The Complexity of Respiratory Training: What The Trainer Should Know

May 28, 2019 | Article

          Respiration is a complex process that delivers us the ability to create energy to move. The respiratory system pulls in oxygen and expels carbon dioxide through a never ending circulatory cycle within the body. The complexity of breathing makes respiratory training unique based on each individual. How people move and how they behave is based on their contributions and withdrawals of movement engrams over the course of their lives. Every individual is in a different place in their lives and respiratory training should reflect that. Respiratory rates range from 12 to 60 breaths per minute based on the age of an individual. That is anywhere from 17,280-86,400 neuromuscular respiratory contractions a day. The range is too big to approach respiratory training the same way for each individual.

           Wilkens et al. (2010) looked at 39 patients post lung transplants and found that after patients with either cystic fibrosis (n=9), COPD (n=21), or pulmonary fibrosis (n=9) had distinct differences in breathing mechanisms for respiration after lung transplant. Cystic fibrosis is a defect in the CFTR protein in the lungs creating inflammatory responses leading to scaring within the lungs, COPD is an umbrella term that progressively obstructs airflow over time, and pulmonary fibrosis is a lung disease that also causes thickening in the lung tissue making it difficult for the lungs to expand.

All three of the complications increase inflammatory responses, damage lung tissue and decrease lung function over time, but they do so differently. Even after the patient’s received new lungs, the patient’s respiratory patterns still varied based on the individual.  Wilken’s study leads us to hypothesize that lung health and function are not the only factors that need to be addressed when improving lung function. Respiratory muscles are not built solely for respiration but are also built to control the body through movement and gravitational forces, which also need to be taken into consideration when designing a training program.  When designing a training approach, intensity, frequency, duration and volume must be addressed in an approach that best fits the individual.

          Respiratory neuromuscular training is similar to cardiovascular endurance training. To train cardiovascular endurance, an individual would run over a period of time. As the sessions progressed, the individual would change the stimulus by running further, speeding up their pace, or increasing the time at which they run. From healthy individuals to individuals fighting pulmonary diseases, the concept is the same, but respiratory neuromuscular training is formulated based on each individual. Progressing the individual from low to high intensities, and/or low to high volume of work, is important in creating improved lung capacity.


To give you an idea of what we are talking about, here are a couple of examples for how we have progressed our client’s respiratory exercise capacity:


Focusing on Improving Lower Intensity Respiratory Endurance

Low-Medium Intensity/Low Volume/Short Rest 

Low-Medium Intensity/Medium Volume/Medium Rest

Low-Medium Intensity/High Volume/Medium-High Rest 

Focusing on Improving Higher Intensity Respiratory Endurance

Medium Intensity/Low Volume/Medium Rest

Medium Intensity/Medium Volume/Medium-High Rest

High Intensity/High Volume/High Rest

Examples of Volume:

* Low Volume: 1-3 sets per exercise

* Medium Volume: 2-5 sets

* High Volume: 4-8 sets

Example of Intensity:

*Low-Medium Intensity: Slow, controlled breaths

* High Intensity: Short, high effort/forced breaths


           As you can see in these different progressions, there is an interplay between the intensity, volume and rest. It is very important to understand that respiratory training recruits the cardiopulmonary and neuromuscular systems at the same time and as the intensity increases or decreases, so will the demand of each system. The biggest component that is lost in this type of training is the adequate amount of recovery in between sets and which exercise is paired with respiratory exercises.

          You do not want to pair a high intensity/high volume respiratory exercise with a heavy deadlift because of the neurological demand that is required for both however, with that being said, pairing a heavy deadlift with a high intensity/volume respiratory exercise may be what is needed to get someone’s tension levels dialed in because the volume is low, which may heighten neuromuscular facilitation for the deadlift.  


          On the other end of the spectrum, meditation is a low intensity neuromuscular strategy. This is great approach to improving lower threshold endurance in breathing. This however, wouldn’t be the optimal approach to take right before a heavy deadlift if the volume was high however, it could be beneficial post deadlift at a low volume to recharge the system before increasing the tension for the next set. The variance of respiratory demand is important in building a system to balance the oxygen to carbon dioxide ratio within the blood, lungs and muscles. It however, is part of an intricate system that is unique based on the individual and must be programmed in a way that fits the individual and his/her goals. Low to higher volume/intensity is required to improve breathing patterns and cycles. Everyone needs the ability to breathe through high respiratory stress and low respiratory stress but more importantly, learn to improve respiratory recovery between and at the end of training sessions.

