How To Use an Elevation Mask for Healthier, Stronger Breathing: Everything You Need to Know
The Benefits of SportsMask, an Altitude Mask by the Creator of the Oxygen Advantage® for Sports Performance and Health
There’s that one guy at the gym with all the gear. He’s always there, pounding the treadmill, his face straining behind a tightly fitted exercise mask. His workout looks intense, because it is. But is he actually benefiting from the mask? Exercise masks promise better breathing efficiency and breathing muscle strength. Also known as a high elevation mask, workout mask or altitude mask, many people use them in the belief that they simulate training at high altitude. And most people breathe heavily through the mouth while wearing them.
To put the exercise mask in context, self-improvement is big right now. People are more than willing to invest in gadgets that claim to help them train better, live better and ‘win’ better. One of the newest wellness trends is something called ‘breathwork’. Of course, it’s not new at all. Yogic breathing techniques go back thousands of years, and practices like the Buteyko Method have been around for decades. But the Covid-19 pandemic has sparked more interest in the breath, and scientific research has begun to delve further into breathing re-education and its therapeutic uses.
While one of the benefits of breathwork is that it’s so accessible, requiring no costly equipment to practice, there are some accessories that can be helpful. Despite questions around its efficacy, the exercise breathing mask is one such tool. As with every trend in wellbeing, the exercise breathing mask is dismissed by some as ‘unscientific’. But used correctly, it’s considered the athlete’s ‘secret weapon’.
Another reason to read this article to the end is that by using an altitude mask incorrectly, you could do more harm than good. According to Dr. Mitch Lomax, of Plymouth University’s Department of Sport and Exercise Science: “If it isn’t done right, there is the risk of hyperventilating and passing out. Technique with these devices really matters because they can also cause injury or strain if they aren’t used correctly.”
With that in mind, let’s look at the evidence. What is an elevation mask? Does a training mask really work? What does it do? Does the altitude mask have uses outside of sport that may benefit a wider group of people? And how should you be using it to see results?
What is a Training Mask?
We know from the simplest breathing exercises that it is possible to change the way we breathe. We can slow the breath down, speed it up, breathe more or less air and hold the breath. We also know that the best way to build and strengthen muscle is to work it harder. Even with this awareness, it might not cross your mind that you can deliberately move, and even strengthen, your diaphragm.
A training mask is a sports training device designed to strengthen the breathing muscles, in particular, the diaphragm. It does this by adding resistance to the breathing. An elevation mask reduces the volume of air you breathe. This adds a ‘load’ to the breathing muscles, making them work harder.
What is a training mask? It is a device based on an idea called respiratory muscle training, which was originally developed for patients with COPD. Breath training for these patients was performed in a seated position and practiced several times a day over a period of time. Used during exercise, the training mask will create adaptations in the body that make for better endurance, oxygenation and breathing efficiency. It works gradually to strengthen the diaphragm in the same way that weightlifting progressively builds muscles in the arms.
It turns out that one reason some reviewers are dismissive about various altitude training mask products is that no training mask actually simulates training at high altitude. Even though it reduces airflow and therefore oxygen intake, it does not create the intermittent drop in blood oxygen saturation synonymous with altitude training. Simulation of high altitude training requires practice of specific breath hold exercises. To intensify the effect of the breath holding exercises, they can be practiced whilst wearing the mask. Only then can it realistically be called an altitude training mask.
Breathe Through Your Nose
Remember the guy at the start of this article? Pounding away on the treadmill, breathing heavily through his mouth? It’s important to understand that an altitude mask for running will be most effective if you can learn to maintain nasal breathing.
Nose breathing is healthy breathing. It ensures that inhaled air is warmed, humidified and filtered before it reaches the airways. You might believe that your mask is filtering the air, but the training mask won’t help you access nasal nitric oxide, an important gas that acts to open the blood vessels in the airways and lungs. Nose breathing harnesses significant quantities of nasal nitric oxide, which, once in the lungs, improves exchange of oxygen and carbon dioxide. Nitric oxide is known to be antiviral, antibacterial and anti-pathogenic.
Nose breathing is slower, engaging the diaphragm, while mouth breathing tends to be fast and in the upper chest. Because the nostrils provide a smaller opening than the mouth, nasal breathing adds greater resistance, both to the inhalation and exhalation. This causes air to stay in the lungs for longer. The result; more air gets to the alveoli, the tiny air sacs where gas exchange occurs. For this reason, nose breathing prompts a 10 to 20% greater uptake of oxygen to the blood1.
Even inside your mask, nasal breathing is better. A review published in Frontiers in Physiology in 2019 demonstrated that nasal breathing generates greater lung volume and diaphragm activity than mouth breathing2. The study found that loaded breathing through the nose was more effective in recruiting breathing muscles including the diaphragm, and produced greater improvements in lung volume, than loaded breathing through the mouth.
What is the Diaphragm?
The diaphragm is the largest breathing muscle. It is a thin muscle located between the chest and the abdomen. During inhalation, it contracts, flattens and descends, drawing air into the lungs. During exhalation, it relaxes, pushing air out of the lungs3. As this description implies, inhalation is more active, while exhalation is more passive. The diaphragm is a striated muscle – the same type as the muscles that move the joints of the skeleton4. The fact that it is under conscious control can be demonstrated with this simple exercise:
- Put your hand on your belly button
- Push your belly out by making your abdominal wall bulge
The only muscle that can make this happen is the diaphragm5. It does so by pushing down on the contents of the abdomen.
