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and fancy . High Alt Med Biol . 20 02 Summer;3(2):177–193. Levine
BD. Sh ould “artificial” high altitude environments be con sidered
doping? Scand J Med Sci Sports. 2006 Oct;16(5):297–301. Levine BD,
Stray-Gundersen J. “Living hig h-training low”: Ef fect of moderate-
altitude acclimatization with lo w-altitude training on performa nce. J
Appl Physiol . 1997 Jul;83(1):102–12. 102  Levine and Stray-Gundersen: Levine, Stray-Gundersen 1997, 102–12. 102  These improvements were: Ibid. 102  Furthermore, the increase: Stray-Gundersen J, Chapman RF , Levine
BD. “Living high–training low” altitude training improves sea level
performance in male and female elite runners. J Appl Physiol . 2001
Sep;91(3):1 1 13–20. 102  D uring the 200 6 T orino: W allechinsky D. The Complete Book of the
W inter Olympics . T urin 2006 e d. W ilmington , DE: Sport Media
Publishing; 2005. 103  T he authors of the study conc luded that although: Moderate-i ntensity
aerobic training  that improves the maximal aerobic power does not
change anaerob ic capacity , and adequate high-intensity inter mittent
training may improve both anaerobic and aerobic ener gy supplying
systems signific antly . T abata I, Nishimura K, Kouzaki M, et al. Ef fects
of moderate-intensity endurance and high-intensity intermittent
training on anaerobic capacity and VO 2  max. Med Sci  Sports Exer c . 1996 Oct;28(10):1327–30. 103  Posttrial results: Bailey SJ, W ilkerson DP , Dimenna FJ, Jones AM. Influence of repeated sprint training on pulmonary O 2  uptake and
muscle deoxyge nation kinetics in humans. J Appl Physiol . 2009
Jun;106(6):1875–87. 103  T his means that the athletes: J ones A. Understand the body’ s use of
oxygen during exercise: Oxygen kinetics—start smart for a mean
finish! Sports Performance Bulletin. www .pponline.co.uk/encyc/understand-the-bodys-use-of-oxygen-
during-exercise-36326 (accesse d April 20, 2013). Hagber g JM,
Hickson RC, Ehsani AA, Holloszy JO. Faster adjustment to andrecovery from submaximal exercise in the trained state. J Appl Physiol
Respir Envir on Exer c Physiol . 1980 Feb;48(2):218–24. 105  For hundreds of thousands of years: Rahn H, Y okoyama T . Physiology
of Br eath-Hold Diving and th e Ama of Japan . W ashington, D.C.:
National Academy of Sciences–National Research Council; 1965:369. 105  and  some evolutionary theorists: Hardy A. W as man more aquatic in
the past? New Scientist . March 17, 196 0. Hardy A. W as there a Homo
aquaticus ? Zenith. 1977;15(1): 4–6. 106  G enerally , most humans: W o rld records. Association Internationale
pour le Développement de l’Apnée. www .aidainternational.or g/competitive/worlds-records (accessed July
6, 2012). 106  A num ber of  studies have sought: Isbister JP . Physiology and
pathophysiology of blood vol ume regulation. T ransfus Sci . 1997
Sep;18(3):409–23. Koga T . Correlation between sectional area of the
spleen by ultrasonic tomograph y and actual volume of the removed
spleen. J Clin Ultrasound . 1979 Apr;7(2):1 19–20. Erika Schagatay is
the dire ctor of research at Mi d Sweden University . Her interest in
physiology began after she met native breath-hold divers from several
tribes, including Japanese ama  a nd Indonesian  Suku Laut and  Bajau,
who were able to hold their breath for far longer than medical
literature stated was possible. Schagatay has completed a number of
studies on the ef fects of hold ing the breath on both trained and
untrained breath-hold divers. People. Mid Sweden Univ ersity . www .miun.se/en/Research/Our -Research/Research-groups/epg/About-
EPG/People (accessed August 29, 2012). One of Schaga tay’ s studies involved twenty healthy volunt eers,
including ten who had their spleens removed, to determine the
adaptations caused by short-term breath holding. The volunteers
performed 5 breath holds of maximum duration (as long as possible for
each ind ividual) with a 2-minute rest in between each. The results
