Health, Podcast, Science

Breathing and The Oxygen Advantage with Patrick McKeown | EP#127

 May 14, 2018

By  Mikael Eriksson

Breathing and The Oxygen Advantage with Patrick McKeown | EP#127

Can a different way of breathing make you a better triathlete?

International best-selling author Patrick McKeown, creator of the revolutionary Oxygen Advantage technique tells us about how breathing can improve your performance in both triathlon and general health.

Discuss this episode!

  • Let's discuss this episode and the topic in general. Post any comments or questions in the comments at the bottom of the shownotes. Join the discussion here!

In this Episode you'll learn about:

  • Nose breathing and taking smaller breaths
  • Benefits for triathletes: improved VO2max, running eonomy, oxygen delivery, delayed lactic acid onset, CO2-tolerance, injury prevention, and legal EPO
  • Health benefits: improved sleep, concentration, and reduced stress and anxiety
  • Assess your breathing with the simple BOLT-test
  • How to implement the Oxygen Advantage techniques in your everyday life and in triathlon training

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About Patrick McKeown

0:35 - 

  • Patrick teaches a set of breathing techniques.
  • He proposes that by breathing through your nose rather than your mouth and by taking smaller breaths you can improve both health and performance in a variety of ways from delayed lactic acid, improved VO2max, increased lung capacity and respiratory muscle strength, reduction of risk of injury, and decreased anxiety and stress.
  • He's the international best selling author of the book, The Oxygen Advantage.

About the Oxygen Advantage breathing technique

4:02 -

  • The Oxygen Advantage is looking at athletic performance from two different angles.
  • Number one is, we need to assess the functional breathing and an athlete. It's very important for the stability of the spine, for core strength, for reducing risk of injury, for motor movements that breathing is functional. 
  • How well is their everyday breathing? How your breathe during sports is determined primarily by how you breathe in you're everyday breathing. And a lot of athletes have poor breathing patterns.
  • The second aspect of it is looking at different exercises to lower blood oxygen saturation. We can create a hypoxic effect where there's inadequate oxygen at a tissue level. And we can also create a hypercapnic response, which is high CO2.
  • So we use breath holding to challenge the body and that's going to increase resilience to hypoxia and improve buffering capacity.

Background and areas where nose breathing matters

6:04 -

  • There's a lot of research that's come out in the last number of years, looking at breathing pattern disorders and the negative effects that it's having. 
  • For example, one paper looked at the correlation between the functional movement screen, the FMS, and breathing. Athletes who scored poorly on the FMS also had poor breathing patterns.
  • How well is their everyday breathing? How your breathe during sports is determined primarily by how you breathe in you're everyday breathing. And a lot of athletes have poor breathing patterns.
  • The basis of all of this stems from 1904, when a  physiologist from Denmark named Christian Bohr. He talked about the partial pressure of carbon dioxide in the blood being important, because in order for oxygen to be released from the red blood cells to the cells, you need carbon dioxide.
  • Big breathing is just going to get rid of CO2. The harder you breathe, the more breathless you are, the more your blood vessels constrict and the less oxygen is delivered to the cells. That's just normal basic physiology.
  • There's lots of studies showing that mouth breathing is activating the accessory inspiratory muscles rather than the diaphragm, and really, we need diaphragmatic movement. I'm not saying that there's going to be no movement from the diaphragm by mouth breathing, but there's going to be a lot less. There's quite a few studies on that.
  • Your nose is linked to your diaphragm and your diaphragm is linked to your emotions, so even emotional stability can be improved by nose breathing.
  • When you breathe through your nose, you pick up nitric oxide. That nitric oxide is a natural bronco dilator. It opens up your airways.
  • If you're breathing through your mouth, you're taking more air into the upper part of the lungs, so there's a poor gas exchange taking place. When you breathe in through your nose, you take the air deeper into the lungs.
  • When you breathe slowly, your mind is quieter. And conversely, when you breathe fast, your mind gets agitated. The stress causes us to breathe fast, and fast breathing also feeds into stress.
  • There are also links with focus and concentration.
  • There's a lot of documented evidence going back many, many years on the importance of nose breathing during sleep.You cannot have a good night's sleep if you're sleeping with your mouth open and you're waking up with a dry mouth in the morning.
  • There's also a strong link between mouth breathing and asthma. 
  • Nose breathing can even be used to simulate altitude training.