As well as being the main ‘inspiratory’ muscle (it’s active on the inhalation), the diaphragm is vital for functions outside of breathing too. It is important for spinal stability, core strength, ease of movement and other bodily functions.
If the diaphragm can be consciously moved and is the same as the muscles that move the joints, this indicates that it can be trained, strengthened and improved. A stronger diaphragm can be valuable for breathing efficiency in sports.
Diaphragm exercises have other therapeutic uses too, for example, in the correction of pelvic floor conditions. And research has established the importance of diaphragm breathing for treating urinary incontinence in men who have had prostate surgery6. Scientists have also confirmed that breathing exercises which increase the strength of the breathing muscles improve lung function in older smokers7 and people with asthma8. This indicates several potential roles for the training mask outside of sport.
Why Choose the SportsMask Exercise Mask?
SportsMask is a patented training mask designed by world-renowned breathing expert and creator of the Oxygen Advantage®, Patrick McKeown. It is an altitude training mask for use during exercise, and with the Oxygen Advantage® breathing exercises to simulate high altitude training. It features a secure head strap, ensuring it stays in place during vigorous exercise. It works via an adjustable vent that adds varying degrees of resistance to the breathing. The vent on the training mask can be opened or closed to add more or less ‘load’. The varied resistance settings mean you can control the intensity of training.
SportsMask comes with a manual and training videos that explain the scientifically based techniques for altitude training at sea level. And SportsMask high elevation mask is trusted by sports professionals, emergency rescue workers and certified breathing instructors worldwide.
Unlike some breath training tools, SportsMask altitude training mask encourages nasal breathing. Despite the fact that healthy breathing is through the nose, many breathing muscle training devices on the market use the oral airway. With these products, air is inhaled and exhaled against resistance using a mouthpiece. A recent scientific study into loaded breathing muscle training concluded that nasal breathing is better for the respiratory system2.
Added to which, by training in an altitude mask for runners like SportsMask oxygen training mask, you will develop the ability to maintain nasal breathing for a higher duration and intensity of exercise. This provides many benefits including the reduction of exercise-induced asthma and bronchoconstriction, and better oxygenation.
When you use SportsMask, you breathe against resistance, so your breathing muscles work harder. Because the opening of the valve on the mask is adjustable in order to vary resistance, regular use conditions the breathing muscles in a similar way to weightlifting. The technique of using a device to restrict airflow is called inspiratory flow resistive loading (IFRL), and studies show that it can improve respiratory muscle strength by between 20 and 50 percent.
What is the Oxygen Advantage?
The Oxygen Advantage® program is a series of unique breathing exercises that optimize oxygenation for sport and health. The exercises are based on three pillars of functional breathing:
- The mechanics of breathing (diaphragm function)
- The biochemistry (exchange of oxygen and carbon dioxide)
- The cadence (the speed of the breath)
The program emphasizes the importance of breathing through the nose during training, sleep and everyday life. The exercises within the method focus on either functional breathing or exercises to simulate high altitude training.
What is High Altitude Training?
High altitude training, or simulated elevation training, involves breathing lower levels of air oxygen. This replicates conditions at high altitude where atmospheric oxygen is lower. For athletes, this type of training gives the body a natural advantage when more oxygen is available at lower elevations. The extra diaphragm strength it promotes reduces the effort required to breathe, delaying fatigue and lactic acid buildup and increasing stamina. There may also be benefits for general health, as we’ll see.
In the Oxygen Advantage® training, intermittent, progressive breath hold exercises are used to replicate the lower levels of oxygen. These breath holds cause blood oxygen saturation to drop. When blood oxygen saturation drops, the body is stimulated to break down blood sugar, giving a boost of energy. This ‘intermittent hypoxia’ (when the blood oxygen saturation repeatedly drops below normal) triggers new red blood cells to mature. It reduces the response of the breathing system to hypercapnia and hypoxia (high levels of blood carbon dioxide and low levels of blood oxygen). It enables increased VO2 max (the threshold of the body’s ability to transport and use oxygen during physical activity) and produces better running economy, better repeated sprint ability for team sports and better maintenance of fitness during rest or injury. Intermittent hypoxia has also been found valuable in speeding the process of muscle repair after injury9.
The Elevation Mask Health Benefits
The training mask benefits for sport are well documented. But there is also evidence that an altitude mask and breathing exercises to simulate high altitude may improve disease resistance and general health. One lengthy scientific study held between 1965 and 1972, examined the health of 20,000 soldiers stationed at altitudes of between 3,692 and 5,538 meters above sea level10. The men had limited access to basic personal hygiene, which meant they rarely took baths or changed their underwear. Researchers expected that a lengthy stay at high altitudes in these conditions would result in reduced performance and poor mental and physical health. Instead, they found that after two or three years, the men suffered significantly fewer illnesses like respiratory infections, hypertension, diabetes, asthma and skin diseases. The number of mental health disorders was more than halved too, despite the monotony of the men’s surroundings and anxiety around isolation from family members10. This strongly suggests that, when used with exercises to simulate altitude training, an elevation mask or workout mask may have benefits for general health.
