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The Oxygen Advantage: Simple, Scientifically Proven Breathing Techniques to Help You Become Healthier, Slimmer, Faster, and Fitter by Patrick McKeown

Improve your body’s oxygen use and increase your health, weight loss, and sports performance–whether you’re a recovering couch potato or an Ironman triathlon champion.

One of the biggest obstacles to better health and fitness is a rarely identified problem: chronic over-breathing. We often take many more breaths than we need–without realizing it–contributing to poor health and fitness, including a host of disorders, from anxiety and asthma to insomnia and heart problems.

In The Oxygen Advantage, the man who has trained over 5,000 people–including Olympic and professional athletes–in reduced breathing exercises now shares his scientifically validated techniques to help you breathe more efficiently. Patrick McKeown teaches you the fundamental relationship between oxygen and the body, then gets you started with a Body Oxygen Level Test (BOLT) to determine how efficiently your body uses oxygen. He then shows you how to increase your BOLT score by using light breathing exercises and learning how to simulate high altitude training, a technique used by Navy SEALs and professional athletes to help increase endurance, weight loss, and vital red blood cells to dramatically improve cardio-fitness.

Following his program, even the most out-of-shape person (including those with chronic respiratory conditions such as asthma) can climb stairs, run for a bus, or play soccer without gasping for air, and everyone can achieve:

Easy weight loss and weight maintenance Improved sleep and energy Increased concentration Reduced breathlessness during exercise Heightened athletic performance Improved cardiovascular health Elimination of asthmatic symptoms, and more.

With The Oxygen Advantage, you can look better, feel better, and do more–it’s as easy as breathing.

Chronic Overbreathing

Scientific research, as well as the experience of thousands of people I have worked with, has shown me the vital importance of learning how to breathe correctly. The problem is that correct breathing, which should be everyone’s birthright, has become extremely challenging in our modern society. We assume that the body reflexively knows how much air it needs at all times, but unfortunately this is not the case. Over the centuries we have altered our environment so dramatically that many of us have forgotten our innate way of breathing. The process of breathing has been warped by chronic stress, sedentary lifestyles, unhealthy diets, overheated homes, and lack of fitness. All of these contribute to poor breathing habits. These in turn contribute to lethargy, weight gain, sleeping problems, respiratory conditions, and heart disease.

Our ancestors lived on a natural diet in a far less competitive environment and physically worked hard, a lifestyle conducive to maintaining an efficient breathing pattern. Compare that to modern-day living, in which we spend hours slouched at a desk on computers and talking on phones, surviving on a rushed lunch of convenience food, trying to manage a seemingly neverending series of tasks and financial obligations.

Modern living gradually increases the amount of air we breathe, and while getting more oxygen into our lungs might seem like a good idea, it is in fact light breathing that is a testament to good health and fitness. Think of an overweight tourist and an Olympian both arriving for the Summer Games. As they picked up their luggage and carried it up a flight of stairs, whom would you expect to be huffing and puffing? Certainly not the Olympian.

The biggest obstacle to your health and fitness is a rarely identified problem: chronic overbreathing. We can breathe two to three times more air than required without knowing it. To help determine if you are overbreathing, see how many of these questions you answer “yes” to:

•  Do you sometimes breathe through your mouth as you go about your daily activities?
•  Do you breathe through your mouth during deep sleep? (If you are not sure, do you wake up with a dry mouth in the morning?)
•  Do you snore or hold your breath during sleep?
•  Can you visibly notice your breathing during rest? To find out, take a look at your breathing right now. Spend a minute observing the movements of your chest or abdomen as you take each breath. The more movement you see, the heavier you breathe.
•  When you observe your breathing, do you see more movements from the chest than from the abdomen?
•  Do you regularly sigh throughout the day? (While one sigh every now and again is not an issue, regular sighing is enough to maintain chronic overbreathing.)
•  Do you sometimes hear your breathing during rest?
•  Do you experience symptoms resulting from habitual overbreathing, such as nasal congestion, tightening of the airways, fatigue, dizziness, or light-headedness?

Answering yes to some or all of the questions above suggests a tendency to overbreathe. These traits are typical of what happens when the amount of air we breathe is greater than what we need. Just as we have an optimal quantity of water and food to consume each day, we also have an optimal quantity of air to breathe. And just as eating too much can be damaging to our health, so can overbreathing.

