Breathing at High Altitude during Tour de France

Tour de France 2019 is a gruelling event. The 21 stage race begins on the flat. But this isn’t for long. The race winds its way through flat, hilly and finally mountainous terrain. This year, we now know, is one of the most demanding Tour de France races. It includes 7 mountain stages with 5 mountain-top finishes. Because the seven mountain stages climb above 2,000 metres, it is one of the highest Tours for many years. This adds another challenge for the riders, that of breathing at high altitude. This is particularly challenging for riders of the 2019 Tour, as the highest point in the race, the Col de l’Iseran mountain pass has an altitude of 2,770m.

Breathing at high altitude

As a cyclist climbs to high altitude breathing increases. This happens automatically. The reason for this is because the body is responding to less oxygen in each breath. As a result, ventilation increases as they try to increase oxygen uptake. However, in spite of an increase in breathing, less oxygen will reach the working muscles, such as the legs. This is because signals are sent to the nervous system telling it to redirect oxygen from the legs to the diaphragm in order to keep up with breathing at altitude. Consequently, the cyclist’s leg muscles begin to suffer from fatigue. Inevitably, this affects performance.

Effects of high altitude breathing

Breathing harder and quicker is an automatic response to the fall in air pressure. In addition to this, the heart works harder too. It does this to try and increase the flow of oxygen-carrying red blood cells to the lungs. It’s a desperate bid to ensure the lungs don’t ‘steal’ the oxygen-carrying red blood cells from straining muscles.

In this article, 2018 Tour de France winner Geraint Thomas says,

“You just can’t do the same powers that you do at sea level… It is just like a thinner sort of air, really, up there. You can just tell, like, when you’re breathing, you’re just not getting quite as much oxygen in the lungs as you normally would.”

Another consequence of the challenges that breathing at high altitude inflicts on the body, is that of greater quantities of lactic acid. Cycling at altitude requires intense power and energy to climb the hills. But the body’s response to trying to produce energy with less oxygen is to produce larger amounts of lactic acid. It’s the build-up of lactic acid in the muscles that causes that feeling of ‘muscle burn’. It’s also responsible for slowing a cyclist down as it reduces the muscles ability to function. explain that lactic acid is the end product of anaerobic metabolism. It says that a build-up of lactic acid occurs when there is insufficient oxygen to produce the energy required by the exercise. Furthermore, they say that when a very high level of work is reached, as in the Tour, lactic acid production becomes constant. As a result, the cyclist will experience acute muscle fatigue.

Preparing for the challenges of breathing at altitude

This 2019 Review Article in Frontiers in Physiology investigates the use of respiratory muscle training (RMT), including inspiratory muscle training (IMT) with POWERbreathe, for acclimatising to the altitude. The review provides evidence that such training,

“…has the potential to minimize at least some of the limiting factors related to the respiratory system occurring during training / competition at altitude / in hypoxia.”

It goes on to suggest the expected benefits may include:

  1. A delay in the onset of premature fatigue.
  2. A delay in respiratory muscle metaboreflex onset/activation.
  3. An improvement in clearance and tolerance to anaerobic metabolite products.
  4. A decrease in the perception of dyspnea (‘air hunger’).
  5. An increase in oxygen saturation values.
  6. A more favourable blood redistribution to the locomotor muscles.

Recovering from high altitude breathing problems

By incorporating breathing exercises for high altitude before the Tour de France or Giro d’Italia, cyclists will cope better with the challenges of breathing at high altitude. Inspiratory Muscle Training, such as with POWERbreathe, increases the strength and stamina of the breathing muscles, reducing breathing fatigue. Even better would be to perform IMT during turbo training. This will target the inspiratory muscles in the hunched position the athlete will be in during cycling.