Elevation Mask Benefits Emergency Workers
Oxygen Advantage instructors, Dirk Van Spitaels and Pieter Libot of Breathe and Connect in Antwerp, Belgium, work with emergency rescue professionals including firefighters, and in sports and corporate settings. Dirk explains that the training mask has professional uses outside sport:
“Training with Oxygen Advantage helps us to improve our breathing in complex rescue situations. Breathe and Connect combines the techniques from Oxygen Advantage® with the experience from us firefighters. In a small study we came to the conclusion that a good breathing pattern, after a long-term training, can allow us to work 15 minutes longer with breathing apparatus. Also, an improvement of communication and situation awareness leads to better solutions and faster rescue when there is a mayday. All this, just by learning how to breathe under stress!”
Dirk’s point is that by training using the breathing exercises and the exercise training mask, firefighters and other emergency personnel are able to work for 15 minutes longer in their breathing apparatus. This extra 15 minutes could mean life or death in some situations.
What is a High Altitude Mask?
A high altitude mask is the same thing as a training mask, an exercise mask and a high elevation mask. They are all just different names for the same thing. It’s an exercise breathing mask that can be used with breath hold exercises to reduce blood oxygen saturation and boost health and performance.
When the SportsMask is worn without using the breath hold exercises, it adds resistance, strengthens the inspiratory muscles and increases carbon dioxide (CO2) in the blood. By increasing CO2 in the blood, it is possible to reduce the body’s sensitivity to the gas, which is helpful in reducing breathlessness. The training mask only simulates high altitude training if it is worn to practice Oxygen Advantage® breath holding exercises.
Elevation Mask Benefits for Biochemistry and Oxygenation
When you wear any kind of mask, whether it’s a training mask for runners, an elevation mask or a protective face mask, exhaled carbon dioxide pools inside the mask. The concentration of carbon dioxide in exhaled air is around 4 or 5%. In inhaled air it’s 0.04%. A concentration of 5% carbon dioxide is perfectly safe to breathe.
When you re-breathe this carbon dioxide, levels of CO2 slightly increase in your blood. This triggers feelings of air hunger, or not getting quite enough air. When carbon dioxide rises in the blood, the blood pH drops, causing the affinity of the hemoglobin in the red blood cells for oxygen to reduce. The hemoglobin releases oxygen more readily to the tissues and organs. Blood oxygen saturation will drop temporarily, but the muscles and cells will be better oxygenated. The mechanism by which carbon dioxide prompts the hemoglobin in red blood cells to offload oxygen to the tissues is called the Bohr Effect.
One study of workout masks cites claims by manufacturers that wearing an elevation training mask will increase endurance, improve lung function and improve VO2 max11. In a report in Ace ProSource, the study’s authors described how: “The name of the device and the settings it provides would make you believe that the mask simulates different levels of altitude training. However, the decreases in saturation of oxygen in the blood were small while wearing the mask (2 percent), which is far below the desaturation experienced when a person actually climbs to higher elevations. There is no doubt, however, that wearing the mask makes it more difficult to breathe, making it more like an inspiratory muscle training device.”
The study did find increases in maximal power output and VO2 max in participants who trained using a mask, though this was thought to be due to the trapping of CO2 in the mask during exercise. Regardless, the improvements represented significant benefits for performance. The researchers concluded that the exercise training mask could be “a very valuable training adjunct for endurance athletes who are looking to improve their performance.” Dr. John Porcari, who headed the research teams said: “The ventilatory threshold is the primary limiting factor of endurance capacity, so making improvements there is potentially very exciting.”
Training Mask Purpose for Strengthening Breathing Muscles
What is a training mask? When you work out at the gym, lifting weights to get stronger and fitter, you are loading a muscle group. This is necessary in order to strengthen those muscles. You can apply a load to your muscles in various ways, using weights, tension or friction. The exercise breathing mask works using the same principle.
In order to strengthen any muscle, it is necessary to work that muscle harder. The training mask adds a load to the breathing muscles by controlling air flow. Over time, the extra resistance to breathing trains the diaphragm muscle, making it stronger. A strong diaphragm can help you reach your fitness goals, and it can be really beneficial for health.
Scientists believe that the diaphragm is the most important breathing muscle to target. One study shows that more than half of healthy athletes develop diaphragmatic fatigue after bouts of high intensity training12. When worn during training, the workout mask strengthens the diaphragm. When breath hold exercises are practiced along with the mask, the diaphragm gets an even more thorough workout.
The SportsMask can be worn to practice Oxygen Advantage® exercises to reduce the volume of breathing. During breathe light exercises for biochemistry, biomechanics and cadence, an altitude mask for runners will slow down the breathing and generate a feeling of air hunger. To help counter the feeling of air hunger while wearing the mask, it is easier if you breathe only through the nose, slowly and deeply. Used in this way, the mask provides biochemical and biomechanical breathing practice.
Training Mask for Runners
During intensive exercise, the breathing muscles can become exhausted. As these muscles tire, blood flow is diverted from the legs to help support the breathing. Under stress, the body will always prioritize breathing. And so, you experience feelings of exhaustion and weak legs. In this case, your legs don’t feel weak because your leg muscles are tired. They tire because of depleted circulation (this is called the metaboreflex). Breathing ‘hard’ requires a lot of hard work from the breathing muscles, both on the inhalation and exhalation13. Blood flow diverts to where it is most needed to support respiration. When the breathing muscles work too hard, lactic acid can build up in the blood. This reduces the circulation even more.