found th at the volunteers with spleens showed a 6.4 percent increase in
hematocrit (Hct) and a 3.3 percent increase in hemo globin
concentration (H b) following the breath holds. This means that after
just 5 breath ho lds, the oxygen-carrying capacity of the blood was
significantly improved. However , for the individuals who had theirspleens removed, there were no recorded changes to the blood
resulting from breath holding. Schagatay E, Andersson JP , Hallén M,
Pålsson B. Selected contribution: Role of spleen emptying in
prolonging apneas in humans. Journal of Applied Physiology . 2001
Apr;90(4):1623–9. During a separate study by Schagatay , seven male volunteers
performed 2 sets of 5 breath holds to near maximal duration, on e in air
and the other with their faces immersed in water . Each breath hold was
separated by 2 minutes of rest and each set separated by 20 minutes. Both Hc t and Hb concentration  increased by approximately 4 p ercent
across both series of breath holds—in air and in water . Schagatay E,
Andersson JP , Nielsen B. Hematological response and diving response
during apnea and apnea with face immersion. Eur J Appl Physiol . 2007
Sep;101(1):125–32. 106  The spleen is an or gan: Isbister 1997, 409–23. 106  This means that after as few: Schagatay , Andersson, Nielsen 20 07 Sep,
125–32. 106  b reath-hold divers peaked: A study by Bakovic´ et al. from Un iversity
of S plit School of Medicine, Croatia, was conducted to inve stigate
spleen r esponses resulting from  5 maximal breath holds. T en trained
breath-hold divers, ten untrained volunteers, and seven volunteers who
had thei r spleen removed were recruited. The subjects performed 5
maximum breat h holds with their face immersed in cold wat er , and
each bre ath hold  was separated by a 2-minute rest. The duration of the
breath holds peaked at the third attempt, with breath-hold divers
reaching 143 seconds, untrained divers reaching 127 seconds, and
splenectomized persons achieving 74 seconds. Spleen size dec reased
by a total of 20  percent in both  breath-hold divers and the un trained
volunteers. Researchers concluded that the results show rapid,
probably active contraction of the spleen in response to breath hold in
humans. Rapid spleen contraction and its slow recovery may
contribute to prolongation of successive, briefly repeated brea th-hold
attempts. Bakov ic´ D, V alic Z, Eterovic´ D, et al. Spleen volume and
blood fl ow resp onse to repeated breath-hold apneas. J Appl Physiol . 2003 Oct;95(4):1460–6. 106  Not only that but: Ibid.107  While these studies generall y: In a paper by Dr . Espersen and
colleagues from Herlev Hospital, University of Copenhagen,
Denmark, splenic contraction w as found to take place even with very
short breath holds of 30 seconds . However , the strongest contraction of
the spleen was as it released blood cells into circulation, occurring
when a subject held their breath for as long as possible. Esper sen K,
Frandsen H, Lorentzen T , Kanstrup IL, Christensen NJ. The human
spleen as an erythrocyte reservoir in diving-related interventions. J
Appl Physiol . 2002 May;92(5):2071–9. 107  However , the strongest contractions: Ibid. 107  Another useful piece of: This study in particular provides pertinent
information abo ut the consequence of breath holding: Since there was
no visible increase in the results of breath holding with the su bjects’
faces im mersed in water , the aut hors concluded that the breath hold, or
its consequences, is the major stimulus evoking splenic contraction. Schagatay , Andersson, Nielsen 2007 Sep, 125–32. 107  Performing just 3 to 5 breaths: Ibid. 108  While this reduces the: In his doctoral thesis entitled “Haematological
changes arising from spleen contraction during breath hold and altitude
in huma ns,” Matt Richardson investigated the role played by higher
levels of carbon dioxide. Eight no n-divers performed 3 sets of breath holds on three separate
days under dif ferent starting conditions, varying the levels of carbon
