Hypoxic Endurance Exercise Performance benefits from IMT

This new study (2019) looks into whether chronic IMT improves hypoxic endurance exercise performance.

Endurance exercise performance

The study, in the International Journal of Sports Physiology and Performance, is using a cycling time trial to measure endurance exercise performance. Endurance exercise is typically performed at submaximal intensity. The purpose of this is to estimate VO2max, or ‘aerobic fitness’. The measurement VO2max is the maximum amount of oxygen a person will consume during intense exercise. In fact, cycling time trials offer the ideal exercise to increase both heart rate and breathing. Similarly, so do running and swimming.

What is IMT?

IMT is a form of resistance training for the breathing muscles. The term IMT stands for inspiratory muscle training. The inspiratory muscles, the breathing muscles, are the ones that draw air into the lungs. The main inspiratory muscle is the diaphragm. Like any other group of muscles, the inspiratory muscles benefit from training too. Inspiratory muscle training, such as with POWERbreathe, provides the stimulus for that training. Following IMT, the breathing muscles adapt and become stronger after only a few weeks. This results in exercise feeling easier and an improvement therefore in performance.

Why IMT?

Although breathing comes naturally, some of the time it can feel like an effort. This may be due to the demand endurance exercise places on breathing. It may be due to a respiratory issue. Either way, it’s not uncommon for the respiratory muscles to fatigue, just like any other muscle.

If the respiratory muscles are weak from disease or exercise is overloading them, breathing demand will not be met. As a result, breathing will start to feel shallow and rapid. Sustaining this type of breathing is impossible. Furthermore, the more rapid the breathing, the more oxygen they require and the more carbon dioxide they produce. Consequently, oxygen is re-directed from the skeletal muscles, such as arms or legs, to the breathing muscles, where it is most needed. This results in fatigue of the skeletal muscles.

Inspiratory muscle training helps the body meet the needs of both the respiratory muscles and the skeletal muscles by improving their strength and stamina. The way IMT achieves this is by providing a resistance to breathe in against. POWERbreathe IMT is just like a ‘dumbbell for your diaphragm’.

Study results

Data from this recent study suggest that,

“performing 6 weeks of inspiratory muscle training may benefit hypoxic endurance exercise performance lasting 30-40 minutes.”

Athletes Do Not Condition Inspired Air More Effectively than Non-athletes

There is a study that aims to assess athletes’ ability to warm and humidify inspired air. This study is published in Medicine and Science in Sports and Exercise. It is called, Athletes do not condition inspired air more effectively than non-athletes during hyperpnea.

Endurance athletes’ inspired air

Airway disease is more prevalent in endurance athletes. This is possible because they need to adapt their breathing to cope with large volumes of inspired air. And they need to inspire large volumes of air because of the intense exercise they perform. But the environment they train in may also be relevant.

Study method

The study measures the difference between each athlete’s inhaled and exhaled air temperature. It did this during and after a Eucapnic Voluntary Hyperpnea test (EVH). This is the test that is used to diagnose exercise-induced asthma or exercise-induced bronchospasm. It is a 6 minute test during which the athlete breathes a cold, dry gas at very high ventilation rates.

All 23 athletes in the study attend a laboratory on three occasions. Two of these occasions are for baseline measurements and information. The third is to perform a modified EVH test. This is to measure their inspired and expired air temperatures.

No evidence of improved capacity to condition inspired air

The test results show no evidence of improved capacity to condition inspired air. And by ‘conditioned’ air the study means the athlete’s ability to warm and humidify inspired air. If the study did find evidence, this could suggest an increased bronchial blood flow or another adaptive mechanism. Bronchial blood flow supplies nutrients and oxygen to the cells that constitute the lungs, as well as carrying waste products away from them. Therefore the absence of an adaptive mechanism could contribute to airway damage observed in endurance athletes. This may be that colder but mainly dryer air is penetrating deeper in the lung.

Strategies to reduce impact on airway injury

A pre-exercise warm-up is well known to reduce the severity of exercise-induced bronchospasm and exercise-induced asthma. It is thought the reason for this is because of an increase in bronchial blood flow. A warm-up involves performing the athlete’s activity at a slower pace and reduced intensity. It gradually raises the body temperature. Furthermore it increases blood flow to the muscles.

An inspiratory warm-up

It is also beneficial to warm-up the breathing muscles. A scientifically proven way of doing this is with Inspiratory Muscle Training (IMT). POWERbreathe is an IMT device that is quick and easy to use. POWERbreathe IMT is performed as part of an athlete’s daily training. But research and trials have also shown it to be beneficial for an inspiratory warm-up. This means simply reducing the breathing load on the POWERbreathe IMT device to a lower setting. Better still the POWERbreathe K3, K4 and K5 with Breathe-Link Live Feedback Software feature an automatic warm-up mode. This automatically sets the optimal resistance for an inspiratory muscle warm-up.

Can You Have Asthma And Still Be An Elite Athlete?

This review published in the European Respiratory Society’s June issue of Breathe aims to inform respiratory physicians of the relevant components of the World Anti-Doping Code and to indicate some of the pitfalls that can arise and how to negotiate them so as not to cause problems for their athlete patients with asthma. People with asthma have generally been advised to undertake some form of physical activity to improve their health and fitness and although many asthma patients experience exercise-induced bronchoconstriction (EIB), some have gone on to achieve great sporting success and become world and Olympic champions. In fact asthma and asthma/airway hyperresponsiveness (AHR) are the most common medical conditions encountered among summer and winter Olympic athletes, affecting between 7%-8% of them. The prevalence of asthma/AHR is principally identified in sports that require endurance training, including triathlon (25.7% of athletes at the Beijing 2008 games), cycling (17.3% at the Beijing 2008 games), cross country skiing (16.9% at the Torino 2006 games) and speed skating (14.9% at the Torino 2006 games). Swimmers had one of the highest prevalence of inhaled β2-agonist (IBA) use at the five Summer Olympic Games from 1996 to 2008. The review therefore suggests that it seems a reasonable proposition that asthma/AHR may be an occupational hazard for many endurance trained athletes and “we should be devoting more attention endeavouring to prevent or reduce this outcome.” POWERbreathe Inspiratory Muscle Training (IMT) offers athletes with asthma a drug-free, clinically-proven method of reducing their symptoms and putting them in control of their asthma. In this research published in Chest, Inspiratory muscle training in patients with bronchial asthma, long-term inspiratory muscle training was shown to reduce absence from school/work (by ~95%); reduce use of healthcare resources (by ~75%); and reduce the consumption of medication (by ~79%). In addition to helping athletes reduce their asthma symptoms, POWERbreathe IMT has been shown to improve sports performance by increasing breathing strength and stamina and reducing whole body effort and fatigue.

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TUEs, asthma and athletes

Therapeutic Use Exemptions (TUEs) allow an athlete to take medication on WADA’s Prohibited List when competing.

TUEs in the news

TUEs have become a hot topic as a result of the cyber attack leaking WADA data on 29 athletes. It was just after the Rio Olympics. Selected athletes’ medical records are being hacked into by a group from Russia calling themselves Fancy Bears. They were hacking into the World Anti-Doping Agency’s Anti-Doping Administration and Management System (Adams) database. This stores athletes laboratory results, anti-doping rule violations and therapeutic use exemption (TUE) authorisations.

What’s the big deal about TUEs

It is this data hacking into TUEs that is opening our eyes to the number of elite athletes being given permission to use them. It is raising doubt about their use in ‘fair’ competition. People are asking if they are really needed, and if not, are they providing athletes with a performance edge? In fact Dr Ross Tucker refers to the prevalence of corticosteroid use. Athletes will be given this if they experience breathing problems. It is however also considered to be performance-enhancing.