When it comes to using an altitude mask for running, research into breathing techniques demonstrates that when the effort of inhalation is reduced, blood flow to the legs increases by up to 7%.
Think about it. If you use a training mask to prep for competition, your breathing muscles will find inhalation much easier when resistance to breathing is normal. You will be able to keep going for longer with less fatigue, better stamina and a whole lot more potential.
Training Mask Purpose
So far, we’ve discovered that the elevation mask is helpful for athletes. The high altitude mask for runners will help VO2 max and stamina. We have also learned that there are potentially wider uses for health. So what is the training mask purpose for sport?
- Build diaphragm strength in athletes, preventing breathing muscle fatigue
- Improve stamina for endurance athletes
- Reduce sensitivity to changes in levels of blood carbon dioxide (this is important for a lot of health conditions from panic disorder to obstructive sleep apnea)
- Strengthen the diaphragm muscle for better core function
The training mask can also help non-athletes. Everyone can benefit from better core muscle function, and many people are affected by sleep disorders, asthma and anxiety. Let’s look at the training mask purpose outside of sport:
- Help develop strong breathing muscles for firefighters and other emergency workers who are required to wear breathing apparatus as part of their job
- The diaphragm places pressure on the esophagus to prevent acid reflux. A stronger diaphragm muscle may help reduce symptoms of hiatus hernia14
- A stronger diaphragm helps with urinary continence
- The diaphragm supports the spine and pelvis15, so strengthening the breathing muscles may improve stability, balance and mobility
There is currently little awareness of the potential therapeutic impact of diaphragm exercises for gastric reflux or hiatus hernia. But in an email to the Oxygen Advantage inbox, one student describes his experience:
“On a daily basis I take a strong dose of Omeprazol (a stomach acid blocker, also called a proton-pump inhibitor or PPI) due to a hiatal hernia… A few days into following the exercises, the mentioned daily dose is now down to at least 50%, and some days I don’t take anything at all.”
His experience is validated by a 2011 study from scientists in Austria which found that elderly patients with gastric reflux experienced significant reductions in symptoms and PPI use, and marked increase in quality of life after practicing diaphragm breathing exercises for nine months16. It would be interesting to find out whether loaded breathing exercises using a workout mask would produce even better or faster results.
While this type of training mask is often marketed as a training mask for runners, it is important to understand that breath holds to simulate high altitude, practiced with a training mask, can have benefits for anyone with poor diaphragm function.
What Does an Elevation Mask Do?
We already know that in order to stimulate any muscle to adapt and strengthen, it is necessary to work that muscle harder than usual. But you may not know that it is actually very difficult to work the breathing muscles in this way. The level and duration of high intensity exercise required to improve the strength of the breathing muscles is not possible for most people. Aerobic physical exercise can only be practiced within the comfort of the respiratory system. Once those muscles tire, you can’t just keep pushing through.
So, What Does an Elevation Mask Do?
1. Provides a strategy to improve diaphragm strength
When used alongside the Oxygen Advantage® exercises to simulate high altitude, the elevation mask provides a meaningful strategy for the long-term improvement of respiratory muscle strength. The vent in the mask can be adjusted to alter airflow, adding an extra load in a controlled, sustainable way. The high altitude exercises in the Oxygen Advantage can be practiced both with and without an altitude training mask. It is recommended that you use a pulse oximeter to monitor blood oxygen saturation. This can be very motivating as you can see exactly how the exercises are impacting your blood oxygen levels. It will also help you to practice safely.
2. Triggers the production of new red blood cells
The elevation mask, when used with the exercises, causes spleen contraction, generally within around 30 seconds of a breath hold. The spleen is an organ that acts as a blood bank. When the body signals an increased demand for oxygen, the spleen releases stores of red blood cells into circulation. The red blood cells are important because they carry oxygen around the body in hemoglobin.
3. Safely and legally increases production of EPO
High altitude training is also called intermittent hypoxic/hypercapnic training. It uses breath holding to intermittently lower the oxygen saturation of the blood below 91% and increase the concentration of arterial carbon dioxide. Intermittent hypoxic/hypercapnic training triggers synthesis of EPO (erythropoietin) in the body. EPO is a hormone secreted mainly by the kidneys in response to cellular hypoxia. It stimulates the bone marrow to ‘mature’ red blood cells. This process takes around 3 or 4 days. This training can be practiced using specific breath holding techniques, with or without the mask. Used without the exercises, the mask does not increase EPO.
What is EPO?
EPO is a hormone produced in the kidneys. It stimulates the bone marrow to release more red blood cells into circulation. The red blood cells carry oxygen from the lungs to the muscles. A higher concentration of red blood cells in the blood can greatly increase aerobic capacity – an important factor for athletes.
Medically produced EPO, which is used for patients whose bone marrow is suppressed (and is sometimes used in doping) is almost identical to the hormone produced by the body.
Breath hold exercises to stimulate high altitude increase the production of EPO naturally. One study found a 24% increase in EPO from breath holding exercises17. Another reported that EPO increased by 24% and 36% respectively when blood oxygen saturation dropped below 91% for 24 seconds and 26 seconds18. The impact of the breathing exercises on oxygen saturation is intensified when an altitude training mask like SportsMask is used.
Training Mask Benefits
Let’s look at some of the science behind the training mask and benefits of elevation mask for improving fitness, endurance and breathing muscle function. What does an elevation mask do for athletes?