dioxide availabl e to the subjec ts before each test. The first test was
preceded by the breathing of 5 percent CO 2  i n oxyg en (hyp ercapnic),
the second with pre-breathing of 100 percent oxygen (normocapnic),
and the third with hyperventilation of 100 percent oxygen
(hypocapnic). The duration of each breath hold was kept constant in all 3 sets, and
baseline values of Hb and Hct w ere the same for all conditions . After
the 3 breath ho lds, the increase in Hb in the hypercapnic (higher
carbon dioxide) trial was 9.1 per cent greater than in the normal carbon
dioxide trial (normocapnic) and  71.1 percent greater than in the lower
carbon dioxide trial (hypocapnic). Richardson concluded that an
increased capni c stimulus during breath hold may elicit a strongerspleen response and subsequent Hb increase than breath hold preceded
by hype rventilation. Richardson, MX. Hematological changes arising
from spleen contraction during apnea and altitude in humans. Doctoral
dissertation. Mid Sweden University; 2008. 108  Higher levels of carbon dioxide: Ibid. 108  By exh aling an d holding the b reath: Dillon WC, Hampl V , Sh ultz PJ,
Rubins JB, Archer SL. Origins o f breath nitric oxide in humans. Chest . 1996 Oct;1 10(4):930–8. 109  One of the func tions of EPO: Joyner MJ. VO 2 MAX, b lood dop ing, and
erythropoietin. Br J Sports Med. 2003 Jun;37(3):190–191. Lemaître F ,
Joulia F , Chollet D. Apnea: A new training method in sport ? Med
Hypotheses . 2010 Mar;74(3):413–5. 109  Breath holding is an ef fective:  Lemaître, Joulia, Chollet 2010 Mar ,
413–5. 109  Th e concentration of EPO: De Bruijn and colleagues from the
department of natural sciences,  Mid Sweden University , investigated
whether subjecting the body to lower oxygen levels by holding the
breath could increase EPO concentration. The study involved ten
healthy voluntee rs performing 3 sets of 5 maximum duration breath
holds, w ith each set separated by 10 minutes of rest. Results s howed
that EPO concentration increase d by 24 percent, peaking three hours
after the  final breath hold and re turning to baseline two hours la ter . De
Bruijn R, Richardson M, Schagatay E. Increased erythropoietin
concentration af ter repeated apneas in humans. Eur J Appl Physiol. 2008 Mar;102(5):609–13. 109  A clear example: Cahan C, D ecker MJ, Arnold JL, Goldwasser E,
Strohl KP . Erythropoietin levels with treatment of obstructive sleep
apnea. J Appl Physiol . 1995 Oct;79(4):1278–85. A study by W innicki
and colleagues from the Medical University of Gdansk, Poland, tested
the hyp othesis that the repetitive lowering of oxygen levels from
breath holds during sleep apne a increase EPO. The study in volved
eighteen severe and ten very mild patients. Results showed a 20
percent increase to EPO in patients with severe obstructive sleep
apnea, which decreased followi ng elimination of the breath holds by
treatment. W innicki M, Shamsuzzaman A, Lanfranchi P , et al.Erythropoietin and obstructive sleep apnea. Am J Hypertens . 2004
Sep;17(9):783–6. 111  As U.S. Army general: Patton GS Jr . Thir d Ar my , Sta ndar d Operating
Pr ocedur es, 1944 . historicaltextarchive.com/sections.php? action=read&artid=384 (accessed September 2, 2014). 112  S tudies with ath letes have demonstrated: Lemaître F , Polin D, Joulia F ,
et al . Physiological responses to repeated apneas in underwater hockey
players and controls. Undersea Hyperb Med. 2007 Nov–
Dec;34(6):407–14. W oorons X, Bourdillon N, V andewalle H, et al. Exercise with hypoventilation induces lower muscle oxygenation and
higher blood lactate concentration: Role of hypoxia and hypercapnia. Eur J Appl Physiol . 2010 Sep;1 10(2):367–77. 114  Dr . Joseph Mercola: Mercola J. Baking soda uses: T o remove splinters
—and to address many other health needs . Mercol a.com. A ugust 27,
2012. articles.mer cola.com/sites/articles/archive/2012/08/27/baking-
soda-natural-remedy .aspx (accessed June 10, 2013). 114  The therapeutic potential: Marty Pagel, PhD, awarded $2 million NIH