Breathing is an issue in many athletes

The most common breathing condition among elite athletes in endurance sports is asthma. In fact according to Asthma UK 25% of the 2012 Team GB athletics squad suffer from exercise-induced asthma.

Why do so many elite athletes have exercise-induced asthma?

Vigorous exercise and endurance sports such as long-distance running, cross-country skiing and cycling cause problems for people with exercise-induced asthma. This is because it makes them breathe much faster which in turn affects airflow. Dr John Dickinson says such athletes “have an asthma response to doing high-intensity exercise.” He continues, “It’s not necessarily the exercise that’s the problem, but rather the volume of air that they breathe and the amount of time that they stay at this level for.” Dr John Dickinson is a world renowned expert on asthma in sport and head of the respiratory clinic at Kent’s School of Sport and Exercise Science.

TUEs for athletes with asthma

Symptoms of exercise-induced asthma include coughing, wheezing, chest-tightness and difficulty in breathing. Because of this inhaled treatment is allowed. This is only allowed however where asthma is documented and dispensation has been granted when needed. By contrast systemic β2-agonist intake is strictly prohibited.

POWERbreathe IMT can help strengthen breathing

Most importantly for athletes with asthma, POWERbreathe IMT is drug-free. It has no side-effects or drug interactions. POWERbreathe is an Inspiratory Muscle Training device. This means it trains the inspiratory muscles only; the muscles used to breathe in. It’s these muscles that work the hardest, your diaphragm and intercostal muscles.

How POWERbreathe IMT works

You simply breathe in through the device. As you breathe in you’ll feel a resistance to your in-breath. This is the resistance working. As you breathe in against the resistance you are exercising your breathing muscles. Exercising your breathing muscles in this way makes them stronger. It strengthens your breathing muscles just like resistance training strengthens your other muscles. And the more you train the stronger your breathing muscles become. Then you can simply increase the resistance, just as you would in other training, so that you continue to improve.

Scientifically proven training

POWERbreathe IMT is the breathing training device that both sports scientists and medical professionals are using in tests. And it is sports scientists who found the most effective training protocol. Their findings showed that just 30 breaths twice a day is the most effective. They were also to discover that just as other muscles experience the ‘use it or lose it’ phenomenon, so do the breathing muscles.

The benefits of POWERbreathe IMT

POWERbreathe IMT will strengthen your breathing muscles, improve breathing stamina and reduce breathing fatigue. And it will improve sports performance and time trial performance. In fact, POWERbreathe IMT is the device of choice in many scientific studies into its benefits for sports and fitness.

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Non-Asthma Related Breathing Problems In Athletes

This BASES Expert Statement looks into exercise respiratory symptoms, such as wheezing, tight chest, difficulty breathing, shortness of breath and coughing which are commonly reported by athletes.

These non-specific symptoms need to be assessed in order to confirm or eliminate the presence of cardio-pulmonary causes.

There is a high prevalence – 70% – of asthma and exercise induced bronchoconstriction (EIB) in sports with high breathing requirements, and it has been assumed that exercise-induced respiratory symptoms in these athletes is due to asthma or exercise-induced-asthma (EIA).

Symptoms however are misleading and this Expert Statement looks at these differential causes of exercise respiratory symptoms: Exercise-Induced Laryngeal Obstruction (EILO) and Dysfunctional Breathing.

Interventions are then discussed which include breathing pattern retraining and inspiratory muscle training and finally conclusions are made.

You can read the full Expert Statement here, Assessment and Management of Non-asthma Related Breathing Problems in Athletes.

Proper Breathing – POWERbreathe Can Help

Your primary breathing muscle is your diaphragm; a dome shaped thin sheet of muscle separating your rib cage from your abdomen.

When you inhale this dome shape flattens out as your diaphragm contracts, pushing down on the contents of your abdomen (your gut) and increasing the space in your chest cavity.

