Laukkanen and colleagues from the University of Kuopio, Finland, investigated the association between ST depression and the risk of sudden cardiac death in a population-based sample of 1,769 men. During the eighteen years of follow-up, a total of 72 deaths occurred due to sudden cardiac death in those found with asymptomatic ST segment depression. The risk of sudden cardiac death was found to have increased among men with asymptomatic ST segment depression during exercise and during the recovery period. It was noted “asymptomatic ST-segment depression was a very strong predictor of sudden cardiac death in men with any conventional risk factor but no previously diagnosed coronary heart disease.” Laukkanen JA, Mäkikallio TH, Rauramaa R, Kurl S. 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 Mar;30(5):558–65.
201 When this happens: Kasper DL, Harrison TR. Harrison’s Principles of Internal Medicine. New York: McGraw-Hill Medical Publishing Division; 2005.
201 In assessing ECG: Thompson PD. Exercise and the heart: The good, the bad, and the ugly. Dialog Cardiovasc Med. 2002;7(3):143–62.
201 Studies have found: Corrado. Electrical repolarization changes in young athletes.
201 However, certain abnormal: Ibid.
201 Markedly abnormal: Pelliccia, Di Paolo, Quattrini, et al. 2008 Jan 10, 152–61.
202 ST segment depression: Kligfield P, Lauer MS. Exercise electrocardiogram testing beyond the ST segment. Circulation. 2006;114:2070–82.
202 In a study including: Laukkanen, Mäkikallio, Rauramaa, Kurl 2009, 558–65.
202 A study conducted by: Alexopoulos D, Christodoulou J, Toulgaridis T, et al. Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects: Incidence, mechanisms and affecting factors. Eur Heart J. 1996 Sep;17(9):1432–7.
204 Dr. Lum was well known: Laurence Claude Lum. Royal College of Physicians. munksroll.rc plondon.ac.uk/Biography/Details/6079 (accessed September 2, 2014).
204 Dr. Lum dedicated: Ibid.
204 Both activities increase breathing: Rutherford, Clutton-Brock, Parkes 2005, R148–55. Hashimoto, Okazaki, Okutsu 1990, 437–41. Kazmaier et al. 1998, 831–7. Neill, Hattenhauer 1975, 854–8.
205 Up to 10 percent: Chelmowski MK, Keelan MH Jr. Hyperventilation and myocardial infarction. Chest. 1988 May;93(5): 1095–6.
205 In one particular study: Ibid.
205 A study of twenty patients: Elborn JS, Riley M, Stanford CF, Nicholls DP. The effects of flosequinan on submaximal exercise in patients with chronic cardiac failure. Br J Clin Pharmacol. 1990 May;29(5):519–24.
206 This research: Buller NP, Poole-Wilson PA. Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure. Br Heart J. 1990 May;63(5):281–3. The authors observed that patients with breathing problems had reduced arterial carbon dioxide and increased breathing volume per minute. Furthermore, patients with problem breathing had greater impaired cardiac function. Fanfulla FM, Mortara A, Maestri R, et al. The development of hyperventilation in patients with chronic heart failure and Cheyne-Stokes respiration: A possible role of chronic hypoxia. Chest. 1998 Oct;114(4):1083–90. Vasiliauskas D, Jasiukeviciene L. 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. 2004 Jun;11(3):223–7.
206 In a 2004 study published: Vasiliauskas, Jasiukeviciene 2004 June, 223–7.
206 Based on improvements: Ibid.
206 Other studies confirm: Patients who practiced breathing exercises for reversing chronic hyperventilation evidenced significantly higher carbon dioxide levels and lower respiratory rates when compared with pretreatment levels measured three years earlier. The authors concluded, “Breathing retraining has lasting effects on respiratory physiology, and is highly correlated with a reduction in reported functional cardiac symptoms.” DeGuire S, Gevirtz R, Kawahara Y, Maguire W. Hyperventilation syndrome and the assessment of treatment for functional cardiac symptoms. Am J Cardiol. 1992 Sep 1;70(6):673–7.
207 We know that hyperventilation: Researchers from the division of cardiology, Kumamoto University School of Medicine, Japan, investigated the hyperventilation test as a clinical tool to induce coronary artery spasm (narrowing of blood vessels to the heart). The study involved 206 patients with coronary spasm and 183 patients without angina at rest (nonspasm). Each patient performed hyperventilation for 6 minutes. Of the spasm group, 127 showed positive responses to the test, including electrocardiographic changes attributable to reduced blood flow. No one in the nonspasm group showed any ischemia (narrowing of blood flow). When clinical characteristics were compared, high disease activity and severe arrhythmias were significantly higher in the hyperventilation test positive patients than in the negative patients (69 percent vs. 20 percent). The authors concluded that “hyperventilation is a highly specific test for the diagnosis of coronary artery spasm, and that hyperventilation test-positive patients are likely to have life-threatening arrhythmias during attacks.” Nakao K, Ohgushi M, Yoshimura M, et al. Hyperventilation as a specific test for diagnosis of coronary artery spasm. Am J Cardiol. 1997 Sep 1;80(5):545–9.