The unconscious habit of overbreathing has hit epidemic proportions all across the industrialized world, and it’s highly detrimental to our health. Chronic overbreathing leads to loss of health, poor fitness, and compromised performance and also contributes to many ailments including anxiety, asthma, fatigue, insomnia, heart problems, and even obesity. It may seem strange that such a disparate range of complaints can be caused by or worsened by overbreathing, but the breath of life influences literally every aspect of our health.

The purpose of this book is to return you to how you were meant to live and breathe. I will teach you simple methods that will counteract bad breathing habits, unearthing a new well of cardiovascular fitness that will improve your overall health and well-being. Serious athletes will achieve new levels of performance, fitness enthusiasts will unleash untapped potential, and those who are still trying to manage their health will overcome barriers to a more healthful lifestyle.

But, as with all conditions, to arrive at the remedy it’s crucial to first understand the ailment.

It is how you breathe during your daily life that determines how you breathe during physical exercise. Breathing too much air every minute, every hour, every day translates into excessive breathlessness during exercise. If our breathing is off during rest, it would be unreasonable to expect it to automatically correct itself during physical exercise. The seemingly innocuous tendency to breathe through the mouth during the day or night and breathe noticeably during rest means you will be more breathless during training and often limits your capacity to go faster and farther.

These poor breathing habits can be the difference between a healthy and vibrant life and an ill and feeble one. Overbreathing causes the narrowing of airways, limiting your body’s ability to oxygenate, and the constriction of blood vessels, leading to reduced blood flow to the heart and other organs and muscles. These systemic impacts affect your health profoundly, whether you’re a professional athlete or your main exercise is walking up the stairs of your house. Great sports careers can plateau or even be cut short by an athlete’s overbreathing. The lungs let the individual down, and—no matter how strong the rest of the body is—unnecessary, excess breaths take their toll. As most athletes know, our lungs give out long before our arms and legs.

It all comes down to our need for that invisible yet vital basis for human life: oxygen. Here’s the paradox: The amount of oxygen your muscles, organs, and tissues are able to use is not entirely dependent on the amount of oxygen in your blood. Our red blood cells are saturated with between 95 and 99 percent oxygen, and that’s plenty for even the most strenuous exercise. (A few of my clients with serious pulmonary disease have a lower oxygen saturation level, but this is very rare.) What determines how much of this oxygen your body can use is actually the amount of carbon dioxide in your blood. You may remember from biology class that we breathe in oxygen and breathe out carbon dioxide, also called CO₂. Most people learn that carbon dioxide is just a waste gas that we exhale from our lungs, but it is not a waste gas. It is the key variable that allows the release of oxygen from the red blood cells to be metabolized by the body. This is called the Bohr Effect. Understanding and utilizing this physiological principle will allow you to stop overbreathing.

Discovered over a hundred years ago, the Bohr Effect explains the release of oxygen to working muscles and organs. Most people don’t realize that the amount of carbon dioxide present in our blood cells determines how much oxygen we can use. The crux of it is this: How we breathe determines the levels of carbon dioxide present in our blood. When we breathe correctly, we have a sufficient amount of carbon dioxide, and our breathing is quiet, controlled, and rhythmic. If we are overbreathing, our breathing is heavy, more intense, and erratic, and we exhale too much carbon dioxide, leaving our body literally gasping for oxygen.

It’s very intuitive: If we breathe better, increasing the amount of carbon dioxide inside us, then we can deliver more oxygen to our muscles and organs, including the heart and brain, and thus heighten our physical capacity. All we’re really doing is assisting the body in working the way it was meant to work in the first place.

The Oxygen Advantage

The explanation of the Bohr effect and how the body delivers oxygen was really an eye-opener to me. It reminds me of what Rich Roll wrote in his book Finding Ultra about the training method his trainer gave him to improve his running resistance. The instructions he received were basically to run at a pace that wouldn’t give him a heart rate over 140 beats per minute, even if that meant to run extremely slow and walk often. Very similar, Patrick explains several ways to train in this book that train the body to do more with less. For instance, forcing oneself to breathe only through the nose while training.

Measuring Fitness through the BOLT score

There is a great method to measure how efficient our breathing is. It is called the BOLT score. But first, we must understand what it means to be fit in relation to breathing.

