o x y g e n advantage theory 3
TRANSCRIPT
O X Y G E N
ADVANTAGE
THEORY 3
HOW TO MEASURE BREATHLESSNESS
bull Holding of the breath until the first definite desire to
breathe is not influenced by training effect or behavioural
characteristics it can be deduced to be a more objective
measurement of breathlessness
bull Nishino T Pathophysiology of dyspnea evaluated by breath-holding test studies of furosemide
treatment Respiratory Physiology Neurobiology2009 May 30(167(1))20-5
TRAINING METHODS
OXYGEN CARRYING CAPACITY
bull Blood is made up of three parts oxygen-carrying red
cells white blood cells and plasma
bull Hemoglobin is a protein found within the red cells
OXYGEN CARRYING CAPACITY
bull Hematocrit refers to the percentage of red blood cells in
the blood Under normal conditions hematocrit will relate
closely to the concentration of hemoglobin in the blood
Hematocrit is usually found to be 407- 50 for males
and 361- 443 for females
OXYGEN CARRYING CAPACITY
bull Performance improves with an increase in hemoglobin
and hematocrit which increases oxygen carrying
capacity of the blood thus improving aerobic ability
bull J Appl Physiol 1972 Aug33(2)175-80 Response to exercise after blood loss and reinfusion Ekblom B Goldbarg AN Gullbring B
HIGH ALTITUDE TRAINING bull To limit the detraining effects of working at high altitude
while still maintaining the benefits Dr Levine and James
Stray Gundersen from the University of Texas in Dallas
developed the live high and train low model in the
1990s
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
HOW TO MEASURE BREATHLESSNESS
bull Holding of the breath until the first definite desire to
breathe is not influenced by training effect or behavioural
characteristics it can be deduced to be a more objective
measurement of breathlessness
bull Nishino T Pathophysiology of dyspnea evaluated by breath-holding test studies of furosemide
treatment Respiratory Physiology Neurobiology2009 May 30(167(1))20-5
TRAINING METHODS
OXYGEN CARRYING CAPACITY
bull Blood is made up of three parts oxygen-carrying red
cells white blood cells and plasma
bull Hemoglobin is a protein found within the red cells
OXYGEN CARRYING CAPACITY
bull Hematocrit refers to the percentage of red blood cells in
the blood Under normal conditions hematocrit will relate
closely to the concentration of hemoglobin in the blood
Hematocrit is usually found to be 407- 50 for males
and 361- 443 for females
OXYGEN CARRYING CAPACITY
bull Performance improves with an increase in hemoglobin
and hematocrit which increases oxygen carrying
capacity of the blood thus improving aerobic ability
bull J Appl Physiol 1972 Aug33(2)175-80 Response to exercise after blood loss and reinfusion Ekblom B Goldbarg AN Gullbring B
HIGH ALTITUDE TRAINING bull To limit the detraining effects of working at high altitude
while still maintaining the benefits Dr Levine and James
Stray Gundersen from the University of Texas in Dallas
developed the live high and train low model in the
1990s
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
TRAINING METHODS
OXYGEN CARRYING CAPACITY
bull Blood is made up of three parts oxygen-carrying red
cells white blood cells and plasma
bull Hemoglobin is a protein found within the red cells
OXYGEN CARRYING CAPACITY
bull Hematocrit refers to the percentage of red blood cells in
the blood Under normal conditions hematocrit will relate
closely to the concentration of hemoglobin in the blood
Hematocrit is usually found to be 407- 50 for males
and 361- 443 for females
OXYGEN CARRYING CAPACITY
bull Performance improves with an increase in hemoglobin
and hematocrit which increases oxygen carrying
capacity of the blood thus improving aerobic ability
bull J Appl Physiol 1972 Aug33(2)175-80 Response to exercise after blood loss and reinfusion Ekblom B Goldbarg AN Gullbring B
HIGH ALTITUDE TRAINING bull To limit the detraining effects of working at high altitude
while still maintaining the benefits Dr Levine and James
Stray Gundersen from the University of Texas in Dallas
developed the live high and train low model in the
1990s
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
OXYGEN CARRYING CAPACITY
bull Blood is made up of three parts oxygen-carrying red
cells white blood cells and plasma
bull Hemoglobin is a protein found within the red cells
OXYGEN CARRYING CAPACITY
bull Hematocrit refers to the percentage of red blood cells in
the blood Under normal conditions hematocrit will relate
closely to the concentration of hemoglobin in the blood
Hematocrit is usually found to be 407- 50 for males
and 361- 443 for females
OXYGEN CARRYING CAPACITY
bull Performance improves with an increase in hemoglobin
and hematocrit which increases oxygen carrying
capacity of the blood thus improving aerobic ability
bull J Appl Physiol 1972 Aug33(2)175-80 Response to exercise after blood loss and reinfusion Ekblom B Goldbarg AN Gullbring B
HIGH ALTITUDE TRAINING bull To limit the detraining effects of working at high altitude
while still maintaining the benefits Dr Levine and James
Stray Gundersen from the University of Texas in Dallas
developed the live high and train low model in the
1990s
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
OXYGEN CARRYING CAPACITY
bull Hematocrit refers to the percentage of red blood cells in
the blood Under normal conditions hematocrit will relate
closely to the concentration of hemoglobin in the blood
Hematocrit is usually found to be 407- 50 for males
and 361- 443 for females
OXYGEN CARRYING CAPACITY
bull Performance improves with an increase in hemoglobin
and hematocrit which increases oxygen carrying
capacity of the blood thus improving aerobic ability
bull J Appl Physiol 1972 Aug33(2)175-80 Response to exercise after blood loss and reinfusion Ekblom B Goldbarg AN Gullbring B
HIGH ALTITUDE TRAINING bull To limit the detraining effects of working at high altitude
while still maintaining the benefits Dr Levine and James
Stray Gundersen from the University of Texas in Dallas
developed the live high and train low model in the
1990s
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
OXYGEN CARRYING CAPACITY
bull Performance improves with an increase in hemoglobin
and hematocrit which increases oxygen carrying
capacity of the blood thus improving aerobic ability
bull J Appl Physiol 1972 Aug33(2)175-80 Response to exercise after blood loss and reinfusion Ekblom B Goldbarg AN Gullbring B
HIGH ALTITUDE TRAINING bull To limit the detraining effects of working at high altitude
while still maintaining the benefits Dr Levine and James
Stray Gundersen from the University of Texas in Dallas
developed the live high and train low model in the
1990s
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
HIGH ALTITUDE TRAINING bull To limit the detraining effects of working at high altitude
while still maintaining the benefits Dr Levine and James
Stray Gundersen from the University of Texas in Dallas
developed the live high and train low model in the
1990s
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
HIGH ALTITUDE TRAINING bull The premise of the method is to enable athletes to
benefit from the positive physiological changes
associated with living at a high altitude while enabling
them to train at their maximum work rate
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
HIGH ALTITUDE TRAINING bull A study of 39 male and female collegiate distance
runners who were evenly matched in fitness level
bull Results for the live high and train low group showed a
9 improvement in red blood cell volume and a 5
improvement in maximal oxygen uptake (VO2 max)
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
TRAINING METHODS bull The improvement in maximal oxygen uptake was in
direct proportion to increased red cell mass volume This
translated to an impressive performance improvement of
134 seconds in a 5000 metre run
bull Stray-Gundersen J Chapman RF Levine BD Living high-training low altitude training improves
sea level performance in male and female elite runners Journal of Applied Physiology2001(Sep91(3))1113-20
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
HIGH-INTENSITY TRAINING
bull Tabata training where athletes give their full effort at an
exhausting work rate for periods of just 20 seconds at a
time
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
HIGH-INTENSITY TRAINING
bull Concluded that although moderate-intensity aerobic
training improved aerobic power high-intensity
intermittent training improved both anaerobic and aerobic
performance
bull Tabata I Nishimura K Kouzaki M Hirai Y Ogita F Miyachi M Yamamoto K Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max Medicine and science in sports and exercise1996(Oct28(10))1327-30
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
Acidosis
ACIDOSIS
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
REDUCED ACIDOSIS bull Fatigue- physiological- breaking point at which the athlete
cannot continue exercise intensity
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
REDUCED ACIDOSIS bull Delaying fatigue is important in sports requiring
anaerobic performance
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
REDUCED ACIDOSIS
bull Metabolism produces CO2 dissociates to H+ and HCO3-
