Improving the Quality of Life in Individuals Fighting Pulmonary Diseases

The Complexity of Respiratory Training: What The Trainer Should Know

May 28, 2019 | Article, Blog

          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 

More From THE Blog

How Cystic Fibrosis Has Changed Our Lives

May is Cystic Fibrosis (CF) Awareness Month and a time for us to reflect on how well we are doing on improving the approaches to fitness for individuals with CF. Just a little over six years ago, the idea of the institute came to be. The integration of a multidisciplinary





1009 2nd Street

San Rafael, CA 94901

%d bloggers like this: