathers will certainly experience a far greater loss of moisture than
those who have a normal breat hing volume and who breathe through the
nose. Remember that there are no convenience stores at high altitude, so the
more moisture you can hold on to, the less you need to carry. Finally, inhaling cold, dry air th rough the mouth can cause the  airways
to n arrow. As the airways con strict, the feeling is similar to breathing
through a narrow straw, and the result is often to breathe harder and faster
to c ompensate for the restricte d airflow. This is a common  occurrence
experienced by individuals with asthma and can cause even greater
dehydration and cooling of the airways, which may lead to even greater
respiratory problems. In the next chap ter we will lea rn exercises that simulate high-altitude
training in order to increase the oxygen-carrying capacity of yo ur blood for
better sports performance, or to prepare for an ascent to high altitude. CHAPTER 7
B r i n g  t h e  M o u n t a i n  t o  Y o u
W orld-renowned Brazilian track coach V alério Luiz de Oliveira used
breath-hold training techniques with Olympic athletes Joaquim Cruz and
Mary De cker, w ho between them set six world records in 800-meter to one-
mile distance running events in the 1970s and 1980s. De Oliv eira’ s go al was to enable athletes to maintain form at the end of
an anaerobic race of 400–800m. Another aspect was to improve
psychological preparedness by allowing the athletes to maintain composure
during a n oxygen-deprived state. One final factor was to train the runners
not to pay atte ntion to their b reathing, but instead to focus on tactical
maneuvers and running form. De Oliveira’ s techniques were a case of
getting results first and figuring out the science later, but his theories
certainly proved to be right. The method de Oliveira used with his athletes is as follows:
•   A thletes run 200 meters on a  straight course at near race pace,
holding the breath on an inhalation for the last 15 meters. •   After a partial  rest of 30 seconds, this breath hold is repeated 3
more times. •   Athletes then spend 3 minutes recovering before repeating. •  In total, the athletes perform 3 sets of 4 breath holds. According to de Oliveira, “Everybody’ s capable of holding their breath
for a very long time. But you’ve got to do three of these sets. By the finalset, you’ re going to become ver y, very tired. It’ s hard to hold yo ur breath at
that point. But if you use my drill, you will see results. ”
De O liveira uses another exercis e in which his 400m and 800m runners
hold their breath for the last 30  meters, simulating the end of a race when
they will be mos t fatigued. Maintaining form during the last 30  meters of a
race like this is crucial. According to de Oliveira, “The most important
thing yo u can do in the race no m atter how exhausted you get is to maintain
your form. ”
Joaquim Cruz, coached in this  way by de Oliveira, won gold in the
800m co mpetition during the 1984 Olympics in Los Angeles a nd silver at
the 1988 Olympics in Seoul. Fu rther accomplishments included bronze in
the 800 meters at the 1983 W o rld Championships and gold in the 1,500
meters during the 1987 and 1995 Pan American Games. By  the end of
1984, he  was the National Collegiate Athletic Association champion and
Olympic champ ion; undefeated in all seven of his 800m finals; had run the
second-, fourth-, fifth-, and sixth-fastest 800m times in history; and easily
ranked as number one in the world for the 800 meters in 1984. The legendary Czech athlete Emil Zátopek, described by the New Y ork
T imes  as perhaps one of the greatest distance runners ever, also incorporated
breath holding into his regular training. Zátopek was a man of small stature,
standing 5 feet 8  inches tall and  racing at 139 pounds, but he found an edge
over his  competitors by developing his own innovative training techniques,
which included interval training  and breath holding. While wal king to and
from wo rk each  day, he passed a lane lined with poplar trees. On the first
day, he held his breath until he r eached the fourth poplar. On the  second day
he h eld his brea th until he reach ed the fifth poplar, increasing the distance
of his breat h hold by one tree each day until he could hold his brea th for the
entire line of trees. On one occasion, Emil held his breath until he passed
out. Wh ile it is not necessary to practice to this extreme, it is fascinating to
note tha t one of history’ s great est runners was performing breath holding
long before it formed part of training for some present-day athletes. The dif f iculty in  presenting accounts of active athletes is that they strive