207 but studies have: In the aptly titled paper “Death by Hyperventilation: A Common and Life-Threatening Problem During Cardiopulmonary Resuscitation,” researchers tested the hypothesis that excessive ventilation rates during the performance of CPR by overzealous but well-trained rescue personnel increases the likelihood of death. The paper investigated thirteen adult deaths where manual CPR with an average of 30 breaths per minute was administered to patients. The paper also documented a study investigating ventilation per minute and survival rate during cardiac arrest in pigs. Three groups of seven pigs were treated with 12 breaths, 30 breaths, or 30 breaths plus carbon dioxide per minute. Survival rates in the groups were as follows: six out of seven pigs treated with 12 breaths per minute, one out of seven pigs treated with 30 breaths per minute, and one out of seven pigs treated with 30 breaths per minute plus carbon dioxide. The authors commented that “despite seemingly adequate training, professional rescuers consistently hyperventilated patients during out-of-hospital CPR,” and that “additional education of CPR providers is urgently needed to reduce these newly identified and deadly consequences of hyperventilation during CPR.” Aufderheide TP, Lurie KG. Death by hyperventilation: A common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004 Sep;32(9 Suppl):345–51.
In a paper entitled “Do We Hyperventilate Cardiac Arrest Patients?” published in the journal Resuscitation in 2007, researchers studied data from twelve patients who had received manual ventilation by a self-inflating bag in the emergency department of a UK hospital. Results showed that the number of manual breaths administered to the patients varied from 9 to 41 per minute, with an average of 26. The corresponding median volume of air per minute was 13 liters. The researchers noted that while guidelines on the number of breaths to administer during CPR are well known, “it would appear that in practice they are not being observed.” O’Neill JF, Deakin CD. Do we hyperventilate cardiac arrest patients? Resuscitation. 2007 Apr;73(1):82–5.
207 Researchers investigated instances: Ibid.
207 One study concluded: Ibid.
12. Eliminate Exercise-Induced Asthma
210 Exercise-induced asthma: Rundell KW, Im J, Mayers LB, Wilber RL, Szmedra L, Schmitz HR. Self-reported symptoms and exercise-induced asthma in the elite athlete. Med Sci Sports Exerc. 2001 Feb;33(2):208–13.
210 Interestingly, one study: Sidiropoulou MP, Kokaridas DG, Giagazoglou PF, Karadonas MI, Fotiadou EG. Incidence of exercise-induced asthma in adolescent athletes under different training and environmental conditions. J Strength Cond Res. 2012 Jun;26(6):1644–50.
211 Tackling asthma from: Zinatulin SN. Healthy Breathing: Advanced Techniques. Novosibirsk, Russia: Dinamika Publishing House; 2003.
21
2 Normal breathing volume: Johnson BD, Scanlon PD, Beck KC. Regulation of ventilatory capacity during exercise in asthmatics. J Appl Physiol. 1995 Sep;79(3):892–901. Chalupa DC, Morrow PE, Oberdörster G, Utell MJ, Frampton MW. Ultrafine particle deposition in subjects with asthma. Environ Health Perspect. 2004 Jun;112(8):879–82. Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: A blinded randomised controlled trial. Med J Aust. 1998 Dec 7–21;169(11–12):575–8.
212 of air per minute: Pulmonary structure and function. In: McArdle, Katch, Katch, Exercise Physiology, 263.
212 During an exacerbation of asthma: GINA Report, Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma; 2014:74. www.gin asthma.org/guidelines-gina-report-global-strategy-for-asthma.html (accessed December 27, 2012).
213 A study at the Mater Hospital: Bowler, Green, Mitchell 1998, 575–8.
214 The reason for this: Ibid.
214 Further studies reinforced: McHugh P, Aitcheson F, Duncan B, Houghton F. Buteyko Breathing Technique for asthma: An effective intervention. N Z Med J. 2003 Dec 12;116(1187):U710. Cowie RL, Conley DP, Underwood MF, Reader PG. A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Resp Med. 2008 May;102(5);726–32.
214 Based on the fact: Ibid. Bowler, Green, Mitchell 1998, 575–8.
215 People diagnosed with asthma: Hallani M, Wheatley JR, Amis TC. Initiating oral breathing in response to nasal loading: Asthmatics versus healthy subjects. Eur Respir J. 2008 Apr;31(4):800–6. A paper published in the medical journal Chest noted that “asthmatics may have an increased tendency to switch to oral (mouth) breathing, a factor that may contribute to the pathogenesis of their asthma.” Kairaitis K, Garlick SR, Wheatley JR, Amis TC. Route of breathing in patients with asthma. Chest. 1999 Dec;116(6):1646–52.
