Patrick Obolgogiani (00:08)
John, you were probably the first one to test an entire Olympic team for asthma back in the early 2000s. Can you tell us more about what was that experience like?

John Dickinson (00:20)
Well, yeah, mean, when I first worked with the British Olympic team, I obviously came in to that team and in the UK, no one had really screened elite athletes for breathing problems in the past. It was an opportunity for me because I just sort of, I was about six months out of graduating as an undergraduate student. And this opportunity came up to basically do a PhD, but at the same time, what that was all about was kind of…

finding out the prevalence and the best way to diagnose elite athletes for breathing problems like exercise-induced asthma.

So in the first sort of six months was a big learning curve because when I first started, I didn’t really know that much about respiratory testing. But at the same time, because there was no one else doing it in the UK, there wasn’t really anybody else to learn the techniques of. it was very much using some kind of drawing on some of the the specialists who were working at the British Olympic Medical Centre at the time. And then, you know, just jumping into it really.

I went from sort of graduating as an undergraduate in June 2002 and in February time, 2003, I was testing people like Matt Pinson, was an elite gold medalist. So it’s a little bit kind of thrown into the fire with that, but it was a brilliant experience. you know, probably…

ever since then I haven’t really looked back because of the opportunities that kind of arose from all of that. We found about 21 % of that Olympic team that went to the Athens Olympic Games had an asthmatic related condition, which then sort of asked a lot of questions about kind of what the best way of managing those types of athletes are. Well, on the flip side of that, we also found about 20 % of the team that had been given an inhaler in the past actually couldn’t give us any evidence of asthma.

And then we started to look into these experiences. thought, well…

Maybe not every time an athlete’s breathless, it’s an asthmatic problem. Could it be something else? And we now know things exist such as exercise-induced lavngel obstruction, which is an upper airway issue, or we know other things such as the way people kind of try and move their rib cage to get air in and out of their lungs can cause breathlessness, which I’m pretty sure we’ll probably talk about later on. But so that kind of work in the early 2000s in the UK really kind of helped sort of start the process

of looking at all these different aspects in their league’s athletes.

Patrick Obolgogiani (02:41)
Yeah. Yeah. So it’s like both on one hand, under diagnosing and over diagnosing at the same time, which is very interesting. And we’ll make sure to, to go into that, but I’m curious to hear, course, like 15 years later, you were definitely, uh, least contributing a lot to the success that same team with medals and, and, and, 20, 2016, do you have any favorite success stories of like helping an athlete with their breathing?

John Dickinson (03:07)
Yeah, well, I think, I mean, it’s difficult to actually single out individual athletes. I don’t want to sort of start saying, but what I will say is that particular Olympic Games, we obviously worked with, I’d worked with individual athletes across the process and build up to Rio. But probably the team I worked most closely with was the British swimming team. And what was great about working with them is I started working with them in 2013.

Patrick Obolgogiani (03:12)
Of course. No, no, no, of course.

John Dickinson (03:34)
and they didn’t really have a strong kind of respiratory testing process. But over the course of between 2013 and 2015, myself and Dr. James Hall, we worked really closely with them and basically helped put together probably what is now

rolled out to all Olympic sports in the UK but we basically developed this kind of systematic respiratory screening plan which basically screened these swimmers for other airway problems.

for lower airway problems like asthma and for breathing pattern disorders. And then we had this kind of yearly annual update with them that allowed us to kind of make sure the athletes were cared for in the best way, depending on what breathing problem they had. And when they actually got into the Olympic games, they had the best, I mean, they’ve done better since, but up to that point, they had their most successful Olympic games as a group of swimmers. And there were some individual swimmers that we really,

really closely with that had kind of issues such as breathing pattern disorder and they were really struggling kind of putting a finish to maybe a 200 meter race because of their breathing. And we worked with them and developed their breathing technique to make them as efficient as possible as we could. And that helped them be stronger over the last 50 meters and those athletes actually went onto a medal and some of them got gold medals. So, you know, you kind of like, obviously we’re…

well away from the pool by the time they actually do their swim but you just make it when you’re watching them on TV you go actually I helped do that so it’s quite a nice little feeling.

Patrick Obolgogiani (05:10)
Yeah, definitely. mean, it’s

a team sport, right? Ultimately, no matter who’s in the pool, it requires other people around those athletes. So that must have been appreciated. I was going ask you later actually, but now that you mentioned the breathing pattern disorder, like I think we all know asthma is pretty prevalent. I think I read somewhere like 260 million people. And as far as I understand, think also Aashish who was Dr. Aashish Vyas was on the first podcast. You know him as well.