Recovering from high levels of lactic acid

For cyclists in the Tour de France and Giro d’Italia an IMT recovery session is proven to be beneficial as it:

Research shows that breathing against a small inspiratory load immediately after exercise reduces lactate by 16%. It also reduces lactate as soon as exercise finishes, unlike traditional active recovery which may take 5-minutes to clear lactate. Another bonus for Tour de France and Giro d’Italia riders is that subsequent research demonstrates a post-exercise inspiratory resistive loading (after a Wingate test) reduces post-exercise effort perception and improves peak power on subsequent all-out maximal-intensity exercise. This is obviously beneficial when riders need to perform at their best, day-after-day.


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.”

Charity Bike Ride Begins at Briançon

Four amateur cyclists from RAF Coningsby Ground System Support Flight are currently training for their 3 Peaks of Briançon Charity Bike Ride. In addition to their cycling training, they are using POWERbreathe IMT, in preparation for the breathing challenges ahead.

Difficulty breathing when cycling

The simple design of a bike will affect the position of the body. And the design of a road bike is made with aerodynamics in mind. For the RAF team, each rider will also make their body aerodynamic too. This means they will be continuously bending forward over the handlebars. This results in the shoulders pulling away from the spine, the rib cage flattening and the ribs descending. In addition, the organs in the abdomen push the diaphragm up. And as the diaphragm is the main breathing muscle, this compression restricts its normal movement. Consequently breathing becomes more difficult.

RAF charity bike ride

The four members of the RAF team are planning to conquer three of the toughest and most gruelling peaks the Alps have to offer. These are the Col d’Izoard, Col du Chaussy and the Col du Galibier. Furthermore, they plan to conquer them in three consecutive days. This will present a challenge for their breathing muscle strength and stamina. And altitude too challenges the breathing muscles, and Briançon is at an altitude of 1,326m (4,350ft). Additionally, their legs will have to cope with cycling many miles uphill. So fitness training beforehand is essential. And this is exactly what the team is doing at present.

In Chris’ post, on the team’s Facebook page, he talks about his latest training ride, saying:

“Well I did it! It was hard work, a struggle towards the end. My legs hurt and my bum hurts which is my own fault. Tested my new Velochampion longs out today, they performed well but no matter how good a pad is, you still need to condition. By the end of the ride, everything hurt, except my lungs. Something that I always used to struggle with but not so much anymore. POWERbreathe.”

The objective of this 70-mile sportive training ride is to beat a Personal Best. And it sounds as though the hills are a challenge, not just for the legs, but also for breathing:

“I myself have a distance PB to beat on Sunday in a 70-mile sportive, and the hills are gonna be a burn on the legs. But hopefully, with the help of our trustee POWERbreathe apparatus, the lungs won’t feel the burn so much.”

Breathing training for charity bike ride

It’s well accepted that the work of breathing during any form of exercise, including cycling, can be high enough to cause the breathing muscles to fatigue. In fact, research has shown that cycling as little as 20km at race pace induces significant fatigue of the breathing muscles.

A research group at Birmingham University shows that inspiratory muscle training (IMT) improves cycling performance. IMT is the scientific term for breathing muscle training. IMT is shown to reduce breathing fatigue and improve cycling time trial performance. In fact, improvements of 4.6% are shown. This is equivalent to slicing around 2 minutes off a 40k PB. And this is after just 6-weeks of inspiratory muscle training.

POWERbreathe inspiratory muscle training targets the breathing muscles, strengthening them by around 30-50%, significantly improving performance and helping to eliminate breathing fatigue.

The scientifically proven training regimen for POWERbreathe IMT is to perform 30 breaths in through the device, twice a day. And that is exactly what the RAF team are doing:

“Resting up tomorrow, apart from the lungs, POWERbreathe every day! As ordered 🙂 ”

Breathing tip for a charity bike ride

Warm-up the breathing muscles prior to the start. Using the POWERbreathe IMT device on a reduced load setting will prepare the breathing muscles for the rigours that the ride will bring. In fact, research shows that a standard pre-exercise warm-up routine fails to prepare the breathing muscles for the rigours of exercise.