Elevation Mask Benefits for Sport:
- In a 2018 study, a twelve-week program of inspiratory muscle training resulted in better respiratory muscle strength in handball athletes. It also improved their aerobic physical performance. These findings “could be applied in sports training as a strategy to minimize the effects of respiratory fatigue in athletes, favoring a greater time in practice and an improvement in overall performance”19.
- In 2004 research, a ten-week program of inspiratory ‘resistive’ loading improved respiratory muscle strength in cyclists by 34%. Endurance also increased 38% and an increase in diaphragm thickness was observed. These improvements translated into a 36% increase in cycling time to exhaustion at 75% of VO2 max. During the cycling trials, heart rate, ventilation and perception of exertion were all lower in the participants who took the inspiratory load training20.
- Another study of elite athletes concluded that incremental inspiratory load training increases respiratory muscle strength and endurance in highly trained men and women. The results of this trial indicate that incremental inspiratory muscle training may generate greater pressure at higher lung volumes and lessen breathlessness during periods of sustained aerobic performance21.
- In another paper, scientists explain that because of neural connections between the brain and the diaphragm, when the diaphragm begins to tire, the brain prompts blood vessels to the arms and legs to constrict. In other words, because the diaphragm can’t take a break like other muscles, once it begins to tire, the brain makes it less and less possible for you to perform work22. This means that the fitness of your diaphragm will impact your performance, making performance dependent on what your brain will allow your body to do.
- Research from 2016 examined cyclists participating in a 6-week high-intensity ergometer training program. Scientists found that the elevation training mask does not act as a simulator of altitude. Instead, it behaves more like a respiratory muscle training device. They concluded that wearing the training mask “may improve specific markers of endurance performance beyond the improvements seen with interval training alone”23.
Using a Running Mask During Exercise
In 2007, the French physical education specialist and biologist Xavier Woorons demonstrated that slower breathing rates in trained men at sea level and at high altitude were related to a higher tolerance to carbon dioxide in the blood24. Endurance athletes are generally less sensitive to changes in blood oxygen and carbon dioxide than non-athletes25. Woorons’ study casts doubt on the idea that the feeling of breathlessness during exercise can only be lessened by intense physical training26. In fact, as we’ve already seen, the level of training required to achieve this by exercise alone is not realistic for most people.
The exercises in the Oxygen Advantage® provide a practical solution. By practicing the breathing exercises and the exercises to simulate high altitude, with and without a training mask for runners, it is possible to reduce the body’s response to buildup of carbon dioxide. As your ability to hold the breath after a passive exhalation increases (BOLT score), sensitivity to carbon dioxide lessens.
The training mask for runners is effective in adding an extra variable load to the breathing muscles. This makes it possible to achieve great results without having to physically train at an unsustainable intensity. By using breath holds and an altitude training mask and learning to maintain full time nasal breathing, it is easy to integrate this training into your routine without injury or overtraining. Training with breathing resistance can increase maximal load by 11.5% and ventilatory threshold (the point at which breathing begins to speed up during exercise) by 36%. This indicates that when breathing resistance is combined with exercise training, greater improvements in performance may result23.
Training the breathing muscles creates beneficial adaptations in endurance athletes. The most marked improvements are reduced perception of breathing effort, and delay to respiratory muscle fatigue. In practical terms this means the limbs can work harder for longer, retaining better blood flow. This allows improvements to both fixed-workload tasks and time trial performance27.
The manual and videos supplied with your SportsMask training mask for runners will give you full instruction so you can:
- Use the workout mask with breathing exercises
- Use the workout mask during training
- Learn to open or close the vent to add the level of resistance appropriate for you
Remember, any tool is only effective if you use it properly. To get the best results for sport or health from your altitude mask, read the manual and watch the training videos.
Benefits of Elevation Mask for Health
- A study examining the connection between static balance and diaphragm function found that deterioration to the diaphragm following lung surgery was closely linked with worsening balance28. Scientists found a relationship between diaphragm health, thickness and movement and the ability to balance, both with eyes open and closed.
- According to a 2020 paper, a thicker diaphragm indicates better breathing muscle strength29.
- In 2010, scientists performed an experiment to find whether inspiratory muscle training devices enhance the benefits of slow breathing30. Thirty patients with Stage I or II high blood pressure (hypertension) were divided into groups, practicing either slow diaphragm breathing or slow diaphragm breathing using a device loaded with 20cm water. The water in this experiment acts in the same way as a training mask, adding resistance to increase the strength of the breathing muscles. The results of the trial showed that systolic and diastolic blood pressure notably decreased with diaphragm breathing exercises. But with the training mask, the results were even more significant. At the same time, with load-added breathing, heart rate in these hypertensive patients dropped by 9 beats per minute.
- In 2019, scientists in Pakistan reported that diaphragm breathing exercises are useful for people with type 2 diabetes and if practiced regularly can minimize hyperglycemia and avert some of the major complications associated with the disease.
- Exercises to strengthen the diaphragm have been found to help in speech disorders including stuttering31,32.
By practicing load added diaphragm breathing exercises using an oxygen training mask, you will learn to slow down the breath. Slow breathing is essential for better gas exchange, and for balancing the autonomic nervous system. There are many applications for slow breathing exercises for anxiety and chronic stress.