It has been said that one of the main differences between endurance athletes and nonathletes is their response to low pressures of oxygen (hypoxia) and higher levels of carbon dioxide (hypercapnia). In other words, endurance athletes are able to tolerate a greater concentration of carbon dioxide and lower concentration of oxygen in the blood during exercise. Intense physical exercise results in increased consumption of oxygen and increased production of carbon dioxide, so it is vitally important that athletes are able to cope well with changes to these gases.

In order to attain outstanding performance during sports, it is essential that your breathing does not react too strongly to increased concentrations of carbon dioxide and decreased concentrations of oxygen. Over time, intense physical training will help to condition the body to better tolerate these changes, but a more effective method can be found in the pages of this book. The breathing exercises outlined in the Oxygen Advantage program can easily be incorporated into any form of exercise, no matter what your fitness level and even if you are laid up with an injury. You can even improve your fitness using a simple 10-minute exercise while sitting down.

A performance-related term you need to know is maximal oxygen uptake, or VO₂ max. This simply refers to the maximum capacity of your body to transport and utilize oxygen in 1 minute during maximal or exhaustive exercise. VO₂ max is one factor that can determine an athlete’s capacity to sustain physical exercise and is considered to be the best indicator of cardiorespiratory endurance and aerobic fitness. In sports that require exceptional endurance, such as cycling, rowing, swimming, and running, world-class athletes typically have a high VO₂ max.

Furthermore, the goal of most endurance programs is to increase VO₂ max.
Studies have shown that athletic ability to perform during increased carbon dioxide and reduced oxygen pressure corresponds to maximal oxygen uptake. In other words, the ability to tolerate higher concentrations of carbon dioxide in the blood means a higher VO₂ max can be achieved, culminating in better delivery and utilization of oxygen by the working muscles.

The Body Oxygen Level Test (BOLT)

As far back as 1975, researchers noted that the length of time of a comfortable breath hold served as a simple test to determine relative breathing volume during rest and breathlessness during physical exercise. The Body Oxygen Level Test (BOLT) is a very useful and accurate tool for determining this relative breathing volume. BOLT is simple, safe, involves no sophisticated equipment, and can be applied at any time. BOLT differs from other breath-hold tests because it represents the length of time until the first definite desire to breathe. Holding the breath until you feel the first natural desire to breathe provides useful information on how soon the first sensations of breathlessness take place and is a very useful tool for the evaluation of breathlessness. Other breath-hold tests tend to focus on the maximum time you can hold your breath, but this measurement is not objective as it can be influenced by willpower and determination.

Athletes possess bucketloads of willpower and determination, so there is no doubt that many of us will be tempted to measure our BOLT score by holding the breath for as long as possible. But if you are serious about improving your breathing efficiency and VO₂ max using the breath-hold exercises in this book, I urge you to follow the instructions carefully and measure your BOLT correctly—by holding your breath only until the first distinct urge to breathe is felt.

In short, the lower the BOLT score, the greater the breathing volume, and the greater your breathing volume, the more breathlessness you will experience during exercise.

To obtain an accurate measurement, it’s best to rest for 10 minutes before measuring your BOLT score. Read the instructions carefully first and have a timer on hand. You can measure your BOLT now:

1. Take a normal breath in through your nose and allow a normal breath out through your nose.
2. Hold your nose with your fingers to prevent air from entering your lungs.
3. Time the number of seconds until you feel the first definite desire to breathe, or the first stresses of your body urging you to breathe. These sensations may include the need to swallow or a constriction of the airways. You may also feel the first involuntary contractions of your breathing muscles in your abdomen or throat as the body gives the message to resume breathing. (Note that BOLT is not a measurement of how long you can hold your breath but simply the time it takes for your body to react to a lack of air.)
4. Release your nose, stop the timer, and breathe in through your nose. Your inhalation at the end of the breath hold should be calm.
5. Resume normal breathing.

Please be aware of the following important points when measuring your BOLT score:

•  The breath is taken after a gentle exhalation.
•  The breath is held until the breathing muscles first begin to move. You are not measuring the maximum time that you can hold your breath.
•  If you do not feel the first involuntary movements of your breathing muscles, then release your nose when you feel the first definite urge or first distinct stress to resume breathing.
•  The BOLT is not an exercise to correct your breathing.
•  Remember that measuring your BOLT involves holding your breath only until you feel the first involuntary movements of your breathing muscles. If you need to take a big breath at the end of the breath hold, then you have held your breath for too long.