to keep their training regimens  a secret. It doesn’ t make much sense to
disclose your innovative techniques, especially when they give you an edge
over the competition. T o date, I have worked with a number of Olympic and
professional ath letes who have incorporated the breathing exercises in thisbook int o their training. Given the tiny (but highly important) dif ference in
mar gin of performance between  one elite athlete and another, I am very
much aware of the importance  of keeping training information close to
one’ s chest. However, sometimes hints and snatches of information can be gleaned
through the press, suggesting that breath holding is becoming more widely
practiced in the athletic commu nity. For example, a recent ar ticle on the
athletic website Eightlane. or g reported that Galen Rupp— the current
American record holder for the 10,000 meters and indoor 3,000  meters, and
silver medal winner at the 2012 London Olympics—had recently collapsed
during training. Rupp’ s headph ones had fallen of f and “he was unable to
hear his coach reminding him to breathe. ” Reading between the lines, it
seems as if Rupp may well have been practicing breath holding during his
training sessions, with his coach setting his limits. Please note that it is
neither necessary nor safe to hold your breath in order to create such an
extreme air hunger. T o get the most benefit from the breath-ho ld exercises
in th is b ook, only hold your breath until you experience a mediu m to strong
ur ge for air. Pay attention to the intensity of the air hunger you create as you
perform each exercise, and rele ase your nose when you feel challenged. Y ou should be able to recover your breathing within 2 to 3 breaths
following a breath hold. T o the uninitiated, purposely h olding the breath may seem strange. Oxygen is necessary for life, so why subject the body to such a limitation. Just as physical  training is a very natural activity for mankin d, so too is
breath h olding. As a child, you might have held your breath any time you
swam to  pick up a coin or other object from the bottom of a  swimming
pool. A t other times, you may  have held competitions with siblings or
friends to see who could hold their breath for the longest, with  passing the
1-minute mark being an acceptable accomplishment. For the past th irteen years, thousands of children have attended my
courses to help address coughing, wheezing, and symptoms of
breathlessness a nd asthma. Children as young as four are able t o practice a
number of dif ferent breath-hold exercises, each with a specific purpose. For
example, there is a breath-hold exercise to help unblock the nose, another to
help stop a wheeze or a cough, while another is designed to improve
breathing volume by holding the breath for as long as possible. While ad ults ma y at first be wary of holding their breath, children often
take to it like ducks to water. I usually work with five or six children to a
group, ranging in age from fo ur to fifteen years. Beginners are gently
introduced to the exercises by walking a distance of 10 paces while they
hold the ir breath. After 3 or 4 re petitions, the number of paces is increased
in in crements of 5 until the child  understands the exercise and ex periences a
moderate need for air. Most chi ldren master the exercise in no  time at all,
and are soon in friendly competi tion with their peers to hold their breath for
as many steps as possible. I usually expect children to hold their breath for 30 paces during the
first session, increasing by 10 e xtra paces each week. Some c hildren will
make qu icker pr ogress and can learn to hold their breath for up  to 80 paces
in a s little as two or three weeks without losing breath control or
experiencing any stress. Even professional athletes would be impressed by
this feat. More important, at 80 paces, in my experience, the child’ s blocked
nose, cough, wheeze, or exercise-induced asthma will have completely
disappeared. The beauty of breath holding is that while the air shortage can be
relatively extrem e, it is entirel y under our own control and for a short
duration of time only. For premenstrual women, vegetarians, or those with a history of anemia,
it m ay b e necessary to take an iron supplement to support the production of
normal red blood cells. If, despite sustained practice of these exercises, your
BOL T score fails to increase, it may be useful to visit your doct or to have a
complete blood count. If your hemoglobin is low, speak with your doctor
about iron supplementation. In  some individuals, I have witnessed iron