215 Air taken in through: Fried (ed.), Hyperventilation Syndrome, 1987.
215 The mouth is simply: Ibid.
216 Unlike nasal breathing: Djupesland PG, Chatkin JM, Qian W, Haight JS. Nitric oxide in the nasal airway: A new dimension in otorhinolaryngology. Am J Otolaryngol. 2001 Jan–Feb;22(1):19–32. Scadding G. Nitric oxide in the airways. Curr Opin Otolaryngol Head Neck Surg. 2007 Aug;15(4):258–63. Vural C, Güngör A. Nitric oxide and the upper airways: Recent discoveries. Tidsskr Nor Laegeforen. 2003 Jan;10(1):39–44.
216 Taking all these factors: Hallani M, Wheatley JR, Amis TC. Enforced mouth breathing decreases lung function in mild asthmatics. Respirology. 2008 Jun;13(4):553–8.
216 The paper concluded: Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF. The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. Am Rev Respir Dis. 1978 Jul;118(1):65–73.
216 In simple terms: Researchers studied the effects of nasal breathing and oral breathing on exercise-induced asthma. Fifteen people were recruited for the study and asked to breathe only through their nose. The study found that “the post-exercise bronchoconstrictive response was markedly reduced as compared with the response obtained by oral (mouth) breathing during exercise, indicating a beneficial effect of nasal breathing.” Mangla PK, Menon MP. Effect of nasal and oral breathing on exercise-induced asthma. Clin Allergy. 1981 Sep;11(5):433–9.
217 The difference between: In the words of respiratory consultant Dr. Peter Donnelly, which were published in the medical journal the Lancet, “In most land based forms of exercise, patterns of breathing are not constrained, ventilation increases proportionately throughout exercise and end tidal CO2 tensions are either normal or low. Therefore, there is no hypercapnic (increased carbon dioxide) stimulus for bronchodilation (airway opening) and asthmatics have no protection.” Donnelly PM. Exercise induced asthma: The protective role of CO2 during swimming. Lancet. 1991 Jan 19;337(8734):):179–80.
217 At the beginning of this chapter: Sidiropoulou, Kokaridas, Giagazoglou, Karadonas, Fotiadou 2012 Jun, 1644–50.
217 Although the act of: Uyan ZS, Carraro S, Piacentini G, Baraldi E. Swimming pool, respiratory health, and childhood asthma: Should we change our beliefs? Pediatr Pulmonol. 2009 Jan;44(1):31–7. Fjellbirkeland L, Gulsvik A, Walløe A. Swimming-induced asthma. Tidsskr Nor Laegeforen. 1995 Jun 30;115(17):2051–3. Bernard A, Carbonnelle S, Michel O, et al. Lung hyperpermeability and asthma prevalence in schoolchildren: Unexpected associations with the attendance at indoor chlorinated swimming pools. Occup Environ Med. 2003 Jun;60(6):385–94. Nickmilder M, Bernard A. Ecological association between childhood asthma and availability of indoor chlorinated swimming pools in Europe. Occup Environ Med. 2007 Jan;64(1):37–46.
13. Athletic Endeavor—Nature or Nurture?
221 In 1704: Cooper C. The Stud: Why retirement will be a full-time job for Frankel. Independent. October 26, 2012. www.independent.co.uk/sport/racing/the-stud-why-retirement-will-be-a-fulltime-job-for-frankel-8228820.html (accessed June 10, 2013).
221 Geneticist Patrick Cunningham: Cunningham EP, Dooley JJ, Splan RK, Bradley DG. Microsatellite diversity, pedigree relatedness and the contributions of founder lineages to thoroughbred horses. Anim Genet. 2001 Dec;32(6):360–4.
222 Although the natural: Abreu RR, Rocha RL, Lamounier JA, Guerra AF. Prevalence of mouth breathing among children. J Pediatr (Rio J). 2008;84(5):467–70.
223 It has been well: Tourne LP. The long face syndrome and impairment of the nasopharyngeal airway. Angle Orthod. 1990 Fall;60(3):167–76. Deb U, Bandyopadhyay SN. Care of nasal airway to prevent orthodontic problems in children. J Indian Med Assoc. 2007 Nov;105(11):640, 642. Harari D, Redlich M, Miri S, Hamud T, Gross M. The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope. 2010 Oct;120(10):2089–93.
224 Yogi Bhajan: Bhajan. The Living Chronicles of Yogi Bhajan aka the Siri Singh Sahib of Sikh Dharma. WhoAreTheSikhs.com. www.harisingh.com/LifeAc cordingToYogiBhajan.htm.
