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Improving strength of the muscles which bring air into the lungs (high-resistance inspiratory training) improves the function of blood vessels

Updated: 6 days ago

Exercise with nasal breathing

I found the statements below from a paper published in The Journal of the American Heart Association and the associated editorial profound and exciting:

A editorial stated ‘Of particular interest was the improvement in endothelial (blood vessel) function with high‐resistance inspiratory training in oestrogen‐deficient postmenopausal women, a group that generally does not demonstrate improvements in endothelial function with exercise training’ (1)

'High‐resistance inspiratory training is a safe, highly adherable lifestyle intervention for improving blood pressure and endothelial function in midlife/older adults with above‐normal initial systolic blood pressure' (2)

Women after menopause experience an increased risk of cardiovascular disease (CVD) and female heart health differs compared to men. Click here to read my blog on the differences. The study was a small (36 individuals) double‐blind, randomized, sham‐controlled trial over six weeks however this has the potential to represent another method of reducing CVD risk especially in oestrogen-deficient post-menopausal women.

Since I read these documents over a year ago I have incorporated high‐resistance inspiratory training into my daily routine with improvements in my blood pressure, pulse and exercise tolerance. I have also observed clinical improvement in individuals who have improved inspiratory strength.

What is high‐resistance inspiratory training?

It is a form of physical training which involves inhaling (bringing air into the body) against a resistance.

What muscles do we use during inspiration (bringing air into the body)?

The main inspiratory muscles are the diaphragm (located under the lungs) and the external intercoastal muscles (located in between the ribs). These skeletal muscles are like the biceps: they get weaker if not used and stronger if used against a resistance. It is known muscle mass decreases approximately 3–8% per decade after the age of 30 and this rate of decline is even higher after the age of 60. Therefore the ageing process can result in reduced muscle strength in the breathing muscles and consequently increased work of breathing and associated breathlessness during activities of daily living in older adults. A systematic review and meta-analysis (3) concluded inspiratory muscle training can be beneficial in terms of improving inspiratory muscle strength in older adults regardless of their initial degree of inspiratory muscle weakness.

The heart and lungs are connected

The blood arrives from the body into the right side of the heart where it is pumped into the lungs. The blood returns from the lungs into the left side of the heart where it is pumped out into the body. How we breathe therefore impacts the heart.

What device was used in the study

Unfortunately the device used in the study currently retails at £550. The device also uses the mouth to breathe which I find strange as it is more likely we use the diaphragm when we use the nose to breathe. I would love to be involved in a study using the method I have developed as it is cheaper, uses the nose to breathe and works on all three dimensions of breathing (biochemical, biomechanical and psychophysiological).

How does high‐resistance inspiratory training improve blood vessel function?

It is complicated and for those that would like to understand the science the details are contained within the paper cited below (2). Briefly the pressure generated with a breath and the expansion of the lungs influence the volumes and pressures in the chambers of the heart and blood vessels. These changes, in turn, stimulate sensory nerves that influence the autonomic nervous system which also regulates heart rate and blood pressure. Also it appears high‐resistance inspiratory training results in improvements in nitric oxide bioavailability. Nitric oxide in the body is a key regulator of cardiovascular function, metabolism, neurotransmission, immunity, and more, and abnormal nitric oxide signalling has been linked with disorders including cardiovascular disease, diabetes, and cancer (4)

What are the practical things I can take from this study?

Nasal breathing during exercise involves an increase in the amount of air the individual is breathing and therefore the individual needs to inhale against a resistance to maintain nasal breathing which provides inspiratory muscle training. There are various reasons an individual may find maintaining nasal breathing during exercise difficult however one reason is their carbon dioxide tolerance. A feeling of air hunger (or suffocation) often occurs when the individual reaches their carbon dioxide tolerance however their tolerance can be retrained.

What is my clinical experience of helping individuals with inspiratory training?

Breathing efficiency varies between individuals. Often the individual who finds it more difficult to re-establish nasal breathing will frequently have more to gain. Maintaining nasal breathing during exercise takes time and patience to improve the strength of the breathing muscles and carbon dioxide tolerance. Practising nasal breathing at rest, during sleep and during lower intensity movement is often helpful initially. Also I have found improving carbon dioxide tolerance at rest makes it easier to sustain nasal breathing during higher intensity exercise.

If you would like some support to re-establish nasal breathing during exercise I provide breathing re-education programmes. Below is some of the feedback from those whom I have supported:

'I had to give latest blood pressure readings to GP's surgery recently and mine (although always in normal range) has gone down. So my work the last 6 months has definitely had an impact. Still can't quite believe the benefits to be gained from efficient nasal breathing.'

‘I am 68 years old and now recognise I've been a life long mouth breather. I can now skip continuously for 8 minutes whilst nasal breathing. Two months ago I would have needed to stop frequently due to air hunger'

75 year old 'Particularly helpful is nasal breathing which I manage to do my running three times a week all with nasal breathing so far.  Have not tested myself out on steepish hills but do the gradual inclines with nasal breathing'

'I walk to work up & down hills, I cycle up steep hills & I have started gig rowing recently & consciously use nasal breathing.  I never feel out of breath unlike the others who are panting & groaning'

‘I can smell and taste which I’m delighted about. I’m managing to nasal breathe whilst exercising and I’m sleeping much better. I had assumed that breathing inefficiently was an unconscious and valid adjustment to environmental factors. Had not twigged that it could be a potentially incorrect adaptation that could be doing more harm than good’

 'The most significant change is I understand air hunger, am no longer afraid of it, and am able to work with it to help my oxygen levels. This has also resulted in less physical tension around breathing, and I no longer have urges to gasp in a breath through my mouth'

'Nasal breathing transformed my life, sleep better and feel better during the day'

How we breathe matters.

We can change how we breathe.

(1) Joyner MJ, Baker SE. Take a Deep, Resisted, Breath. J Am Heart Assoc. 2021 Jul 6;10(13):e022203. doi: 10.1161/JAHA.121.022203. Epub 2021 Jun 29. PMID: 34184555; PMCID: PMC8403307.

(2) Craighead DH, Heinbockel TC, Freeberg KA, Rossman MJ, Jackman RA, Jankowski LR, Hamilton MN, Ziemba BP, Reisz JA, D'Alessandro A, Brewster LM, DeSouza CA, You Z, Chonchol M, Bailey EF, Seals DR. Time-Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above-Normal Blood Pressure. J Am Heart Assoc. 2021 Jul 6;10(13):e020980. doi: 10.1161/JAHA.121.020980. Epub 2021 Jun 29. PMID: 34184544; PMCID: PMC8403283.

(3) James Manifield, Andrew Winnard, Emily Hume, Matthew Armstrong, Katherine Baker, Nicola Adams, Ioannis Vogiatzis, Gill Barry, Inspiratory muscle training for improving inspiratory muscle strength and functional capacity in older adults: a systematic review and meta-analysis, Age and Ageing, Volume 50, Issue 3, May 2021, Pages 716–724,

(4) Lundberg JO, Weitzberg E. Nitric oxide signaling in health and disease. Cell. 2022 Aug 4;185(16):2853-2878. doi: 10.1016/j.cell.2022.06.010. PMID: 35931019.

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What fascinating research on women's CVH and so helpful to read as a menopausal woman. Thanks for distilling all of this and explaining it in such an understandable way..

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You are welcome. Thank you Colette for reading my blog and your kind words 🙏😊

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