bull Sufficient oxygen to the muscles H+ is oxidised in the
mitochondria to generate water
bull Insufficient oxygen all H+ cannot be oxidised and
associates with pyruvic acid to form lactic acid
bull Lactic acid quickly dissociates into lactate ion and H+
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
REDUCED ACIDOSIS
bull Breath holding after an exhalation causes a decrease to
the concentration of oxygen to trigger increased lactic
acid therefore increased H+
bull At the same time carbon dioxide also increases leading
to an increased concentration of hydrogen ions to further
acidify the blood
bull During breath holding CO2 increases to 50mmHg in the
lungs
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
REDUCED ACIDOSIS
bull Fall of O2 and increase to CO2 greatly disturb the blood
acid base balance
bull Causes a combined acidosis metabolic and respiratory
bull (metabolic acidosis decrease in pH associated with a fall
in HCO3-)
bull Due to a drop on pH and increase in H+
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
REDUCED ACIDOSIS
bull Increase to CO2 increases HCO3- (as CO2 dissociate
into H+ and HCO3-)
bull However the increased lactic acid causes a large
accumulation of H+ therefore HCO3- tends to decrease
bull HCO3 - decreases as it buffers the excess of H+
generated by lactic acid
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
REDUCED ACIDOSIS
bull Near infrared spectroscopy measures oxygen saturation within the
muscle (SmO2)
bull Amount of O2 lower in the muscle
bull Tissue hypoxia increases blood lactate concentrations
bull CO2 also increases in the muscle However because of elevated
aCO2 diffusion gradient between the tissues and blood is reduced
therefore CO2 release is slowed down and the gas accumulates in
the muscle
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
ANEROBIC TRAINING
bull Both the hypoxic and hypercapnic effects are responsible
for the rise in H+ during BH
bull CO2 accumulates within muscle - converted into HCO3-
H+ ions are automatically produced
bull A proportion of H+ ions are neutralised within the muscle
by buffering substances which the most important are
proteins and phosphate
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
ANEROBIC TRAINING
Increased H+ ions in the muscle Increased H+ ions in the blood
A STRONG ACIDITY WITHIN THE MUSCLE TISUE IS A MAJOR
CONSEQUENCE OF EXERCISE WITH BH IT IS THE MAIN
CAUSE OF ADAPTATIONS THAT OCCUR AFTER BH TRAINING
Increased acidosis When this occurs repeatedly adaptation
mechanisms are triggered to reduce acidosis
The buffer systems have the fastest action- enhanced blood and or
muscle buffering capacity
Woorons
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
ANEROBIC TRAINING
bull Main Buffering
bull Blood- Haemoglobin and bicarbonate
bull Skeletal muscle- proteins phosphates (60) and to a
lesser extent bicarbonate (18)
bull Possibly enhanced buffering capacity in muscle
compartments- lowering diffusion of H+ to the blood
bull Woorons X
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
ANEROBIC TRAINING
bull In breath holding following an exhalation maximal lactate
concentration (+ 235 plusmn 13 mmolL-1 on average) and
the rate of lactate accumulation in blood (+ 417 plusmn 394)
were higher at Post- than at Pre- in the three trials
whereas they remained unchanged in CONTROLS
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity
Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
ANEROBIC TRAINING
bull Increased Lactate max reflects an improved anaerobic
capacity and may be due to a greater ability to tolerate
high concentrations of lactate and high level of acidosis
as reported after high-intensity training
bull Woorons X Mucci P Richalet JP Pichon A Hypoventilation Training at Supramaximal Intensity Improves Swimming Performance Med Sci Sports Exerc 2016 Jun48(6)1119-28
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull Free radicals are molecules generated by the breakdown
of oxygen during metabolic activity
bull We all create a certain amount of free radicals through
the very act of breathing to stay alive
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull Highly reactive and attack other cells causing damage
to tissues and negatively affecting lipids proteins and
DNA
bull Implicated in ageing and a number of human diseases
including cancer
bull Devasagayam TP Tilak JC Boloor KK Sane KS Ghaskadbi SS Lele RD Free radicals and
antioxidants in human health current status and future prospects J Assoc Physicians India 2004(Oct52)794-804