grant to study impact of baking  soda on breast cancer . University of
Arizona Cancer  Center . March 21, 2012. azcc.arizona.edu/nod e/4187
(accessed August 10, 2012). 114  Ov er the years  many: J. Edg e and colleagues at the Unive rsity of
Australia in Perth conducted a study of the ef fects of bicarbonate of
soda on the abil ity of muscles to neutralize the acid that accum ulates
during h igh-intensity training. In Edge’ s study , sixteen recreationally
active women were recruited a nd randomly placed in two gro ups of
eight. O ne group  ingested bicarbonate of soda and the other ingested a
placebo. The results showed that the bicarbonate group experienced
greater improve ments in lactate threshold and time to fatigue. Their
working muscles were better able to neutralize the acid resulting from
training, showing improvements to endurance performance. Edge J,
Bishop D, Goodman C. Ef fects of chronic NaHCO3 ingestion during
interval training on changes to muscle buf fer capacity , metabolism,
and short-term endurance performance. J Appl Physiol . 2006
Sep;101(3):918–25. In a study at the  University of B edfordshire in the UK, researchers
investigated the ef fects of sodium bicarbonate on maximum breath-hold time. Eight recreational breath-hold divers were recruited to
partake in two bouts of 3 monitored breath holds while their faces
were im mersed in water . Following the study , the authors sug gested
that ing estion of bicarbonate of soda before breath holds pr olongs
maximum breath-hold time by approximately 8.6 percent. Sheard PW ,
Haughey H. Sodium bicarbonate and breath-hold times. Ef fects of
sodium bicarbonate on voluntary face immersion breath-hold times. Undersea Hyperb Med . 2007 Mar–Apr;34(2):91–7. Researchers from the Academy of Physical Education in Katowice,
Poland c onducted a study to eva luate the ef fects of oral administration
of sodium bicarbonate on swim performance in competitive youth
swimmers. The swimmers completed two time trials: one after
ingestion of bicarbonate and o ne after ingestion of a placebo . T otal
time for the 4 x 50m test trial improved from 1.54.28 to 1.52.85 s. In
addition, bicarbonate had a significant ef fect on resting blood pH. Researchers concluded that the ingestion of sodium bicarbonate in
youth athletes is an ef fective buf fer during high-intensity interval
swimming and suggested that such a procedure may be used in youth
athletes to increase training intensity and swimming performance in
competition at distances from  50 to 200m. Zajac A, Cholewa J,
Poprzecki S, W askiewicz Z, Langfort J. Ef fects of sodium bicar bonate
ingestion on swim performance in youth athletes. J Sports Sci Med . 2009 Mar 1;8(1):45–50. 114  During high-intensity: Edge, Bishop, Goodman 2006 Sep, 918–25. 114  By ingesting bicarbonate: Ibid. 114  The ingestion of bicarbonate: Sheard, Haughey . 2007 Mar–Apr , 91–7. 114  R esear chers w ho have investigated: Zajac, Cholewa, Po przecki,
W askiewicz, Langfort 2009 Mar 1, 45–50. 114  The se benefits have even: Sieg ler and Hirscher from the department of
sport, he alth, and exercise science, University of Hull, UK, con ducted
a study to observe “the er gogenic potential of sodium bicarbonate
(NaHCO3) ingestion on boxing performance.” T en amateur boxers
were pr ematched for weight and boxing ability , and ingested either
bicarbonate or a placebo. Sparr ing bouts consisted of four 3- minute
rounds, each separated by a 1-minute rest. The paper concluded  that a
standard dose of bicarbonate “improves punch ef ficacy during 4rounds of sparring performance.” Siegler JC, Hirscher K. Sodium
bicarbonate inge stion and boxing performance. J Str eng th Cond  Res . 2010 Jan;24(1):103–8. 116  Marath on runners are: Almond CS, Shin A Y , Fortescue EB , et al. Hyponatremia a mong runners in the Boston Marathon. N E ng J  Med . 2005 Apr 14;352(15):1550–6. 116  In a 2002 study: Ibid. 116  T he state me dical: Smith S. Marathon runner ’ s death linked to
excessive fluid  intake. Boston Globe . August 13, 2002.