          Respiratory training is not just about improving breathing patterns and respiratory rates, but it is also about improving mental focus, neurological recovery, and balancing the mind and body’s ability to create tension and then release it. The best athletes in the world understand how to tense and relax, and respiratory training aids in that process. Respiratory training should be integrated into an individual’s warm up, between resistance and cardiovascular training blocks, and within the cool down. Don’t just use breathing as a method to down regulate the system from a set, but use it as an approach to progress lung capacity and endurance through tension and relaxation.


Wilkens, H., Weingard, B., Lo Mauro, A., Schena, E., Pedotti, A., Sybrecht, GW., & Aliverti, A. (2010). Breathing pattern and chest wall volumes during exercise in patients with cystic fibrosis, pulmonary fibrosis and COPD before and after transplant. Thorax, 65, 808-814.

For more content check out our YouTube Channel: Cystic Fibrosis Fitness Institute 

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Intrinsic motivation is something that develops over time. Kids don’t yet have the cognitive abilities to grasp the concept that, “exercising is good for physical and mental health.” The understanding that by “doing something good for your body now, your future self will thank you,” is far too abstract. Kids don’t live for the future, they live for the here and now.

By the time children are in high school and/or go through puberty, those high order thinking cognitive processes begin to develop. However, social obligations and a sense of figuring out one’s own identify often trump the desire to be consistently active for one’s own physical and/or mental health purposes.

Sports certainly help, as they play a role in encouraging healthy competitiveness within oneself and others, as well as promotes team building and social opportunities that child and young adults actively seek out. However, not every kid plays a sport or has the health opportunities to actively participate in one. So, how do we encourage motivating?


There are two types of motivation: intrinsic motivation and extrinsic motivation. Some will say, intrinsic motivation is ideal because it creates long lasting effects on one’s drive and purpose to reach a goal. The definition of intrinsic motivation is, “behavior that is driven by internal rewards.” Extrinsic motivation is the opposite. Extrinsic motivation is defined as, “behavior that is motivated to perform an activity to receive an award or avoid punishment.”


When starting to increase your child’s motivation to exercise, extrinsic motivation is the “easiest” way to go. When young, a child/teen is beginning to develop his/her own sense of motivation and enjoyment from exercising, something that is not going to happen overnight. Fortunately, exercising regularly will naturally contribute to developing intrinsic motivation, as it increases the feel-good happy chemicals in your brain (serotonin, dopamine, endorphins). But, habits do take time, so here are three tips to increase your child’s motivation to exercise!

  1. Reward System

There are often mixed reactions to implementing a reward system. However, a reward system is not something to frown about when working on establishing a foundation for positive behaviors. Research has shown that children respond better to positive reinforcements than they do to negative reinforcements.

How to begin a behavior reinforcement plan:

  • For children ages 7-12: Make a personalized goal tracker with your child. For example, if want your kid to do something physically active 3x a week, create a page with three boxes per week to check off after each workout (e.g., can use stickers, a drawing, a penny, etc.)
  • For children 13 and older: they can often keep rack on their own, and independence is key for teenagers and young adults.
    • Each workout = 1 point.
      • It is up to you to decide how often a reward occurs and what the reward will be.
      • Reward types: with your child’s help, create a list of 5 items/things that might be motivating to earn. For example, 30 minutes of a favorite show, a new toy or “surprise box,” staying up later one night a week, choice of a favorite meal for dinner, a new book, etc. The possibilities are endless!
  1. Social Opportunity

As an adult, performing 15 reps, 4x on one exercise is manageable. Our attention is longer. We enjoy isolation more. We have intrinsic motivation or tangible goals set for ourselves, like losing weight. However, children and young adults are heavily socially dependent with shorter attention spans. Their worlds thrive around social opportunities, So, make physical exercise a social experience. Workout with your child, put on a YouTube video and together and complete 30 minutes. Put on your child’s favorite music on in the background and encourage your child to work out for 20 minutes (set a timer). One time a week (or more) invite a friend or sibling, make it an event that can be done inside or outside, and make it fun.

  1. Bring back Play

Which brings us to our third tip: Bring back play! Even if you have a teenager or young adult, play is important to developing a positive attitude towards physical exercise. Play can consist of hiking with friends or family, trying a new activity in your community, and generally, reducing the strict structure around exercise that children and young adults often try to escape as they build independence and autonomy. A majority of the time, exercising can consist of structured exercises catered around a specific goal, however, a few times a month it’s important to switch it up and encourage exploring of physical exercise through unstructured (play) opportunities.


















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