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull Normal levels do not pose a problem since the bodyrsquos
defence mechanism is able to neutralise the molecules
with antioxidants
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull Overbreathing and high-intensity exercise can cause an
increased risk of muscle and tissue damage due to an
overabundance of free radicals in the body
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull Physical exercise increases oxidative stress and causes
disruptions of the homeostasis Training can have
positive or negative effects on oxidative stress depending
on training load training specificity and the basal level of
training Moreover oxidative stress seems to be involved
in muscular fatigue and may lead to overtraining
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and TrainingSports Med2006(36 (4))327-358
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull Exhaustive andor intense physical activity can induce
diseases injuries and chronic fatigue which can lead to
the overtraining syndrome partially because of the
toxicity of free radicals (FR)
bull Finaud J Lac G Filaire E Oxidative Stress Relationship with Exercise and Training Sports Med 2006(36 (4))327-358
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull Nine fit male subjects were studied before and after three
months of running and were found to have significantly
decreased levels of all circulating antioxidants except for
ascorbate during training
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull The conclusion reached was that ldquorelatively intense
aerobic training decreases circulating antioxidant
concentrationsrdquo
bull Bergholm R Maumlkimattila S Valkonen M Liu ML Lahdenperauml S Taskinen MR Sovijaumlrvi A
Malmberg P Yki-Jaumlrvinen H Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo Atherosclerosis1999 Aug(145(2))341-9
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS bull In what is considered to be one of the toughest foot races
on Earth competitors run the equivalent of six regular
marathons over six days in the Sahara desert during
which they are required to carry their own food
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS bull Blood samples were taken 72 hours after completion of
the race with researchers noting a ldquosignificant alteration
of the blood antioxidant defence capacityrdquo and
concluding that ldquosuch extreme competition induced an
imbalance between oxidant and antioxidant protectionrdquo
bull Machefer G Groussard C Rannou-Bekono F Zouhal H Faure H Vincent S Cillard J Gratas-
Delamarche A Extreme running competition decreases blood antioxidant defense capacity Journal American College Nutrition2004(Aug23(4))358-64
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
FREE RADICALS
bull The use of dietary antioxidants to reduce oxidative stress
and exercise-induced muscle injury have met with mixed
results to date
bull Clarkson PM Antioxidants and physical performance Critical Reviews of Food Science and Nutrition1995 Jan(35(1-2))131-41
bull Clarkson PM Thompson HS Antioxidants what role do they play in physical activity and health American Journal Clinical Nutrition2000 Aug(72(2 Suppl))637S-46S
bull Urso ML Clarkson PM Oxidative stress exercise and antioxidant supplementation Toxicology2003 Jul 15(189(1-2))41-54
BREATH HOLDING TO REDUCE FREE RADICALS
BREATH HOLDING TO REDUCE FREE RADICALS
bull After a three month breath hold program superimposed
on the training of triathletes ldquoblood acidosis was reduced
and the oxidative stress no more occurredrdquo
bull Fabrice Joulia Jean Guillaume Steinberga Marion Fauchera Thibault Jaminc Christophe
Ulmera Nathalie Kipsona Yves Jammes Breath-hold training of humans reduces oxidative
stress and blood acidosis after static and dynamic apnea Respir Physiol Neurobiol 2003
(Aug 14137(1))19-27
BREATH HOLDING TO REDUCE FREE RADICALS
bull Trained breath hold divers with an ability to hold their
breath for up to 440 seconds during rest were compared
with a second group of non divers who had at most a 145
second breath hold time
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood
lactic acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct
23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Normal breathing group showed an increase in blood
lactic acid concentration and oxidative stress Diver
group the changes in both lactic acid and oxidative
stress were markedly reduced after both breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Conclusion Humans who are involved in a long term
training program of breath hold diving have reduced