Because your gut has to go somewhere as your diaphragm descends, it forces it down and out and your tummy expands. Because of this, this natural, healthy and proper way of breathing is often referred to as abdominal breathing or diaphragmatic breathing.

If you do already have a good breathing technique it can often go awry when you start exercising as you demand more air and your breathing increases to compensate. This is when your breathing technique can change from good diaphragmatic breathing to reverse breathing i.e. pulling in your tummy as you breathe in and letting your tummy go as you breathe out.

Because your diaphragm is a muscle, you can train it like any other muscle to become stronger and helping you retain that good diaphragmatic breathing even when pushed to your limit. POWERbreathe targets your inspiratory muscles – not only your diaphragm but also your intercostal muscles, the tiny muscles in between your ribs, which are recruited during a slightly forced respiration.

You’ll notice when training with POWERbreathe that you have to work harder to breathe in. This is the effect of resistance training acting on your inspiratory muscles. When breathing out, POWERbreathe offers no resistance because when you exhale normally, your diaphragm and intercostals naturally relax and move back up, pushing the air from your lungs.

Effects of IMT on Resistance to Fatigue of Respiratory Muscles in Exercise

EliteVelo Kalas Sportswear Cycling Race Team by Richard Fox Photography

EliteVelo Kalas Sportswear Cycling Race Team using POWERbreathe Plus IMT (above)
PHOTO: Richard Fox Photography


Effects of Inspiratory Muscle Training on Resistance to Fatigue of Respiratory Muscles During Exhaustive Exercise
M. O. Segizbaeva, N. N. Timofeev, Zh. A. Donina, E. N. Kur’yanovich, N. P. Aleksandrova

This study, published in Body Metabolism and Exercise – Advances in Experimental Medicine and Biology (Volume 840, 2015, pp 35-43) concluded that IMT elicits resistance to the development of inspiratory muscles fatigue during high-intensity exercise.


To assess the effect of inspiratory muscle training (IMT) on resistance to fatigue of the diaphragm, parasternal, sternocleidomastoid and scalene muscles in healthy humans during exhaustive exercise.

The sternocleidomastoid muscle flexes the neck and helps with the oblique rotation of the head. Also, the muscle helps in forced inspiration while breathing, and it raises the sternum. As for forced inspiration, the muscle also works in concert with the scalene muscles in the neck. The scalene muscles are lateral vertebral muscles that begin at the first and second ribs and pass up into the sides of the neck. There are three of these muscles. (SOURCE: Healthline.com)


“The study found that in healthy subjects, IMT results in significant increase in MIP (+18 %), a delay of inspiratory muscle fatigue during exhaustive exercise, and a significant improvement in maximal work performance. We conclude that the IMT elicits resistance to the development of inspiratory muscles fatigue during high-intensity exercise.”

Read Effects of Inspiratory Muscle Training on Resistance to Fatigue of Respiratory Muscles During Exhaustive Exercise

Check out more Inspiratory Muscle Training Research here >

Discover POWERbreathe used in Research here >

What causes exercise-induced asthma?

The reason why asthma symptoms may be brought on during exercise has not been completely established but it is thought that because breathing becomes heavy and we breathe faster when we exercise, the linings of our airways narrow and dry out. Also weather conditions and allergies, such as an allergy to pollen, can also trigger asthma-like symptoms when exercising.

Recognising exericse-induced asthma (EIA)

Diagnosis is often made after symptoms, such as wheezing and a tight chest, are experienced during exercise, but this can result in either over-diagnosis, where athletes report symptoms but DO NOT have narrowing of the airways, or under-diagnosis where athletes who’re asymptomatic (showing no symptoms) DO have narrowing of the airways which affects their performance.

The scenarios above are supported in studies where elite athletes have been screened and shown to have EIA, such as reported by British Olympic Teams in the 2012 Olympics where it found that 25% of Team GB suffers from exercise-induced asthma. And at the 1996 Olympic games 20% of athletes reported asthma upon exercising.