Diaphragm Function and the Pelvic Floor
Healthy functioning of the pelvic floor muscles relies on a healthy diaphragm. This means that the strength of the diaphragm muscle is important for the strength of the core. And this suggests that a training mask could help people with conditions as diverse as urinary incontinence and lower back pain. Let’s look at three possible applications or benefits of elevation mask in conditions involving pelvic floor and core muscle dysfunction:
1. Exercise breathing mask and back pain
It is commonly believed that abdominal muscle exercises to strengthen the core can help prevent back pain and correct poor spinal stability. But the breath, and particularly the diaphragm, is crucial too. A study by the physiotherapist Josephine Key states that breathing is integral to core control15. The diaphragm supports functional movement and posture. If the posture is good, breathing will be healthy too. Equally, healthy breathing is reflected in good posture33.
In women, the function of the pelvic floor directly impacts the stability of the sacroiliac joint34. The sacroiliac joint connects the pelvis and the spine, supporting the weight of the upper body.
2. Running mask and incontinence
Poor control of the pelvic floor muscles contributes to urinary incontinence. In both men and women the diaphragm is connected both structurally and functionally to the pelvic floor by fascia and muscles35. These include the pubococcygeus muscle, which controls the flow of urine.
As we already discovered, men recovering from prostate surgery experienced marked improvements in urinary continence after six months practicing diaphragm exercises6.
3. Training mask benefits for sexual dysfunction
The same structures are important for sexual function, contributing to the ability to maintain erection and preventing premature ejaculation in men. During sexual arousal, the pelvic floor muscles apply internal pressure to the veins of the sexual organs, ensuring enough blood flows to the area36. The pubococcygeus muscle, which controls the flow of urine, is also one of the muscles that contracts during orgasm.
Again, it is possible, due to the close connection between the pelvic floor and the diaphragm, that training mask benefits include the prevention or treatment of a widespread number of common conditions associated with poor pelvic floor function.
Mandatory Use of Face Coverings During Covid-19 Pandemic
Another potential use for the altitude mask is in improving breathing for people who have to wear a protective face covering. This applies to medical workers such as doctors and nurses who need to wear PPE, and to retail workers who must wear a mask throughout their shift. Many people find it difficult to breathe in a mask, and masks can cause breathlessness and headaches.
Just as the practice of breathing exercises and an elevation mask or running mask can be helpful for emergency workers who are required to wear breathing apparatus, the techniques could help people who must, by law, wear a face covering all day for work.
The factors that contribute to breathlessness in a face mask are the same as those indicative of poor breathing patterns. These include poor diaphragm function, heightened chemosensitivity to CO2 and fast, upper chest mouth breathing.
To a lesser extent than an exercise mask, a face mask adds resistance to breathing. Because of this, most people will make the switch from nose breathing to mouth breathing in a mask. Chemosensitivity to carbon dioxide causes feelings of breathlessness and suffocation. Hot, humid air trapped against the face can disrupt the body’s sense of thermoregulation, and despite the fact that scientists have found masks cause no increase in core temperature, the stress response can manifest as hot flashes and sweating.
These masks also trigger air hunger due to the pooling and re-breathing of carbon dioxide and the Bohr Effect.
The Oxygen Advantage® suggests that in order to alleviate the feeling of air hunger, you can practice slowing down the breathing to a rate of six breaths per minute. Breathing at six breaths per minute enhances alveolar ventilation, improves breathing efficiency and optimizes gas exchange from the lungs to the blood37.
If training in an exercise mask like SportsMask can create significant improvements for firefighters using protective breathing gear, it will also make it easier to breathe in a protective face mask. The exposure to higher levels of CO2 when training with the exercise breathing mask helps to decrease chemosensitivity to the gas. This reduces air hunger and breathlessness. The improved diaphragm strength that comes from using an altitude training mask will make every-day breathing less effortful. The increased oxygenation that occurs as the result of the breathing exercises will keep your brain and body feeling energized for longer. And the slower breathing that develops over time as the result of load-added diaphragm breathing exercises and reduced chemosensitivity to carbon dioxide triggers the body’s relaxation response, targeting stress and stress-related conditions.
Summary of Exercise Mask Uses
- Lung health and greater lung capacity
- Posture, back pain, neck pain and pelvic floor
- Diaphragm strength for less effortful breathing
- Maintain nasal breathing at a higher intensity of exercise, better for respiratory health and helps reduce exercise-induced asthma
- Reduce chemosensitivity to CO2, less breathlessness
- May help with hiatus hernia and gastric reflux
- Greater endurance and duration working in protective equipment, for example, firefighters and emergency workers
- Increased oxygenation and aerobic capacity
So in answer to our initial question, does a training mask really work? Yes. As long as you follow the proper instructions for use, it can provide very effective results.
Oxygen Training Masks for Training in Emergency Workers
The breathing resistance offered by a high elevation mask impacts physical ability both during submaximal and maximal exercise. Athletes use breathing muscle training to enhance performance, but the techniques were originally used in a non-exercise setting.
For emergency workers, the same techniques can provide a low-cost training tool to help offset the negative impact of self-contained breathing apparatus (SCBA) on lung function. High intensity interval training (HIIT) while breathing from the SCBA can be a powerful way for workers like firefighters to train. However, the SCBA is expensive and the cylinders need to be regularly refilled.