blood acidosis and oxidative stress following breath holds
and exercise
bull Joulia F Steinberg JG Wolff F Gavarry O Jammes Y Reduced oxidative stress and blood lactic
acidosis in trained breath-hold human divers Respir Physiol Neurobiol2002 (Oct 23133(1-2))121-30
BREATH HOLDING TO REDUCE FREE RADICALS
bull Group of trained divers and a group of people with no
diving experience at all Results showed significant
improvements in antioxidant activity across both groups
with little difference between the divers and non-divers
bull BULMER ANDREW C COOMBES JEFF S SHARMAN JAMES E STEWART IAN B Effects of Maximal Static Apnea on Antioxidant Defenses in Trained Free Divers Medicine amp Science in Sports amp Exercise200840(7)1307-1313
BREATH HOLDING TO REDUCE FREE RADICALS
bull One small land-based mammal has managed to
confound the overwhelming evidence to support the
negative effects of oxidative stress For the past few
decades scientists have studied the naked mole rat ndash a
bald blind creature that looks like a hot dog with teeth
and lives for up to twenty-eight years almost eight times
longer than any other rodent
BREATH HOLDING TO REDUCE FREE RADICALS
bull The naked mole rat lives in East Africa where it is
considered a pest by local farmers as it burrows tunnels
underneath fields and eats vegetable crops
BREATH HOLDING TO REDUCE FREE RADICALS
bull The breathing rate of the naked mole rat is very low in
comparison to other rodents and it lives in crowded
colonies where there is little oxygen and high levels of
carbon dioxide
BREATH HOLDING TO REDUCE FREE RADICALS
bull Despite living with high oxidative stress from a young
age the naked mole rat maintains good health and
longevity and in all the years this rather ugly animal has
been studied it has never been known to develop
cancer
bull Buffenstein R Negligible senescence in the longest living rodent the naked mole-rat insights
from a successfully aging species J Comp Physiol B 2008 May(178(4))439-45
BREATH HOLDING TO REDUCE FREE RADICALS
bull Even when scientists have injected the mole rat with
cancer-causing agents the disease was resisted Exactly
why the naked mole rat is immune to cancer is unknown
bull Akshat Rathi Cancer immunity of strange underground rat revealed httptheconversationcomcancer-immunity-of-strange-underground-rat-revealed-15358 (accessed
2nd Sep 2014)
BREATH HOLDING TO REDUCE FREE RADICALS
bull Researchers have discovered that the negative affects of
high oxidative stress may be offset by high carbon
dioxide
bull Veselaacute A Wilhelm J The role of carbon dioxide in free radical reactions of the organism Physiological Research 2002(51(4))335-9
FUNCTIONAL
MOVEMENT
SCREEN (FMS)
bull Normal breathing mechanics play a key role in posture
and spinal stabilization Breathing Pattern Disorders
(BPD) have been shown to contribute to pain and motor
control deficits which can result in dysfunctional
movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The Functional Movement Screen (FMS) has been
shown to accurately predict injury in individuals who
demonstrate poor movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The role BPD play on functional movement is not well
established
bull Furthermore there is currently no single test to clinically
diagnose BPD A variety of methods are used but
correlations between them are poor
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Postural control deficits poor balance altered
proprioception and inefficient motor control have been
shown to contribute to pain disability and interfere with
normal movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Identification of risk factors that lead to these problems
and contribute to dysfunctional movement patterns could
aid injury prevention and performance
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull BPD could be a risk factor for the development of the
dysfunction a result of the dysfunction itself and an
important clinically measurable attribute to consider in
those with musculoskeletal pain
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Thoracic breathing is produced by the accessory muscles
of respiration (including sternocleidomastoid upper
trapezius and scalene muscles) dominating over lower
rib cage and abdominal motion
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Hodges et al stated that since the diaphragm performs
both postural and breathing functions disruption in one
function could negatively affect the other
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Roussel et al found a positive correlation between BPD
and poor performance of motor control tasks