RAF Charity Ride – 3 Peaks of Briançon

The 3 Peaks of Briançon Charity Ride is a team of four amateur cyclists from RAF Coningsby Ground System Support Flight.

The RAF team challenge

Gary, Matty, Chris and Lance are all amateur cyclists. They are challenging themselves to climb and conquer three of the toughest and most gruelling peaks the Alps have to offer. And they aim to complete it in three successive days.

In June 2018 they will be travelling to the Briançon region in the south of France to climb the Col d’Izoard, Col du Chaussy and the Col du Galibier.

Briançon itself is at an altitude of 1,326m (4,350ft). It is often host to the start and finishing stages of the Tour de France, Giro d’Italia and Dauphiné Libéré. And so the ride will present challenges to mental and physical strength and stamina.

Purpose of charity ride

All four members of the team have the same purpose. And that is to raise awareness and funds for four charities all close to their hearts:

  • Cancer Research UK
  • RAF Association
  • RAF Benevolent
  • Breathe on UK

How POWERbreathe will help

Gary, Matty, Chris and Lance will each be using a POWERbreathe Plus MR Inspiratory Muscle Training (IMT) device as part of their training preparation. The reason for this is because cycling in the mountains, like any form of exercise, will cause their muscles to fatigue. And this includes their breathing muscles.

Research has shown that IMT reduces breathing fatigue and enabled participants in a trial to cycle for 33% longer with a lower sense of effort.

Cycling Effort

However, in addition to breathing fatigue, the hunched position adopted while cycling can also create breathing problems. The reason being that the abdomen becomes compressed and pushes up against the diaphragm. This in turn restricts normal movement and makes breathing feel much harder.

Breathing parameters

But before Gary, Chris and Matty begin using their devices, they will each perform a single breath test using the POWERbreathe K5 with Breathe-Link Live Feedback Software. This provides baseline breathing measurements based on age, weight, height and gender. The single breath test measures inspiratory muscle strength, peak inspiratory flow rate and inhaled volume in a single breath.

Next, Gary, Chris and Matty need to complete a 30 breath training session to establish a baseline breathing Load (cmH2O), Power (watts), Flow (Litres/second) and Energy (joules). These are the parameters they will improve after 4-6 weeks of IMT.

Charity ride 2018 – when and where

JUNE 5 – Warm-up to Briançon.

JUNE 6 – On to Col d’Izoard mountain pass at 2,360m (7,743ft). This will test their strength and provide them with an idea of what they are letting themselves in for.

JUNE 7 – Next is the Col du Chaussy, a high mountain pass with an elevation of 1,533m above sea level. It is considered to be a ‘dangerous road’ because of the 3km stretch with 17 hairpins. In fact the road virtually climbs a cliff. And it is at this point when their Inspiratory Muscle Training should stand them in good stead by  helping to reduce the level of breathing fatigue they would otherwise have experienced. And it will help them to cycle for longer.

JUNE 8 – The final leg is to conquer the Col du Galibier mountain pass. This stands at 2,645m (8,678ft) and is considered to be the highest point of the Tour de France. And this is where their strength, stamina and mental resilience will be pushed to the limit.

Where you can follow them

If you would like to support them, please visit their pages:

  1. Just Giving
  2. Instagram
  3. Facebook

Influence of IMT on Cycling Performance at altitude

This study, Influence of IMT on Ventilatory Efficiency & Cycling Performance in Normoxia and Hypoxia, is published in Frontiers in Physiology. The aim of the study is to analyse the influence of inspiratory muscle training (IMT) on ventilatory efficiency in normoxia and hypoxia. It also investigates the relationship between ventilatory efficiency and cycling performance.