224 The ancient Buddhist: Mallinson J. The Khecarîvidyâ of Adinathâ. London and New York: Routledge; 2007:17–19.
225 In a paper written by researchers: Wong EM, Ormiston ME, Haselhuhn MP. A face only an investor could love: CEOs’ facial structure predicts their firms’ financial performance. Psychol Sci. 2011 Dec;22(12):1478–83.
225 In a separate study: Ibid.
226 Chronic, habitual mouth: Okuro RT, Morcillo AM, Sakano E, Schivinski CI, Ribeiro M, Ribeiro JD. Exercise capacity, respiratory mechanics and posture in mouth breathers. Braz J Otorhinolaryngol. 2011 Sep–Oct;77(5):656–62. Okuro RT, Morcillo AM, Ribeiro M, Sakano E, Conti PB, Ribeiro JD. Mouth breathing and forward head posture: Effects on respiratory biomechanics and exercise capacity in children. J Bras Pneumol. 2011 Jul–Aug;37(4):471–9. Conti, Sakano, Ribeiro, Schivinski, Ribeiro 2011, 471–9.
226 “Many of these children”: Jefferson Y. Mouth breathing: Adverse effects on facial growth, health, academics and behavior. Gen Dent. 2010 Jan–Feb;58(1):18–25.
226 Dr. Egil Peter Harvold: Harvold EP, Tomer BS, Vargervik K, Chierici G. Primate experiments on oral respiration. Am J Orthod. 1981 Apr;79(4):359–72. Miller AJ, Vargervik K, Chierici G. Sequential neuromuscular changes in rhesus monkeys during the initial adaptation to oral respiration. Am J Orthod. 1982 Feb;81(2):99–107. Moses AJ. Airways and appliances. CDS Rev. 1989 Mar;82(2):50–7. Available at: www.tmjchicago.com/uploads/airwaysandappli ances.pdf (accessed September 2, 2014).
227 Dr. Harvold’s: Vargervik K. Egil Peter Harvold, Orthodontics: San Francisco. Calisphere, University of California. texts.cdlib.org/view?docId=hb0h4n99rb &doc .view=frames&chunk.id=div00029&toc.depth=1&toc.id= (accessed September 2, 2014).
227 Research has suggested: Trabalon M, Schaal B. It takes a mouth to eat and a nose to breathe: Abnormal oral respiration affects neonates’ oral competence and systemic adaptation. Int J Pediatr. 2012;2012:207605. O’Hehir T, Francis A. Mouth vs. nasal breathing. Hygientown. September 2012. www.hygienetown.com/hygienetown/article.aspx?i=297&aid=4026 (accessed September 2, 2014).
229 Development of the lower jaw:
Meridith HV. Growth in head width during the first twelve years of life. Pediatrics. 1953 Oct;12(4):411–29.
230 The detrimental effects: Schreiner C. Nasal airway obstruction in children and secondary dental deformities. University of Texas Medical Branch, Department of Otolaryngology, Grand Rounds Presentation. 1996.
14. Exercise as if Your Life Depends on It
232 Dozens of studies: Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc. 2001 Jun;33(6 Suppl):379–99. Crespo CJ, Palmieri MR, Perdomo RP, et al. The relationship of physical activity and body weight with all-cause mortality: Results from the Puerto Rico Heart Health Program. Ann Epidemiol. 2002 Nov;12(8):543–52. Oguma Y, Sesso HD, Paffenbarger RS Jr, Lee IM. Physical activity and all cause mortality in women: A review of the evidence. Br J Sports Med. 2002 Jun;36(3):162–72.
232 Not only this: A most interesting study investigating the relationship between regular physical exercise and cardiovascular health was conducted as far back as 1952 by Scottish epidemiologist Dr. Jeremy Morris. Commonly, known as the “bus conductor study,” Dr. Morris and colleagues investigated the incidence of heart attacks across 31,000 male transport workers between the ages of 35 and 65 who worked during the years 1949 and 1950. Morris JN, Heady JA, Raffle PA, Roberts CG, Parks JW. Coronary heart-disease and physical activity of work. Lancet 1953 Nov 21;265(6795):1053–7.
232 The same study: Andrade J, Ignaszewski A. Exercise and the heart: A review of the early studies, in memory of Dr R.S. Paffenbarger. B C Med J. 2007 Dec;49(10):540–6.
Appendix: Upper Limits and Safety of Breath Holding
290 Another effect is bradycardia: Lindholm P, Lundgren CE. The physiology and pathophysiology of human breath-hold diving. J Appl Physiol. 2009 Jan;106(1):284-92. Espersen, Frandsen, Lorentzen, Kanstrup, Christensen 2002 May, 2071–9.
The Oxygen Advantage: The Simple, Scientifically Proven Breathing Techniques for a Healthier, Slimmer, Faster, and Fitter You Page 31