bull Hodges et al showed diaphragmatic activity can assist
with mechanical stabilization of the trunk along with
concurrent maintenance of ventilation by increasing intra-
abdominal pressure leading to a stiffening of the lumbar
spine
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Poor coordination of the diaphragm may result in
compromised stability of the lumbar spine altered motor
control and dysfunctional movement patterns
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
BPD ARE
MULTIDIMENSIONAL
bull Thoracic breathing can have an acute effect on
respiratory chemistry specifically a decrease in the level
of carbon dioxide (CO₂) in the bloodstream This causes
the pH of the blood to increase and a state of respiratory
alkalosis results Respiratory alkalosis can trigger
changes in physiological psychological and neuronal
states within the body that may negatively affect health
performance and the musculoskeletal system
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Method to assess this biochemical aspect of respiratory
function is capnography Capnography measures average
CO₂ partial pressure at the end of exhalation known as end
tidal CO₂ (etCO₂) and has good concurrent validity when
compared to arterial CO2 measures
bull Normal ranges are between 35-40 mmHg while values of
lt35mmHg were suggestive of a BPD
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Breath-holding ability is an aspect of breathing
functionality that is commonly disturbed in individuals
with dysfunctional breathing Times of lt20 seconds are
proposed to indicate the presence of BPD and to
correlate with resting CO2 levels
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
THE STUDY
bull 34 healthy men and women
bull Resting etCO₂ and resting RR were the most sensitive
measures of BPD with over 70 of subjects having
disordered results
bull Between 50 to 60 of participants had abnormal scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Variables Mean plusmn SD MIN MAX
FMS Score 1471 plusmn 184 1200 1900
Rest etCO₂ (mmHg) 3370 plusmn 274 2770 3933
Active etCO₂ (mmHg) 3428 plusmn 244 2937 4017
Rest RR (breathsmin) 1839 plusmn 341 1225 252
Active RR (breathsmin) 2430 plusmn 306 1765 3064
BHT (sec) 1922 plusmn 505 1057 3413
NQ 924 plusmn 643 000 2700
FMStrade Functional Movement Screentrade etCO₂ end-tidal carbon dioxide
RR respiratory rate BHT breath-hold time NQ Nijmegen Questionnaire
TM
bull NQ results were found to be negatively correlated to
active etCO₂ and positively correlated to active RR
indicating that subjects who scored higher on the NQ
had a lower etCO₂ during the FMStrade test and a higher
RR
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Active RR negatively correlated with active etCO₂ measurements indicating individuals with a high RR
during the FMStrade had lower etCO₂ measurements
bull Resting etCO₂ measurements were significantly different
between diaphragmatic (mean=3547 mmHg) and
thoracic breathers (mean=3214 mmHg)
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Individuals with a less efficient breathing pattern scored
worse on the FMStrade compared to those subjects who
had normal breathing patterns Resting etCO₂ was
positively correlated with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull The results from this study show that a relationship exists
between elements of BPD and functional movement
bull Both biomechanical and biochemical measures of BPD
had a significant association with FMStrade scores
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Furthermore 875 of individuals who were in the Pass
group on the FMStrade were classified as diaphragmatic
breathers These results demonstrate the importance of
diaphragmatic breathing on functional movement
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull As normal movement is achieved through a balance of
mobility and stability changes in trunk stability will result
in sub-optimal movement and could lead to dysfunction
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull This is in accordance with Roussel et al who showed
that individuals with low back dysfunction exhibited
altered breathing patterns during movements where the
core stability muscles were challenged
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull Okada et al found no significant correlation existed
between core stability and FMStrade despite the emphasis
fitness professionals have placed on functional
movement and core stability
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull However a study by Shinkle et al established that core