supplementation making a remarkable dif ference to BOL T scores within
just a few short weeks. The fol lowing Oxygen Adva ntage breath-hold training e xercises
provide simple ways to simul ate the beneficial ef fects of h igh-altitude
training and high-intensity train ing while allowing you to exercise in your
usual wa y. Each  exercise provides both a hypoxic (lack of oxygen) and a
hypercapnic (high carbon dioxide) response. Combining these two ef fects
produces important changes in the body, such as:
•  Lowering sensitivity to carbon dioxide•  Increasing endurance
•  Reducing discomfort and fatigue from lactic acid buildup
•  Increasing the oxygen-carrying capacity of the blood
•  Improving breathing economy
•  Improving VO 2  max
By i ncorporating  these easy techniques into your routine, you w ill find
that your breath-hold ability increases quickly, and you will begin to see
results within your training and your competitive performance. Using a Pulse Oximeter
T o get the best results from breath-hold exercises, it can be helpful to use a
handheld device  called a pulse oximeter that measures how loaded the
blood is with ox ygen. Convenient and noninvasive, using a pulse oximeter
simply i nvolves placing a probe on your fingertip to measure the oxygen
saturation (SpO 2 ) of your blood. A pulse oximeter can be purchased rather
cheaply, but my advice is to purchase a better -known brand such as
NONIN, as they tend to be more responsive. One of the main  benefits of
using a pulse oximeter is that it can be very motivating to witn ess the drop
in oxyge n satura tion as you prac tice breath holds, reinforcing the success of
the exercise. In addition, the device can help to ensure that you don’ t
overdo the exercises by lowering your SpO 2  below 80 percent. Normal oxygen saturation at sea level varies between 95 and 99 percent
(as we have seen), while the benefits from breath holding occur when the
SpO 2  l eve l is  dropped to below 94 percent. In the beginning, you may not
notice m uch of a decrease to your oxygen saturation while performing
breath holds. However, with practice and the ability to tolerate a stronger air
shortage, the drop to oxygen sat uration will become evident in as little as a
few days. The ef fects of breath holding de pend on two factors—oxygen saturation
during training and the length of the exposure to reduced oxygen—but slow
and steady is the way to go, just as it is whenever you start a new exercise
program. T o get the most out of breath-hold exercises, it helps to startgently, h olding the breath until you feel a medium air hunger during the
first two or thre e breath holds b efore gradually increasing the duration and
intensity. This way, you will fe el in control and be able to practice more
ef fectively. As your BOL T score increases, you will find it easier to manage
the sensation of air hunger, and your blood oxygen saturation will start to
drop below 94 percent. Simulate High-Altitude T raining While W alking
W e beg in by introducing a simple walking exercise that ena bles you to
achieve similar benefits to those experienced during intense physical
training in as litt le as 10 to 15 m inutes. The beauty of this exercise is that it
can be performed anywhere and at any time, even if an injury is preventing
you from  engaging in normal training. Similar to any intense physical
exercise, it is important to practice at least two hours after eating. Just as it
is not advisable to go for a jog directly after eating, it is also best to practice
breathing exercises on an empty stomach. Not only would it be
uncomfortable to  perform breath holds too soon after a meal, bu t the benefit
of the exercise would be much reduced as the process of digestion increases
breathing. During this exercise you will be practicing breath holds as you walk. For the first 2 to  3 breath holds,  in order to gently acclimatize your body to
lower levels of oxygen, it’ s important to hold your breath only until you feel
a medium hunger for air. For the  remaining breath holds, challenge yourself
by aiming to ac hieve a relatively strong need for air. Due to a delay in the
pulse tra nsit tim e, it is commo n for the decrease in oxygen saturation to
take plac e not during the breath hold, but soon after it. Therefore, to get the
most fro m the exercise, minimize breathing for about 15 seconds following
the breath hold by taking short breaths in and out through the nose. If you
have a pulse ox imeter, you might enjoy observing the decre ase to your
oxygen saturation as you do this—ef fectively simulating h igh-altitude