The point of the study

The premise of the study is that IMT improves ventilatory efficiency in normoxia and hypoxia. It also reduces the metabolic demands of the respiratory muscles in both conditions. The study also hypothesizes that improvements in submaximal cycling performance can be linked to improvements in ventilatory efficiency in normoxia and hypoxia.

Study method

The study assigns participants, at random, to either a control group or an inspiratory muscle training (IMT) group. The IMT group were to complete 30 inhalations twice a day using the POWERbreathe K3. They were to do this 5 days a week for 6 weeks. Researchers set the POWERbreathe K3 to 50% of each participant’s Pimax (maximal inspiratory mouth pressure). By contrast, the control group did not perform any IMT.

To determine Pimax participants had to inspire through the K3 as quickly as possible. And in order to achieve a stable measurement they were perform this a few times.

Conclusions for training at altitude

The study suggests a possible positive effect of IMT on cycling time trial performance in both normoxic and hypoxic conditions. It also shows that hypoxia has a negative effect on ventilatory efficiency. It furthermore shows that IMT may reduce this effect.

Additionally the authors report that these findings may have relevance for athletes planning to train at a high altitude, or compete at high altitude.

Finally, the study suggests that Inspiratory Muscle Training before a competition at altitude might be a successful method to improve performance.

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.

Para-Cyclist Leon Selva and POWERbreathe

We recently met up with para-cyclist Leon Selva at his home earlier in November. Leon is training hard with the intention of competing in the Tokyo 2020 Paralympic Games.

Para-cyclist Leon

As a result of a terrible accident and with a positive frame of mind, Leon decided to start his career as a para-cyclist. Leon became badly injured in a car crash. His lung collapsed and the right side of his body is severely damaged. As a result Leon gets around with the aid of a crutch. But not one to let that get in the way, Leon is setting his sights on the Tokyo Paralympic Games in 2020. His ambition is clear to see.

Leon’s cycle training

Leon has a coach to help with his training. His coach also trains with Leon at the National Cycling Centre in Manchester. And his father is responsible for converting a former bedroom into a training room. This room is kitted out with an elliptical, Wattbike and various other pieces of gym equipment. His bike has a special crank bottom bracket that allows both cranks to work independently as he can generate more power from his uninjured side.

Leon’s initial POWERbreathe Inspiratory Muscle Training (IMT)

After Leon’s recovery from his collapsed lung, he began using the POWERbreathe Plus HR. He uses this to strengthen the muscles he uses to breathe. These are his diaphragm and his intercostal muscles. The diaphragm is the main muscle that is used for breathing. The intercostals are muscles that are located between the ribs.

The POWERbreathe Plus HR is not the most suitable model for Leon. It is the highest resistance model in the Plus series. It is designed only for people who have reached the top of the MR (medium resistance) model. Leon finds it quite hard going and so isn’t using it effectively.

Leon’s current POWERbreathe IMT

Realising Leon was struggling with the Plus HR, his father started looking for a more suitable alternative. And so he bought Leon the POWERbreathe K5 with Breathe-Link Live Feedback Software. The K5 offers Leon a more tapered loading resistance. This will match the contraction curve of his own breathing muscles throughout his entire breath. And it’s this that makes it easier for Leon to use. As a result it’s more beneficial. Leon will no longer struggle with the resistance as the K5 does everything for him.

Leon on the POWERbreathe K5

Upon arrival we set up the K5 and Breathe-Link Live Feedback Software for Leon. Leon then starts to train with it immediately. And thanks to the live feedback software it’s clear that Leon’s initial in-breaths are very weak and uncoordinated. So over a period of 90 breaths, and as Leon looked at his live breathing on screen, we corrected his breathing technique. After a short while Leon shows how to get the most from his diaphragm and his breathing improves tremendously.

Leon was so pleased with his training, he exclaimed, “Dad, this is the best investment you have ever made, my improvement is amazing, it’s epic.” You can see this wonderful reaction in our YouTube video.