www .remembercynthia.com/Hypona tremia_BostonGlobe.htm
(accessed September 2, 2014). 116  C omme nting on the tragedy: Doctors:  Marathoner died from too much
water , hyponatremia a danger in long-distance sports. WCVB 5. August 13, 2002. www .wcvb.com/Doctors-Marathoner -Died-From-
T oo-Much-W ater/1 1334548#!bOn 5pH (accessed September 2, 2014). 117  In his book Facing Up : Gry lls B. Facing Up: A R emarkable Journey to
the Summit of Ever est . London: Pan; 2001:29. 118  Almost half o f those: Maggiorini M. Mountaineering and altitude
sickness. Ther Umsch . 2001 Jun;58(6):387–93. 119  At leas t one study shows: In a dissertation by Dr . Zubieta-Calleja,
entitled “Human  adaptation to high altitude and to sea leve l,” the
author noted that “patients wit h high hematocrit values had nearly
twice as long breath holding times as normal and were able to sustain
desaturation (of oxygen) at very low levels.” Zubieta-Calleja G.
Human Adaptat ion to High Altitude and to Sea Level: Acid-Base
Equilibrium, V entilation and Cir culation in Chr onic Hy poxia. Copenhagen: VDM; 2010. 119  Th e air in mountainous: Gal lagher SA, Hackett PH. High-altitude
illness. Emer g Med Clin North Am . 2004 May;22(2):329–55. 120  Other symptoms arising: Hackett PH, Roach RC. High-altitude illness. N Engl J Med. 2001 Jul 12;345(2):107–14. 120  Thi s is a common occurrence: Moloney E, O’Sullivan S, H ogan T ,
Poulter L W , Burke CM. Airwa y dehydration: A therapeutic tar get in
asthma? Chest . 2002 Jun;121(6):1806–1 1. 7. Bring the Mountain to Y ou121  W orld-renowned Brazilian: Lee F . Breathe right and win. V iewzone.com. www .viewzone.com/breathing.html (accessed August
15, 2012). 121  De Oliveira’ s goal was to: Ibid. 121  D e Oliveira’ s techniques: T om Piszkin. Interview with Luiz de
Oliveira. Personal e-mail to Patrick McKeown, November 2012. 122  In total, the athletes: Ibid. 122  “But if you use my drill”: Lee, Breathe right and win. 122  Maintaining form during: Ibid. 122  A ccord ing to de Oliveira: T om Piszkin. Interview with Luiz de
Oliveira. Personal e-mail to Patrick McKeown, November 2012. 122  By the end of 1984: Joaquim Cruz. W ikipedia. en.wikipedia.or g/wiki/Joaquim_Cruz (accessed April 20, 2013). 122  T he legendary Czech: Litsky F . Emil Zatopek, 78, ungainly running
star , dies . New Y ork T imes. November 23, 2000.
www .nytimes.com/2000/1 1/23/sports/emil-zatopek-78-ungainly-
running-star -dies.html (accessed September 2, 2014). 122  On the first day: V aughan D. “Running”: A great Czech athlete inspires
a Fre nch novelist. Radio Praha. August 24, 2013.
www .radio.cz/en/section/books/running-a-great-czech-athlete-inspires-
a-french-novelist (accessed September 2, 2014). 122  On the second day: Ibid. 123  R upp’ s headphones: Fairbourn  J. Farah “confused” when making 2
hour claim says Salazar . Eightlane  (blog). October 6, 2013.