How to breathe correctly


  • Breathe through your nose.
  • Don't take big breaths.

BOLT (Body Oxygen Level Test)


  • The BOLT-score is a measurement that we use to track the breathlessness of an individual.
  • You take a normal breath in through your nose, a normal breath out through your nose. You pinch your nose, your hold your nose with your fingers and you count how many seconds it takes until you feel the first definite desire to breathe. Then you let go.
  • It's not a breath hold test. When your resume breathing, your breath should be relatively calm.
  • If it's less than 25 seconds, it's indicative of dysfunctional breathing. 25 is the lowest acceptable level. 
  • The goal is to be able to hold your breath for 40 seconds before getting the urge to initiate breathing. 
  • There are elite athletes that have BOLT-scores of 9-10 seconds.

Oxygen and carbon dioxide (CO2) and breathing

16:31 -

  • What drives your breathing is usually not oxygen, but carbon dioxide (CO2).
  • Oxygen starts driving breathing when your oxygen levels drop by half, and that will tend only to happen if you're doing, say, high altitude training or if you're doing strong breath holds.
  • The body's response to carbon dioxide is very important during physical exercise. Because when you do physical exercise, you generate more carbon dioxide. 
  • If you've got a strong reaction to carbon dioxide, you're breathing is going to be hard.
  • So what we do is we're getting straight into breathing and change the chemo sensitivity of the brain to carbon dioxide. We want the body to be able to cope with changes in O2 and CO2 both during rest and also during physical exercise.

Endurance athletes and breathing

19:10 -

  • It's estimated that up to 50 percent of athletes are prone to diaphragmatic fatigue and physical exercise doesn't strengthen to diaphragm.
  • Probably the only exception to that is swimming, because you are breathing against resistance, so it is adding an extra load onto your breathing muscles.
  • So what we want to do is we want to improve breathing efficiency. How much air do you need for a given level of physical exercise?
  • In order to train the diaphragm muscle, you need to be nose breathing.
  • If you do a breath hold, what happens is your blood oxygen levels (SpO2) will drop.
  • If you're going for a sprint with your mouth open your blood oxygen saturation will drop from about 97 percent to about 93 percent.

    If you do that same sprint with your mouth closed it will drop down to about 91 percent. So you're going into mild hypoxia at that stage.

    Now when we're doing breath holding we cause severe hypoxia, because we're dropping it down to say 85 percent or even down to 80 percent SpO2. 
  • We use what's called an exhale-hold technique. If you simply breathe in strongly and hold, you're unlikely to get a hypoxic response. You're more likely to get what's called hypercapnic response, high CO2. Instead, breathe in through your nose normally and then pinch your nose.
  • Then we'd have the individual, say, walk. Then, as the air hunger gets stronger, we'd have to increase the intensity. So we are causing a hypoxic and hypercapnic response
  • In hypoxia you're exposing the body to inadequate oxygen to cause it to make adaptations to improve the buffering capacity. Your ability to neutralize acid increases. So you're delaying onset of lactic acid and lactic acid fatigue.
  • One study found that by using the exhale-hold technique, hemoglobin increased by about 5% and VO2max increased by 10.79%.

Simulating altitude training

25:17 - 

  • At rest at an altitude of 2500 meters, your SpO2 will drop down to about 93 percent. During physical exercise it will drop more.
  • We can simulate altitude by using breath holds while training and measuring SpO2 with a pulse oximeter, that you can get for 30 euros from Amazon. 
  • We're not just looking at the simulation of altitude training in terms of the hypoxic response. We're also increasing the hypercapnic response. And I think that's very important because it's CO2 which is the primary stimulus to breathe.
  • An altitude mask does not cause a hypoxic response. It causes a hypercapnic response, by raising the CO2-levels in the blood.
  • Whether you use an altitude mask or simulate altitude with breath holds, you can improve your anaerobic threshold because of the increased tolerance towards carbon dioxide. 