strength does have a significant effect on an athletersquos
ability to create and transfer forces to the extremities
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
bull A higher etCO₂ level indicating efficient respiratory
function was positively correlated with a higher FMStrade
score
The International Journal of Sports Physical Therapy | Volume 9 Number 1 | February 2014
Breathing Pattern Disorders
bull Breathing mediates neuromusculoskeletal responses
through its influence on the autonomic nervous system
(ANS) and the central nervous system (CNS)
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Paradoxical breathing where the abdomen draws in
during inhalation and out on exhalation is often
considered the most severe BPD Result of this BPD is
inadequate tidal volume and over activation of the
scalenes and other accessory breathing muscles of the
upper chest
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The subsequent insufficient exchange of gasses is
thought to lead to respiratory distress and
musculoskeletal imbalances
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull BPDs known as hyperventilation syndrome and
tachypnea alters the bodyrsquos pH producing respiratory
alkalosis which results in an array of symptoms including
headache dizziness chest pain trouble sleeping
breathlessness light sensitivities exhaustion and
cramps
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull The specific cause(s) of BPDs are unknown and each
patient may adapt individual neuromuscular patterns
associated with faulty breathing patterns
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Postural and structural adaptations could possibly result
in pain andor dysfunction of muscles ligaments or joints
with no apparent organic source possibly resulting in
various BPD signs and symptoms
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Correction or re-education of BPDs can result in new
neural connections and restoration of normal motor
control patterns in the CNS
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull An athlete with an abnormal breathing pattern during
physical activity may experience premature
breathlessness or muscle fatigue resulting in decreased
performance
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull Breathing patterns are established subcortically and often
associated with an injury pain andor movement
dysfunction
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
bull ldquoIf breathing is not normalized no other movement
pattern can berdquo
The International Journal of Sports Physical Therapy | Volume 11 Number 5 | October 2016
CO₂ amp INJURY
bull Skeletal muscle injuries are commonly observed in sports
and traumatology medicine
bull We investigate whether transcutaneous CO2 application
could enhance recovery from muscle injury
Int Orthop 2017 May41(5)1007-1015
bull Tibialis anterior muscle damage was induced in 27
Sprague Dawley rats
bull After muscle injury rats were randomly assigned to
transcutaneous CO2-treated or -untreated groups From
each group three rats were sacrificed at weeks one two
four and six
Int Orthop 2017 May41(5)1007-1015
bull Injured muscle fibres were completely repaired at week
six in the CO2-treated group but only partially repaired in
the untreated group
Int Orthop 2017 May41(5)1007-1015
bull Endurance exercise generates CO2 via aerobic
metabolism however its role remains unclear
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Exogenous CO2 by transcutaneous delivery promotes
muscle fibre-type switching to increase endurance power
in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Here we determined the performance of rats running in
activity wheels withwithout transcutaneous
CO2 exposure to clarify its effect on endurance exercise
and recovery from muscle fatigue
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Running performance improved over the treatment period
in the CO2 group with a concomitant switch in muscle
fibres to slow-type
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull The mitochondrial DNA content and capillary density in
the CO2 group increased CO2 was beneficial for
performance and muscle development during endurance
exercise it may enhance recovery from fatigue and
support anabolic metabolism in skeletal muscles
Ueha T Increase in carbon dioxide accelerates the performance of endurance exercise in rats J Physiol Sci 2017 Jun 10
bull Carbon dioxide (CO(2)) therapy refers to the
transcutaneous administration of CO(2) for therapeutic
purposes This effect has been explained by an increase