Because of this encouraging endorsement, Leon’s father and coach performed a number of breaths on the K5 too. They did this so that they could experience this training for themselves. They are now also able to offer advice and encouragement as Leon continues to train his breathing.

David Lombardo From Hagens Berman U-23 Team Takes 1st Place In Championships

Photo Credit: Alex Chiu @acaurora

POWERbreathe have been proudly sponsoring this talented team, the Hagens Berman U-23 Team, with POWERbreathe Plus models for riders and a POWERbreathe K5 with Breathe-Link Live Feedback Software for the coach so that assessment and analysis of each team member’s breathing can regularly take place as part of their overall fitness testing and training.

Photo Credit: Alex Chiu @acaurora

The team has been performing well and at the USA Cycling National Championships at North Lake Tahoe, CA (June 24-28) they raced exceptionally well, and it is with great pleasure that we announce the exciting news that team member David Lombardo took top spot as the 2015 U-23 National Criterium Champion! Congratulations David!

The criterium race is a short race, and in the case of the Criterium Male U23 19-22 Pro/Cat 1/2, it was a 75-minute race held on open roads. It’s quite different to road racing, in fitness requirements, racing style and tactics as it’s a shorter, more technical and faster race.

Why train with POWERbreathe?

POWERbreathe IMT exercises the riders’ breathing muscles, mainly the diaphragm and intercostals, making them stronger and more resistant to fatigue which translates into improved stamina. And because the breathing muscles are stronger, they don’t need to steal blood from other working muscles for them to do their job properly, which means more oxygen-rich blood to the legs for more pedal-power. And because research has shown that cycling as little as 20km at race pace induces significant fatigue of the inspiratory muscles, more and more cyclists are choosing to include POWERbreathe IMT as part of their daily training.

Women’s eliteVELO Cycling Race Team and POWERbreathe

Through our main UK distributor, HaB Direct, POWERbreathe are proud to be sponsoring this women’s development and performance road racing team, eliteVELO Kalas Sportswear Cycling Race Team.

The team consists of 6 enthusiastic and highly talented riders: Alice Miller, Frankie Morgans-Slader, Hester Stembridge, Jenny Powell, Julia Hesselberg and Sophie Black.

This weekend at Finlake Lodges in Newton Abbott the team met up for their first training camp together, beginning on Friday night (27th Feb) where the team received their training gear, courtesy of their sponsors POWERbreathe, KALAS Sportswear UK kit, LAZER HELMETS and Power Tap.

We gave each of the girls a POWERbreathe Plus, and one of the reasons POWERbreathe Inspiratory Muscle Training will be of benefit to this team of cyclists is because the hunched position they cycle in makes breathing more of a challenge. This hunched position creates breathing problems as the contents of the abdomen become compressed and push up against the diaphragm, the main breathing muscle. This restricts normal movement of the breathing muscles and makes breathing feel much harder.

POWERbreathe exercises the inspiratory muscles, training them to become stronger as the girls breathe in through the adjustable resistance. This daily training improves their breathing strength and stamina and reduces fatigue, which means they’ll also find they’ll be able to cycle for longer with less effort – all because they’ve been ‘working out’ their breathing muscles which are often neglected.

Another reason POWERbreathe training will be beneficial to the girls is because research has shown that ‘oxygen uptake in respiratory muscles differs between men and women during exercise’, with respiratory muscles in women consuming a greater amount of oxygen than men. Another study also found that ‘women have greater shortness of breath than men when exercising due to greater electrical activation of their respiratory muscles’.

Read more about POWERbreathe breathing training for cyclists >

The team, brought together by coaching company eliteVELO, will be competing at regional and national events including the Women’s Team Series and you can follow their progress on the team’s website, on Twitter, Facebook and here on POWERbreathe, where we also hope to bring you more photos by the team’s official photographer, Richard Fox Photography. In the meantime take a sneak peek of Richard’s EliteVelo Kalas CRT Cycling Shoot.

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 >