More about performance and endurance

28:12 - 

  • Now I'm not saying to do all of your training with your mouth closed, because when it gets very, very tough, there are times that you're going to have to open your mouth. But I would say as much as you want and can to get a BOLT-score of at least about 25 seconds.
  • The other thing about carbon dioxide is it's a vasodilator. It opens up your blood vessels.
  • There's also an energy cost of breathing hard. It is more taxing on the respiratory system to breathe hard compared to breathing lightly.

    If you're sitting down, up to three percent of your oxygen consumption is going to support your breathing muscles. If you do fairly high intensity exercise, it can increase to as high as10 percent. And if you do really maximum intensity exercise it will increase to 15 percent. So 15 percent of your oxygen consumption is going to support your breathing muscles. This directly affects your exercise economy.

    You can lower this energy cost and improve economy by training yourself not to breathe as hard in when you're working out. 
  • Some studies have shown improvements in running economy of up to six percent with breath hold training. 

" This is about so many different applications from improving your everyday breathing, reducing the risk of injury, better spinal stability, improving core strength and reducing lactic acid and fatigue, improving aerobic capacity and VO2max, improving running economy... And that's what I spent four or five years doing - just joining the dots together. "

Practical advice and how to get started

  • First, take the BOLT-test. Follow the instructions in this video
  • Do an experiment to see how you can influence your blood circulation by changing your breathing:
    • Put one hand on your chest, one on your tummy as you're sitting down. Pay attention to the air flow as it comes in and out of the nose and start gently slowing down the breathing.
    • Do not to hold the breath, don't freeze the breath, don't tense the breathing muscles. Just to gently soften the breath to the point that you feel air hunger, which is signifying that carbon dioxide has increased in the blood.
    • Do that for about three minutes and check a number of things.
    • Do you have a change in body temperature? Do you have increased watery saliva in your mouth?
    • Practice changing your breathing like this daily or a few times per day, and that will increase your BOLT-score. And then that translates into better breathing efficiency during sports performance.
    • It is tremendous to do this before going to sleep.
  • Pre-competition we would do relaxation first to focus the mind. Reduce breathing. But that makes you kind of drowsy because it's activating a parasympathetic response. 

    Therefore, you would then do do six to 10 strong breath holds. That activates a sympathetic response. It also causes the arteries in the brain to dilate, so it makes you alert, it makes you focus.

    Finally, do 30 seconds of hyperventilation to get rid of the acid.
  • In training, if I'm working with an elite athlete, we would do 70% nose breathing, 30% mouth breathing.

Emil Zatopek, 3-time Olympic champion distance runner

" He discovered two things as part of his training that he regularly put into it. One was high intensity interval training, and the second one was breath holding."

Patrick's Oxygen Advantage Webinar

  • Patrick works with athletes around the world through a two-hour, in-depth webinar.
  • Learn more and sign up here
  • The price of the Webinar is $95

Rapid-fire questions

Favorite book, blog, or resource related to triathlon or endurance sports:

Personal habit that's helped you achieve success:

  • Switching to nose breathing saved my life

What do you wish you had known or wish you'd done differently:

  • Not breathing through the mouth for my first 20 years

Key takeaways

  • Take the BOLT-test to find your level of breathlessness. Do you get to the acceptable level of 25 seconds or higher?
  • Breathing can improve endurance performance significantly through various mechanisms like improved VO2max, improved vasodilation, improved blood flow, improved brain oxygenation, improved tolerance to CO2 and lactic acid, and more.
  • There may be a huge upside to doing basic breathing exercises described in this episode for just 3 minutes a couple of times per day either outside of training or in (lighter, to start with at least) training.

Links, resources and contact

Links and resources mentioned

Connect with Patrick McKeown

Connect with host Mikael Eriksson


Hi! I'm your host Mikael,

I am a full-time triathlon coach and an ambitious age-group triathlete. My goal is podium at the Finnish national championships within the next few years.

I first started the website Scientific Triathlon in autumn 2015 as a passion project to share my learnings with a larger triathlon audience. Later on, in early 2017 I started the podcast That Triathlon Show. 

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Let's discuss this episode and the topic in general. Post any comments or questions in the comments below. I'll be here to reply and take an active part in the conversation, so don't be shy! 

Mikael Eriksson

I am a full-time triathlon coach, founder of Scientific Triathlon, and host of the top-rated podcast That Triathlon Show. I am from Finland but live in Lisbon, Portugal.

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