eightlane.or g/farah-confused-making-2-hour -claim-salazar/ (accessed
September 2, 2014). 131  However , unlike some: Sheila T aormina. Personal e-mail to Patrick
McKeown, December 9, 2013. 131  After breath-hold training: French researcher Lemaître found that
breath holds could also improve swimming coordination. After breath-
hold training, swimmers showed increases in VO 2  pea k as well as an
increase in the distance travel ed with each swimming stroke. The
researchers con cluded that their studies indicated that “brea th-hold
training improves ef fectiveness at both peak exercise and submaximal
exercise and can also improve swimming technique by promotinggreater p ropulsive continuity .” L emaître F , Seifert L, Polin D, Juge J,
T ourny-Chollet C, Chollet D. Apnea training ef fects on swimming
coordination. J Str ength Cond Res. 2009 Sep;23(6):1909–14. 132  R esearc hers investigating: In addition to studying the ef fects of breath-
hold training on swimming coordination, Lemaître and colleagues also
investigated the  ef fects of short repeated breath holds on breathing
pattern in trained underwater hockey players (UHP) and untrained
subjects (controls). T wenty male subjects were recruited, with ten
members of a national underwater hockey team allocated to the UHP
group, and ten subjects with little training and no breath hold
experience allocated to the control group. The sub jects pe rformed 5 breath holds while treading water with
their fac es immersed. The breath holds were spaced 5 minutes apart
and per formed after a deep but not maximal inhalation. The
underwater hockey players were noted to have reduced breathlessness
and higher concentration of CO 2  in exhaled breath after the test
(ETCO2). Lemaître et al. 2007 Nov–Dec, 407–14. 132  In addition, lactate: Ibid. 132  T he ef fect of th is method: Researchers from the Human Perfo rmance
Laboratory , University of Calgary , Canada, conducted a study to
investigate the  relationship between a decrease of oxygen
concentration d uring exercise and erythropoietin (EPO) prod uction. Five athletes cycled for 3 minutes at an intensity greater than m aximal
(supramaximal) at two dif fere nt elevations: 1,000m and 2,100m. Oxygen saturation of hemoglo bin was lower than 91 percent for
approximately 2 4 seconds during exercise at 1,000 meters and f or 136
seconds during exercise at 2,10 0 meters, with EPO levels inc reasing
by 2 4 percent and 36 percent  respectively following the exercise. Roberts D, Smith DJ, Donnelly S, Simard S. Plasma-volume
contraction and exercise-induced hypoxaemia modulate erythropoietin
production in healthy humans. Clin Sci . 2000 Jan;98(1):39–45. Korean research ers Choi et al. carried out a study on 263 subjec ts to
determine the relationship betw een hematocrit levels and obstructive
sleep apnea (involuntary holding of the breath during sleep). Patients
with severe sleep apnea had sig nificantly higher levels of hematocritthan mil d and moderate OSA. Study findings showed that hem atocrit
levels were significantly correlated with percent of time sp ent at
oxygen saturatio n of below 90 percent, as well as average oxygen
saturation. Choi  JB, Loredo JS, Norman D, et al. Does obstructive
sleep apnea increase hematocrit? Sleep Br eath . 2006 Sep;10(3):155–
60. 132  Lowering oxygen saturation: Roberts, Smith, Donnelly , Simard 2000,
39–45. 135  Maintaining an oxygen: Ibid. 136  Per forming just 5 maximum: L emaître et al. 2007 Nov–Dec, 407–14. Schagatay E, Haughey H, Reim ers J. Speed of spleen volume changes
evoked by serial apneas . Eur J Appl Physiol. 2005 Jan;93(4):447–52. 137  Bre ath-hold divers: Resting Hb  mass in trained breath-hold div ers was
5 percen t higher than in untrained divers. In addition, breat h-hold
divers showed a lar ger relative increase to Hb after three apneas. The
paper no ted that “the long-term ef fect of apnea training on Hb mass
might be implicated in elite divers’ performance.” Lemaître, Joulia,
Chollet 2010, 413–5. 137  In addition, experienced: Matt Richardson investigat ed the
hematological r esponses to maximal apneas performed by  three
groups: elite apneic divers, elite cross-country skiers, and untrained
subjects. Pretest  hemoglobin tended to be higher in the diver group
than both skiers and untrained i ndividuals. Each subject was required
to pe rform 3 ma ximal breath holds separated by 2 minutes of r est and
normal breathing. Following the breath holds, all groups responded
with increased hemoglobin, with divers showing the lar gest increase. The duration of the third breath -hold time was 187 seconds in divers,
111 seconds in skiers, and 121 seconds in untrained individuals. The
authors observed that the higher Hb concentration in divers “suggests
that regular apnea practice could impart a specific training ef fect,
ef fecting haematological responses to apnea in a manner that dif fers
from that of exercise training.” Richardson M, de Bruijn R, Holmber g
HC, Björklund G, Haughey H, Schagatay E. Increase of hemoglobin
concentration after maximal apneas in divers, skiers, and untrained
humans. Can J Appl Physiol . 2005 Jun;30(3):276-81.Splenic size was measured before and after repetitive breath-hold