It has been found that commercially available breathing muscle training devices like the elevation mask can be used as a substitute for the SCBA during HIIT. Results from a study into the efficacy of the high altitude mask found that five weeks of HIIT training using the mask “significantly improved work capacity and VO2 max” when the firefighter used SCBA. The improvement in VO2 max when training in the high altitude mask was similar to that gained from training in SCBA, as were improvements in lung and heart function.
Integrating a Workout Mask into your Training
The Oxygen Advantage exercises include a workout practice using breath holding and the altitude mask for running. The videos and manual explain how to use the oxygen training mask during your workout. In the videos, Patrick will talk you through the breathing exercises and techniques.
Buying an Exercise Breathing Mask
Some consider it a ‘secret weapon’ that could mean the difference between winning and losing. But it’s a weapon currently used by a minority of athletes. What does an elevation mask do? It trains the inspiratory muscles – the muscles responsible for inhaling – a factor that can improve performance by 15%. This means a runner can run harder for longer, a swimmer can swim faster38, and a firefighter can work in breathing apparatus for longer.
In an article in Medical Xpress News, Dr. Mitch Lomax of Plymouth University, who we met in the introduction, explains, “People overlook that the muscles responsible for breathing are the same as other muscles and training or warming them up before playing sport means you will perform better. Doing both training and warming up is the best of all”38.
If you’re interested in investing in an elevation training mask, either to boost your sporting performance or to improve the strength of your diaphragm for health reasons, it’s worth considering SportsMask. SportsMask is designed by Patrick McKeown, creator of the Oxygen Advantage®. Patrick is recognized as a foremost authority on breathing techniques for sport, performance and health. His methods are safe and effective and can benefit you, whatever your starting point. Patrick has worked with Olympic athletes, children and everyone in between.
If you have any serious health conditions, consult your medical practitioner before attempting breathing exercises, and consult a certified breathing instructor who can devise a progressive program suited to your needs.
- Cottle, M.H., 1987. The work, ways, positions and patterns of nasal breathing (relevance in heart and lung illness). Reprinted in: Barelli, P., Loch, W.E.E., Kern, E.R., Steiner, A. (Eds.), Rhinology. The collected writings of Maurice H. Cottle, MD. American Rhinologic Society, Kansas City, Missouri.
- Fonseca, Jéssica Danielle Medeiros da, Kadja Franciely Gomes Benício, Vanessa Regiane Resqueti, Guilherme Augusto de Freitas Fregonezi, and Andrea Aliverti. “Acute effects of inspiratory loads and interfaces on breathing pattern and activity of respiratory muscles in healthy subjects.” Frontiers in physiology 10 (2019): 993.
- Watson, Alan. “Breathing in singing.” In The Oxford Handbook of Singing. 2014.
- Leanderson, Rolf, and Johan Sundberg. “Breathing for singing.” Journal of Voice 2, no. 1 (1988): 2-12.
- Zachovajeviene, B., L. Siupsinskas, Pavelas Zachovajevas, Z. Venclovas, and Daimantas Milonas. “Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial.” Scientific reports 9, no. 1 (2019): 1-9.
- Jun, Hyun-Ju, Ki-Jong Kim, Ki-Won Nam, and Chang-Heon Kim. “Effects of breathing exercises on lung capacity and muscle activities of elderly smokers.” Journal of physical therapy science 28, no. 6 (2016): 1681-1685.
- Gomieiro, Ludmila Tais Yazbek, Andreia Nascimento, Luciana Kase Tanno, Rosana Agondi, Jorge Kalil, and Pedro Giavina-Bianchi. “Respiratory exercise program for elderly individuals with asthma.” Clinics 66, no. 7 (2011): 1163-1169.
- Ferreira, Inês Raquel Antunes. “Effect of intermittent hypobaric hypoxia on induced muscle injury repair in laboratory rats.” Master’s thesis, 2012.
- Singh, I., I. S. Chohan, M. Lal, P. K. Khanna, M. C. Srivastava, R. B. Nanda, J. S. Lamba, and M. S. Malhotra. “Effects of high altitude stay on the incidence of common diseases in man.” International journal of biometeorology 21, no. 2 (1977): 93-122.
- Green, D. J. “Can Elevation Training Masks Improve Performance? Retrieved September 20, 2018.” (2016).
- Ramsook, Andrew H., Ryan Koo, Yannick Molgat-Seon, Paolo B. Dominelli, Nafeez Syed, Christopher J. Ryerson, Andrew W. Sheel, and Jordan A. Guenette. “Diaphragm Recruitment Increases during a Bout of Targeted Inspiratory Muscle Training.” Medicine and science in sports and exercise 48, no. 6 (2016): 1179-1186.
- Amann, Markus. “Pulmonary system limitations to endurance exercise performance in humans.” Experimental physiology 97, no. 3 (2012): 311-318.
- Key, Josephine. “‘The core’: understanding it, and retraining its dysfunction.” Journal of bodywork and movement therapies 17, no. 4 (2013): 541-559.
- Eherer, A. J., F. Netolitzky, C. Högenauer, G. Puschnig, T. A. Hinterleitner, S. Scheidl, W. Kraxner, G. J. Krejs, and Karl Martin Hoffmann. “Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized, controlled study.” American Journal of Gastroenterology 107, no. 3 (2012): 372-378.
- de Bruijn R, Richardson M, Schagatay E. “Increased erythropoietin concentration after repeated apneas in humans.” Eur J Appl Physiol 2008; 102:609–13. Epub 2007 Dec 19.