How to train our breathing

At this point you have an idea why good breathing matters. The question you probably have — or should have — is, how can I train my breathing to increase my bolt score?

I’d highly recommend the Wim Hof breathing method as it seems a better system for daily practice to me than what is presented in this book. But I will quote one technique from the author.

Simulate High-Altitude Training While Walking

We begin by introducing a simple walking exercise that enables you to achieve similar benefits to those experienced during intense physical training in as little as 10 to 15 minutes. The beauty of this exercise is that it can be performed anywhere and at any time, even if an injury is preventing you from engaging in normal training. Similar to any intense physical exercise, it is important to practice at least two hours after eating. Just as it is not advisable to go for a jog directly after eating, it is also best to practice breathing exercises on an empty stomach. Not only would it be uncomfortable to perform breath holds too soon after a meal, but the benefit of the exercise would be much reduced as the process of digestion increases breathing.

During this exercise you will be practicing breath holds as you walk. For the first 2 to 3 breath holds, in order to gently acclimatize your body to lower levels of oxygen, it’s important to hold your breath only until you feel a medium hunger for air. For the remaining breath holds, challenge yourself by aiming to achieve a relatively strong need for air. Due to a delay in the pulse transit time, it is common for the decrease in oxygen saturation to take place not during the breath hold, but soon after it. Therefore, to get the most from the exercise, minimize breathing for about 15 seconds following the breath hold by taking short breaths in and out through the nose. If you have a pulse oximeter, you might enjoy observing the decrease to your oxygen saturation as you do this—effectively simulating high-altitude training and bringing the mountain to you.

•  Walk and hold:After a minute of continuous walking, gently exhale and pinch your nose to hold your breath. If you feel uncomfortable pinching your nose while walking in public, you can simply hold your breath without holding your nose. Continue to walk while holding your breath until you feel a medium to strong air shortage. Release your nose, inhale through it, and minimize your breathing by taking very short breaths for about 15 seconds. Then allow your breathing to return to normal.
•  Continue walking for 30 seconds and repeat:Continue walking for around 30 seconds while breathing through your nose, then gently exhale and pinch your nose with your fingers. Walk while holding the breath until you feel a medium to strong hunger for air. Release your nose and minimize your breathing by taking short breaths in and out through your nose for about 15 seconds. Then allow your breathing to revert to normal.
•  Repeat breath holds 8 to 10 times:While continuing to walk, perform a breath hold every minute or so in order to create a medium to strong need for air. Minimize your breathing for 15 seconds following each breath hold. Repeat for a total of 8 to 10 breath holds during your walk.

This exercise will take about 12 minutes to complete and is highly effective at teaching your body to do more with less. At first you may only be able to hold your breath for 20 or 30 paces before you feel a strong air shortage (or less if you have asthma or are out of breath). As the number of paces per breath hold increases, the air shortage you experience will progress from easy to moderate to strong. As you feel an increased hunger for air, the breathing muscles in your abdomen or neck will begin to contract or spasm. An added effect of the contractions is to provide your diaphragm with a workout, thereby strengthening your main breathing muscle. During the longer breath holds, as you feel your breathing muscles spasm, focus on relaxing your body. Allow your muscles to go soft as you hold your breath. Relaxing the body in this way allows a longer breath hold with less stress.

With repetition, as the weeks go by, you will find yourself being able to hold your breath for 80 to 100 paces. Your ability to hold your breath will increase with practice and without stressing your body. Do not overdo it. Ideally, your breathing should recover easily and become calm within 3 or 4 breaths. While this exercise is a challenge, it should not be stressful.

If you notice any side effects, such as an elevated or stronger than normal pulse for a prolonged period after completing breath holding, then it is best to refrain from performing the stronger breath holds. Instead, concentrate on breathing lightly both during rest and physical exercise to bring benefit to your health and sports.

Breath holding can also be incorporated into a jog, run, or bike ride. While you may not be able to hold your breath for as many paces during a jog as you can during a walk, the quality of the exercise will be better because of the greater accumulation of carbon dioxide in the blood.

Breath holding during training adds an extra load that would only otherwise be experienced during maximum intensity exercise.

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