dives to approximately 6 meters in ten Korean ama  (diving women)
and in three Ja panese males who were not experienced in breath
holding. Following the breath holds, splenic size and hematocrit were
unchanged in the Japanese male divers. In the ama,  splenic volume
decreased 19.5 percent, hemoglobin increased by 9.5 percent, and
hematocrit increased 9.5 percent. The study showed that long-term
repeated apneas induce a stronger spleen contraction and resultant
hematological r esponse. Hurfo rd WE, Hong SK, Park YS,  et al. Splenic contraction during breath-hold diving in the Korean ama . J
Appl Physiol . 1990 Sep;69(3):932–6. 138  F or example, a study: Andersson and colleagues from Lund University
in Sweden conducted a study involving fourteen healthy volunteers
who performed a series of 5 maximal duration breath holds whi le their
faces were immersed in water . The authors observed that breath-hold
time increased by 43 percent across the series of breath holds. Andersson JP , Schagatay E. Repeated apneas do not af fe ct the
hypercapnic ven tilatory response  in the short term . Eur J Appl Physiol. 2009 Mar;105(4):569–74. 138  Another study found: French researchers Joulia et al. observed that
trained d ivers who had 7–10 yea rs of experience in breath-hold diving
were abl e to hold their breath fo r up to 440 seconds at rest, compared
with inexperienc ed individuals who held their breath for 145 seconds
at m ost. Joulia F , Steinber g J G, W olf f F , Gavarry O, Jammes Y . Reduced oxidative stress and blood lactic acidosis in trained breath-
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holding into physical exercise, “blood acidosis was reduced a nd the
oxidative stress no more occurr ed.” The paper concluded that “these
results suggest that the practice of breath-holding improves the
tolerance to hypoxemia (inadequate level of oxygen in the blood)
independently from any genetic factor .” Joulia et al. 2003, 19–27. Another study tested whether repeated breath holds by elite breath-
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to ten years of experience in breath hold diving, and with an ability to
hold the ir breath for up to 440 seconds during rest, were com pared
with a second g roup of non-divers who had at most a 145 second
breath-hold time. Both gr oups performed a breath hold during rest, followed by 2
minutes of forearm exercises du ring which the diver group per formed
a b reath  hold and the second group breathed as normal. Interes tingly ,
the grou p who breathed as normal showed an increase in blood lactic
acid con centration and oxidative  stress. In the diver group, the changes
in both lactic acid and oxidative stress were markedly reduced after
both bre ath holds and exercise. The paper concluded that humans who
are involved in a long-term tr aining program of breath-hold diving
have reduced blood acidosis and oxidative stress following breath
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in the journal Medicine & Science in Sports & Exer cise  investigated
the e f fects of breath holding on  oxidative stress using two gro ups of
people: a group of trained diver s and a group of people with no diving
experience at all. Results sh owed significant improvements in
antioxidant activity across both groups, with little dif ference between
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metabolism, mood state, and blood lipids in each swimmer during two
tests: one in a trained state, and another after a resting period of five
weeks. The results of the second test clearly showed an increase of
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cardiac, thoracic, and vascular sciences at the University of Padvoa,
Italy , pre sented to the 2009 Eur opean Society of Cardiology congress
in Barcelona. The title of his presentation was “Electrical
repolarization changes in young athletes: What is abnormal?” Dr .Corrado recogn ized that ECG changes in athletes are common and
usually reflect remodeling of the heart as an adaptation to regular
physical training . However , although an abnormal ECG reading of T -
wave in version is rarely observed in healthy athletes, it was found to
be a potential expression of an underlying heart disease, presenting a
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the 8 1 a thletes w ith abnormal ECGs, 1 died suddenly at the age of 24
years from cardiac failure. Of the 80 surviving athletes, 3 developed
heart dis ease at the ages of 27,  32, and 50, including 1 who had an
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223–7. 206  Based on improvements: Ibid. 206  Oth er studies confirm: Patients who practiced breathing exercises for
reversing chron ic hyperventilation evidenced significantly higher
carbon d ioxide levels and lower respiratory rates when compared with
pretreatment levels measured three years earlier . The authors
concluded, “Breathing retraining has lasting ef fects on resp iratory
physiology , and  is highly cor related with a reduction in re ported
functional cardiac symptoms.” DeGuire S, Gevirtz R, Kawahara Y ,
Maguire W . Hyperventilation syndrome and the assessm ent of