training and bringing the mountain to you. •   W alk and hold:  Aft er a minute of continuous walking, gently
exhale a nd pinch your nose to  hold your breath. If you feel
uncomfortable pinching your nose while walking in public, you
can simply hold your breath without holding your nose. Continue to walk while holding your breath until you feel a
medium to strong air shortage. Release your nose, inhale
through it, and minimize your breathing by taking very short
breaths for about 15 seconds. Then allow your breathing to
return to normal. •   Continue walking for 30 seconds and r epeat:  Continue
walking for around 30 seconds while breathing through your
nose, the n gently exhale and pin ch your nose with your fingers. W alk w hile holding the breath until you feel a medium to
strong h unger for air. Release your nose and minimize your
breathing by taking short breath s in and out through your nose
for a bout 15 se conds. Then allow your breathing to revert to
normal. •   Repeat br eath holds 8 to 10 tim es:  While continuing to walk,
perform a breath hold every minute or so in order to create a
medium to strong need for air. Minimize your breathing for 15
seconds following each breath hold. Repeat for a total of 8 to
10 breath holds during your walk. This exercise will take about 12 minutes to complete and is highly
ef fective at teaching your body to do more with less. At first yo u may only
be able to hold your breath for 20 or 30 paces before you feel a strong air
shortage (or less if you have ast hma or are out of breath). As the number of
paces per breath hold increases, the air shortage you experience will
progress from easy to moderate to strong. As you feel an increased hunger
for air, the breathing muscles in your abdomen or neck will begin to
contract or spasm. An added ef fect of the contractions is to p rovide your
diaphragm with a workout, thereby strengthening your main breathing
muscle. During the longer breath holds, as you feel your breathing muscles
spasm, f ocus on  relaxing your b ody. Allow your muscles to go soft as you
hold your breath. Relaxing the body in this way allows a longer breath hold
with less stress. W ith repetition, as the weeks go by, you will find yourself being able to
hold your breath for 80 to 100 paces. Y our ability to hold your breath will
increase with practice and without stressing your body. Do not overdo it. Ideally, your breathing should re cover easily and become calm w ithin 3 or 4
breaths. While this exercise is a challenge, it should not be stressful. If you notice any side ef fects, such as an elevated or stronger than
normal p ulse for  a prolonged pe riod after completing breath holding, then it
is b est to refra in from performing the stronger breath holds. Instead,
concentrate on breathing lightly  both during rest and physical exercise to
bring benefit to your health and sports. Breath holding can also be incorporated into a jog, run, or bike ride. While you may not be able to h old your breath for as many paces during a
jog as you can during a walk, the quality of the exercise will be better
because of the greater accumulation of carbon dioxide in the blood. Breath holding during training  adds an extra load that would only
otherwise be experienced during maximum intensity exercise. Here is a breath-hold exercise to try while jogging or running:
•   Run and hold:  T en  to fifteen minutes into your run, when your
body has warmed up and is sw eating, gently exhale and hold
your br eath until you experience a medium to strong air
shortage. The length of the breath hold may range from 10 to
40 p aces and w ill depend on your running speed and BOL T
score. •   Br eak f or 1 minute and r epe at:  Following the breath hold,
continue to jog or run with nasal breathing for about 1 minute,
until your breathing has partially recovered. •   Repeat br eath holds 8 to 10 times:  Rep eat the brea th hold 8 to
10 t imes during your run, follo wed each time by a minute of
nasal breathing. The breath holds should be challenging but
should also allow breathing to  recover to normal within a
couple of breaths. If you find this exercise in any way stressful, or have dif ficulty
recovering your  breathing after a breath hold, then refrain from doing the
exercise until your BOL T score has increased to at least 20 seconds. Br eath Holding During Cycling
A similar practice can be employed as you ride your bicycle:
•   A fter your bo dy has warmed up, exhale and hold your breath
for 5 to 15 pedal rotations. •   Resume nasal breathing while continuing to cycle for about 1