Why screen for EIA?

The main reason is because exercise-induced asthma may be detrimental to an athlete’s performance, as it’s already been shown to reduce exercise capacity and running speed in colder environments which will not only affect an athlete during training but also during competition.

Treatment of EIA

Both pharmacological and non pharmacological therapies are currently successfully used to treat EIA, and studies have also highlighted the benefits of adjunctive intervention. POWERbreathe Inspiratory Muscle Training can be used as an adjunctive intervention, not only for daily training, but also as a respiratory warm-up prior to exercise.

Read more about Respiratory Disorders in endurance athletes in our blog.

And here’s an interesting article that looks at Pollen and Exercise Induced Asthma >

Breathe deeply with POWERbreathe for more energy

Deep breathing reaches the deepest depths of your lungs, and by practicing POWERbreathe inspiratory muscle training you’ll be training your respiratory muscles to breathe deeply into your diaphragm, taking in as much air as possible, breathing more in per breath.

As you’re breathing in more air per breath, you’re receiving more oxygen into your body, giving you more energy.

Senior consultant at the National heart Institute, India, and Founder, SAANS Foundation in India, Partha Pratim Bose offers a good example of this,

“By deep breathing exercises you breathe more per breath. If you breathe more per breath you expand your lungs more, you receive more oxygen. You will feel more energetic and also save your breaths. For example, if you breathe 250 ml per breath and your requirement is 5 litres then you need 20 breaths per minute. If you breathe more breath say double i.e. 500ml then you will require only ten breaths. So by breathing deep you breathe less and you feel better and conserve energy.”

Thankfully you can train your breathing muscles to breathe deep, as your respiratory muscles respond in the same way as skeletal muscles do to a training stimuli as they undergo adaptations to their structure and function. POWERbreathe is one such training stimuli, using the principles of resistance training to strengthen the inspiratory muscles. Its pressure loaded inspiratory valve offers the resistance on the inhale, while an unloaded expiratory valve allows for normal, passive exhalation.

How POWERbreathe Works >

You can read about other benefits of deep conscious breathing in Bose’s article ‘Wellness: Breathe like a tortoise, live like a king’ and here in POWERbreathe Benefits.

Efficient respiratory system is key for endurance

Dr. Anthony Alessi, Associate Clinical Professor of Neurology at the University of Connecticut, recently wrote in an article in The Norwich Bulletin about how an efficient respiratory system is crucial for the success of endurance athletes.

He explains how endurance athletes are most vulnerable to any alterations in the respiratory system “due to their reliance in efficient air exchange over prolonged periods of time.” The high-intensity training these athletes have to endure pushes their respiratory system to its limits which can result in respiratory conditions such as exercise-induced asthma.

“A series of breathing tests are necessary to differentiate these conditions and plan a course of treatment,” says Dr. Matt Hall, a sports medicine specialist who works with athletes at the University of Connecticut.

Dr. Alessi summarises his article by saying, “Asthma and other respiratory conditions can be the result of intense exercise but should not be an obstacle to competing, even at the highest levels.”

One type of training that would benefit these endurance athletes and help strengthen their respiratory system for the rigours of their training, is POWERbreathe Inspiratory Muscle Training (IMT) which uses the principles of resistance training to improve the strength of the breathing muscles and increase their stamina. And because POWERbreathe is drug-free, if an athlete does find they need to take medication for say, asthma, then they can safely continue to train their breathing muscles using POWERbreathe as it will have no interactions. Stronger breathing muscles mean more resistance to fatigue and therefore more endurance – a win-win for endurance athletes.

So with POWERbreathe, endurance athletes can help make their respiratory system more resilient by improving the strength and endurance of their breathing muscles, also making their respiratory system more efficient and resilient.

See How POWERbreathe Works >

POWERbreathe benefits for sports and exercise >