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1;70(6):673–7. 207  W e  know tha t hyperventilati on: Researchers from the division of
cardiology , Kumamoto University School of Medicine, Japan,
investigated the  hyperventilation test as a clinical tool to induce
coronary artery spasm (narrowi ng of blood vessels to the heart). The
study involved 206 patients w ith coronary spasm and 183 p atients
without angina at rest (nonspasm). Each patient perf ormed
hyperventilation for 6 minutes. Of the spasm group, 127 showed
positive responses to the test, i ncluding electrocardiographic changes
attributable to reduced blood f low . No one in the nonspasm  groupshowed any ischemia (narrowing of blood flow). When clinical
characteristics were compared, high disease activity and severe
arrhythmias we re significantly  higher in the hyperventilation test
positive patients than in the n egative patients (69 percent vs. 20
percent). The authors concluded that “hyperventilation is a highly
specific test for the diagnosis  of coronary artery spasm, an d that
hyperventilation test-positive patients are likely to have  life-
threatening arrhythmias during attacks.” Nakao K, Ohgus hi M,
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Resuscitation,” researchers tested the hypothesis that ex cessive
ventilation rates  during the performance of CPR by overzealous but
well-trained rescue personnel increases the likelihood of death. The
paper investigated thirteen adu lt deaths where manual CPR with an
average of 30 b reaths per minute was administered to patients. The
paper also documented a study investigating ventilation per minute and
survival rate during cardiac arrest in pigs. Three groups of seven pigs
were treated with 12 breaths, 3 0 breaths, or 30 breaths plus carbon
dioxide per minute. Survival ra tes in the groups were as follows: six
out of seven pigs treated with 1 2 breaths per minute, one out of seven
pigs trea ted wit h 30 breaths pe r minute, and one out of seven pigs
treated with 30 breaths per min ute plus carbon dioxide. The a uthors
commented that “despite seemingly adequate training, professional
rescuers consistently hyperventilated patients during out-of-h ospital
CPR,” and that “additional edu cation of CPR providers is ur gently
needed to reduce these newly identified and deadly consequences of
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published in the journal Resuscitation  in  2007, researc hers studied data
from twelve patients who had r eceived manual ventilation by a self-
inflating bag in the emer gency department of a UK hospital. Resultsshowed that the number of manual breaths administered to the patients
varied f rom 9 to 41 per mi nute, with an average of 26 . The
corresponding m edian volume of air per minute was 13 liter s. The
researchers note d that while guidelines on the number of bre aths to
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_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:

        www. nlm. nih. gov/medline plus/ency/article/003646. htm (accessed
April 20, 2013). 101  A thlete s still use: Levine BD, Stray-Gundersen J. A practical a pproach
to altitu de training: Where to l ive and train for optimal performanceenhancement. Int J Sports Med. 1992 Oct;13 Suppl 1:209–12. 101  T o limi t the detraining: Levine BD. Intermittent hypoxic training: Fact
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BD. “Living high–training low” altitude training improves sea level
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W inter Olympics. T urin 2006 e d. W ilmington, DE: Sport Media
Publishing; 2005. 103  T he authors of the study conc luded that although: Moderate-i ntensity
aerobic training  that improves the maximal aerobic power does not
change anaerob ic capacity, and adequate high-intensity inter mittent
training may improve both anaerobic and aerobic ener gy supplying
systems signific antly. T abata I, Nishimura K, Kouzaki M, et al. Ef fects
of moderate-intensity endurance and high-intensity intermittent
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muscle deoxyge nation kinetics in humans.
To investigate the effects of breath-hold training on athletic performance and physiological responses.
What is the main goal of Dr. Schagatay's research?
To investigate the effects of short repeated breath-holds on the hematological responses of trained and untrained divers.
What is the purpose of the study conducted by Zajac et al.?
The study found that the underwater hockey players showed reduced breathlessness and increased CO2 in exhaled breath, indicating improved performance.
What is the main conclusion of the study by Lemaître et al.?
The study found that humans were able to hold their breath for longer than previously thought.
What is the finding of the study by Rahn and Yokoyma?
The study found that athletes with high levels of anxiety showed a higher risk of sudden cardiac death.
What is the conclusion of the study by Roberts et al.?
To investigate the effects of slow and fast breathing exercises on exercise-induced asthma.
What is the purpose of the study by Geyer et al.?