minute. •  Repeat this exercise 8 to 10 times throughout your ride. Br eath Holding During Swimming
Swimming is the only sport in which breathing volume is controlled, as the
face is immersed in the water and the weight of the body on the water
restricts breathing even further. Breathing through the mouth is probably the
best opt ion during swimming,  as nasal breathing may result in water
inhalation. T o incor porate reduced breathing during swimming, you will need to
increase the number of strokes between breaths. Y ou can do this in gradual
increments, incr easing the number of strokes between breaths fr om 3 to 5 to
7 over a series of lengths. This exercise was employed by former Olympic
swimmer and triathlete Sheila T aormina, who achieved the fastest 1. 5 km
swim during the Sydney Gam es in 2000. In my correspon dence with
T aormina, she explained how reduced breathing was used to create a
training ef fect so that the swimmer would be challenged to do more with
less. However, unlike some spo rts, such as underwater hockey, the breath
hold is never pushed to an absol ute maximum, in order to ensure the safety
of the swimmer. In addition to the hematological benefits from breath-hold training, it
has been found that breath ho lds also improve swimming coordination. After breath-hold training, swimmers have shown increases in VO 2  peak as
well as an increase in the distance traveled with each swimm ing stroke. During t he front crawl it is necessary to turn the head sideway s every few
strokes in order to take a breath. However, each time a swim mer takes a
breath, hydrodynamic drag take s place, which ultimately wastes ener gy and
reduces performance. One of the benefits of having a high BOL T score is
that bre athing becomes more ef ficient, meaning that less air is required
during a  swim. Reducing the number of breaths minimizes drag, helping to
conserve ener gy for improved performance. The same training has also been  applied to underwater hockey players,
who perform their sport below t he surface of the water in a swimming pool. The obje ct of the game is to pass a weighted puck along the bottom of the
pool using an underwater hoc key stick, scoring points in th e opposing
team’ s g oal. As play takes place underwater, it is advantageous, if not
essential, that players are able to hold their breath for long periods of time. Part of the train ing of underwater hockey players includes prolonged and
repeated breath holds and con trolled breathing, which lead to a higher
tolerance for carbon dioxide and an increase in breath-hold time. Researchers inv estigating the ef fects of short repeated breath holds on
underwater hockey players found that these exercise s reduced
breathlessness and produced a higher concentration of carbon dioxide in the
blood. I n addition, lactate values were found to be lower in underwater
hockey players compared to untrained individuals, meaning th at the pain
from lac tic acid buildup was reduced. These athletes clearly have a high
tolerance for carbon dioxide, most likely explained by their experience with
prolonged breath holding for their sport. As we have already seen, reduced
sensitivity to carbon dioxide translates into reduced breathlessness during
exercise as less breathing is re quired to eliminate excess carbon dioxide. This allows greater physical exertion with lighter breathing—enabling your
body to do more with less. Advanced Simulation of High-Altitude T rainingNormal oxygen saturation at sea  level varies between 95 and 99 percent. T o
receive any benefit from hypoxic (reduced oxygen) training, oxygen
saturation levels  must drop below 94 percent (and ideally to  below 90
percent). The ef fect of this m ethod depends on two factors: oxygen
saturation durin g training, and the length of the exposure to reduced
oxygen. Lowering oxyge n saturation below 90 percent for a duration of 1 to 2
minutes can significantly incre ase the production of EPO, and this can
easily be achieved by using this exercise. Before y ou con sider doing this exercise, please get the a ll clear fr om
your physician. T his exercise is only suitable for those who have good
physical fitness,  perfect health, a BOL T score of longer than 30 seconds,
and are accustom ed to performing intense physical exercise. In other words,
if you wish to try this exercise, you must be familiar with experiencing
strong air shortages. Please refrain from doing this exercise if any of the
following statements apply to you:
•   Y ou are in any doubt about your capabilities to perform inten se