- Roberts D, Smith DJ, Donnelly S, Simard S. Plasma-volume contraction and exercise-induced hypoxaemia modulate erythropoietin production in healthy humans. Clinical Science.2000 ;(Jan;98(1):39-45
- Hartz, Charlini S., Márcio AG Sindorf, Charles R. Lopes, José Batista, and Marlene A. Moreno. “Effect of inspiratory muscle training on performance of handball athletes.” Journal of human kinetics 63, no. 1 (2018): 43-51.
- Gething, A. D., M. Williams, and B. Davies. “Inspiratory resistive loading improves cycling capacity: a placebo controlled trial.” British journal of sports medicine 38, no. 6 (2004): 730-736.
- Enright, Stephanie, Ken Chatham, Jon Baldwin, and Hywell Griffiths. “The effect of fixed load incremental inspiratory muscle training in the elite athlete: a pilot study.” Physical Therapy in Sport 1, no. 1 (2000): 1-5.
- Dempsey, Jerome A., Lee Romer, Joshua Rodman, Jordan Miller, and Curtis Smith. “Consequences of exercise-induced respiratory muscle work.” Respiratory physiology & neurobiology 151, no. 2-3 (2006): 242-250.
- Porcari, John P., Lauren Probst, Karlei Forrester, Scott Doberstein, Carl Foster, Maria L. Cress, and Katharina Schmidt. “Effect of wearing the elevation training mask on aerobic capacity, lung function, and hematological variables.” Journal of sports science & medicine 15, no. 2 (2016): 379.
- Woorons, X., P. Mollard, A. Pichon, C. Lamberto, A. Duvallet, and J‐P. Richalet. “Moderate exercise in hypoxia induces a greater arterial desaturation in trained than untrained men.” Scandinavian journal of medicine & science in sports 17, no. 4 (2007): 431-436.
- Scoggin, C. H., R. D. Doekel, M. H. Kryger, C. W. Zwillich, and J. V. Weil. “Familial aspects of decreased hypoxic drive in endurance athletes.” Journal of Applied Physiology 44, no. 3 (1978): 464-468.
- McGurk, S. P., B. A. Blanksby, and M. J. Anderson. “The relationship of hypercapnic ventilatory responses to age, gender and athleticism.” Sports medicine 19, no. 3 (1995): 173-183.
- Granados, Jorge, Trevor L. Gillum, Weston Castillo, Kevin M. Christmas, and Matthew R. Kuennen. ““Functional” respiratory muscle training during endurance exercise causes modest hypoxemia but overall is well tolerated.” The Journal of Strength & Conditioning Research 30, no. 3 (2016): 755-762.
- Kocjan, Janusz, Bożena Gzik-Zroska, Katarzyna Nowakowska, Michał Burkacki, Sławomir Suchoń, Robert Michnik, Damian Czyżewski, and Mariusz Adamek. “Impact of diaphragm function parameters on balance maintenance.” PloS one 13, no. 12 (2018): e0208697.
- Spiesshoefer, Jens, Simon Herkenrath, Carolin Henke, Lisa Langenbruch, Marike Schneppe, Winfried Randerath, Peter Young, Tobias Brix, and Matthias Boentert. “Evaluation of Respiratory Muscle Strength and Diaphragm Ultrasound: Normative Values, Theoretical Considerations, and Practical Recommendations.” Respiration 99, no. 5 (2020): 369-381.
- Jones, Chulee U., Benjarat Sangthong, and Orathai Pachirat. “An inspiratory load enhances the antihypertensive effects of home-based training with slow deep breathing: a randomised trial.” Journal of physiotherapy 56, no. 3 (2010): 179-186.
- Lokenbaha, Mara, Asja Eglite, and Dzintra Vavere. “Speech Disorders and Modern Breathing Techniques.” International Journal of Rehabilitation Research 32 (2009): S113-S114.
- Conelea, Christine A., Kevin A. Rice, and Douglas W. Woods. “Regulated breathing as a treatment for stuttering: A review of the empirical evidence.” The Journal of Speech and Language Pathology–Applied Behavior Analysis 1, no. 2 (2006): 94.
- Kiesel, Kyle, Tonya Rhodes, Jacob Mueller, Alyssa Waninger, and Robert Butler. “Development of a screening protocol to identify individuals with dysfunctional breathing.” International journal of sports physical therapy 12, no. 5 (2017): 774.
- Hodges, P. W., R. Sapsford, and L. H. M. Pengel. “Postural and respiratory functions of the pelvic floor muscles.” Neurourology and urodynamics 26, no. 3 (2007): 362-371.
- Lee, Diane G., Linda-Joy Lee, and L. McLaughlin. “Stability, continence and breathing: the role of fascia following pregnancy and delivery.” Journal of bodywork and movement therapies 12, no. 4 (2008): 333-348.
- Meldrum, David R., Arthur L. Burnett, Grace Dorey, Katherine Esposito, and Louis J. Ignarro. “Erectile hydraulics: maximizing inflow while minimizing outflow.” The journal of sexual medicine 11, no. 5 (2014): 1208-1220.
- Russo, Marc A., Danielle M. Santarelli, and Dean O’Rourke. “The physiological effects of slow breathing in the healthy human.” Breathe 13, no. 4 (2017): 298-309.