in the pressure of O(2) in tissues known as the Bohr
effect
PLoS One 20116(9)e24137
bull In this study we investigate whether the Bohr effect is
caused by transcutaneous application of CO2 in human
living body
PLoS One 20116(9)e24137
bull Application of CO(2) using pure CO(2) gas
bull The intracellular pH of the triceps surae muscle decreased
significantly 10 min after transcutaneous application of CO(2)
bull The NIRS data show the oxy-Hb concentration decreased
significantly 4 min after CO(2) application and deoxy-Hb
concentration increased significantly 2 min after CO(2)
application in the CO(2)-applied group compared to the control
group
PLoS One 20116(9)e24137
bull Our novel transcutaneous CO(2) application facilitated an
O(2) dissociation from Hb in the human body thus
providing evidence of the Bohr effect in vivo
PLoS One 20116(9)e24137
THE HEART
THE HEART bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K
Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate
AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology 89831-7
CARDIAC ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment
Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG
Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary
minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
BREATH HOLDING BREAKPOINT
BREATH HOLDING BREAK POINT
HOW TO MEASURE UPPER LIMIT OF BREATHLESSNESS-
bull Inspiratory muscle activity was the final common pathway
determining the breakpoint
bull The onset of electrical activity during a breath holding
period is closely related to the alveolar Pc02
bull Agostoni E Diaphragm activity during breath holding factors related to its onset J
Appl Physiol 1963 1830-6
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Edward Schneider a pioneer of breath-holding research
described a subject lasting for 15 minutes and 13
seconds under comparable conditions in the 1930s
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull 1959 physiologist Hermann Rahn used a combination of
unusual methodsmdashslowing his metabolism
hyperventilating filling his lungs with pure oxygen and
more to hold his breath for almost 14 minutes
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The lungs alone should contain enough oxygen to
sustain us for about four minutes In the same vein
carbon dioxide does not accumulate to toxic levels in the
blood quickly enough to explain the one-minute limit
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull Breath-holding divers feel compelled to draw a breath
well before they actually run out of oxygen As Schneider
observed ldquoit is practically impossible for a man at sea
level to voluntarily hold his breath until he becomes
unconsciousrdquo
bull Parkes Scientific American April 2012
WHAT DETERMINES HOW LONG WE CAN HOLD OUR BREATH
bull The break point may depend very much on stimuli that
reach the brain from the diaphragm During such a
lengthy contraction the brain might subconsciously
perceive the unusual signals from the diaphragm as
vaguely uncomfortable at first but eventually as
intolerable causing the break point The automatic
rhythm then regains control
bull Parkes Scientific American April 2012
BREATH HOLDING BREAKPOINT
bull The precise mechanisms explaining breath-holding and
causing the breath at breakpoint are unknown There are
several useful reviews (Mithoefer 1965 Godfrey amp
Campbell 1968 1969 Porter 1970 Campbell amp Guz
1981 Lin 1982 Nunn 1987)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull During breath-holding the arterial or end tidal partial
pressure of oxygen falls below its normal level of sim100
mmHg and that of carbon dioxide rises above its normal
level of sim40 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull At breakpoint from maximum inflation in air the PetO2 is
typically 62 plusmn 4 mmHg and the PetCO2 is typically 54 plusmn 2
mmHg and the longer the breath-hold the more they
change
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull It is remarkable that adults normally cannot breath-hold
consistently to unconsciousness even under laboratory
supervision Nunn (1987) estimates that consciousness
in normal adults is lost at PO2 levels below sim27 mmHg
and PCO2 levels between 90 and 120 mmHg
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
BREATH HOLDING BREAKPOINT
bull Breakpoint levels close to these have been reported
eg PetO2 levels as low as 24 mmHg PetCO2 levels as
high as 91 mmHg and breath-hold durations of 14 min or
more (Schneider 1930 Ferris et al 1946 Klocke and
Rahn 1959)
bull Parkes MJ Breath-holding and its breakpoint Exp Physiol 2006 Jan91(1)1-15