physical exercise. •  Y ou are unwell. •  Y our BOL T score is shorter than 30 seconds. •  Y ou are not currently in a regular physical training program. This advanced exercise aims to readjust the composition of your blood
and alt er levels of oxygen and carbon dioxide. After months of
experimenting, I have developed this exercise to lower the oxygen
saturation of arterial blood and to maintain this decrease over a number of
seconds. I have practiced this e xercise hundreds of times and include the
following guide lines to help you to perform it correctly and to be aware of
potential side ef fects:•   T o regulate the decrease in ox ygen saturation to below 94
percent and to ensure that it does not go below 80 percent, it is
important to use a higher -quality pulse oximeter during this
exercise. •   This exerci se should be p racticed on a relatively empty
stomach, at least three hours after eating. •   The f irst brea th hold is between 40 and 60 paces, or until yo u
feel a medium to strong need for air. •   After  the first breath hold, subsequent holds are performe d
every 5 to 10 paces. •   Follow ing eac h breath hold, either exhale through your nose or
take a sip of air in through your nose before the next breath
hold. •   A “si p of air” means taking  a tiny breath in, the purpose of
which is  to relieve tension rathe r than take in air. It is about 10percent of a normal breath. •   Contractions  of the diaphr agm will strengthen as the a ir
shortage progres ses. T ry to bring a feeling of relaxation to your
body as the air shortage increases. •   W ith  each successive brea th hold, oxygen saturation will
continue to decrease. •   Continue to observe the puls e oximeter, ensuring that you do
not go below 80 percent SpO 2. •  Challenge but do not stress yourself. •   If the air shor tage is too great, take a slightly lar ger breath and
continue to relax. •  Perform this exercise for 1 to 2 minutes. The obj ective of the exercise is to generate a reasonably strong air
shortage in order to lower oxygen saturation and to maintain it at a lower
level for a period of between 30 seconds and 2 minutes. Please note that it is not advis able or even necessary to low er your
oxygen saturatio n below 80 pe rcent. Maintaining an oxygen saturation of
less than  91 percent for approximately 24 seconds can result in an increase
of E PO of up to 24 percent, while maintaining this saturation for 136
seconds can result in an increase of EPO of up to 36 percent. Putting the Oxygen Advantage Pr ogram to the T estFrance i s well known for its glo bal cycling events. It is not
only the  home of the T our de France but also to such legendary
mountains as Mont V entoux and Col le da Madone, which lure
cyclists from around the world to conquer their slopes. The
thriving French amateur road racing culture is steeped in
folklore, setting such intense challenges that some athletes are
unable to compete more than a few seasons due to injury,
fatigue, or burnout. Nick Ma rshall i s an Australian cyclist who started racing in
the Paris region. A father of two and a businessman, Nick had
trouble j uggling the demands of work and family with what he
felt w ere “old-school training m ethods. ” Seeking a better way to
train, Nick started using advanced yoga breathing and then the
Oxygen Advant age principles to develop more power while
reducing his overall training lo ad. Initially, Nick had a BOL T
score of  just 25 seconds (common even among elite athletes),
but through the nasal breathing, Breathing Light to Breathe
Right, and simulating high-altitude training, his BOL T score
now regularly reaches 60 seconds. The primary Oxygen Advantage exercise Nick used was a
daily 30-minute routine combining the following:
1. Breathe Light to Breathe Right for 15 minutes.
To lower the oxygen saturation of the blood to simulate the effects of high-altitude training.
What is the primary reason why Oxygen Advantage breath holds are performed after exhalation?
2-4%
What is the maximum increase in hemoglobin that can be achieved through 3-5 breath holds?
Not specified, but it is mentioned that athletes with a BOL T score of shorter than 20 seconds should be careful not to hold their breath for too long.
What is the recommended duration of breath holds for athletes with a BOL T score of less than 20 seconds?
To simulate high-altitude training and improve endurance
What is the purpose of the "Run and Hold" exercise?
Not specified, but it is mentioned that the exercise should not be done if your BOL T score is shorter than 30 seconds, and you should start with 40-60 seconds and gradually increase the duration.
What is the recommended duration of the "Simulate High-Altitude Training" exercise?