He defined as like inflammation in the lungs, as the wheezing happens, always, but often on the exhalation. But how do you differentiate between that, the asthma, from both the breathing pattern disorder that you mentioned, but also something I know you’ve researched a lot is the dysfunctional breathing. Are they just like synonyms or how do you differentiate between those three things?

John Dickinson (06:02)
Yeah, well, I’d probably say the two things. think there’s a bit of legacy in terms of what we call a breathing pattern disorder. So a breathing pattern disorder, probably six, seven years ago, it was called dysfunctional breathing. So they’re kind of same thing that we’re talking about there. One of the reasons why they get misdiagnosed with each other, a lot of the time, because the technology isn’t really available, and the standardization and testing isn’t really available to identify breathing pattern disorder at the moment, a lot of the time,

Patrick Obolgogiani (06:11)
Right, okay.

John Dickinson (06:29)
When an individual goes to the doctor and says, well, when I’m running about, I feel a bit of a tight chest and I feel that my breathing’s limiting me doing the sport or the exercise I’m trying to do. The temptation for the doctor there is to basically, based on those symptoms, is to provide an inhaler and say, well, it sounds like it might be asthma, go away and try this inhaler.

A lot of the time then individuals just kind of go, well, doctor says I’ve got asthma, my tight chest is because of my asthma. they kind of got some sort of answer. However, if it was asthma, the inhalers usually will sort it out quite quickly. But it’s not uncommon that, say where the symptoms kind of cross over are that basically the…

breathing pattern disorder and asthma, they do have very similar symptoms. if an asthmatic is likely to say that when they exercise, they get a tight chest, someone with breathing pattern disorder will say the same thing. They’ll say, my chest gets tight. The difference being that maybe if it’s exercise-induced asthma, that might usually come on kind of after they’ve done a hard bit of exercise or actually after they’ve finished exercise overall, whereas the breathing pattern disorder,

kind of issue will occur during the hard parts of exercise. So they usually experience it during kind of a high intensity piece of exercise. And then as soon as they stop within kind of two or three minutes, their breathing and their tight chest has disappeared. breathing pattern disorders are usually more acute in terms of the symptoms. So other common symptoms are difficulty breathing in, difficulty recovering.

between efforts. Those are all quite common symptoms of breathing pattern disorder, but I’m sure individual with exercise with asthma would report similar symptoms. the only way to differentiate between the two is to do some objective testing. The difficulty is within most, well, especially in the UK within kind of the national healthcare system, at the moment, because there’s been a backlog from COVID, now with five years after COVID, but there’s still a massive backlog in accessing tests.

that allow medical professionals to actually see kind of how well someone’s lungs are functioning. And so, you know, someone who might go to a GP today, depending on where they live, it might take them over a year to get a spirometry test to actually kind of investigate them for asthma. So they might be waiting quite a while, maybe using inhalers.

that might not be working for them. And actually what they need is some support with their breathing pattern to help them overcome their breathing pattern. And the reason why an inhaler doesn’t improve a breathing pattern disorder is because the inhalers kind of help open up your airways. They help reduce the inflammation in your lungs and open up the airway. Whereas a breathing pattern disorder is caused from sort of mechanically the way you’re trying to move your rib cage. So it’s more about the coordination of your respiratory muscles.

and the movement of your rib cage and also linked to that potentially the way you hold your posture and the anxiety and stress about breathing. It’s more of technique to learn, so more of a skill rather than needing an inhaler to overcome it. And then, you know, the other side of it as well is that there’s a bit of gray zone in the middle where we do come across a lot of athletes that have asthma.

Patrick Obolgogiani (09:42)
Right.

John Dickinson (09:50)
but they also have a breathing pattern. So then you’ve got the, you know, then you have to kind of work between the two, but hopefully that describes it a little bit, how they differentiate.

Patrick Obolgogiani (09:59)
Yeah. What does one do? Like you kind of mentioned that it’s about understanding the mechanics of rib cage. It sounds kind of complicated then to at least look if I self-diagnose like, okay, that sounds like me. I know we’re not like a medical, we’re not giving medical advice, but like what would be the first step for someone to start training the diaphragm and so forth from the diagnosis onwards?

John Dickinson (10:22)
Yeah, well, that’s one of the questions we asked ourselves when we looked at the research. So when we had that question asked to us from a lot of athletes, you’re saying I’m not breathing right, but what actually is a good breath? And when we of looked at

Patrick Obolgogiani (10:34)
Yeah.

John Dickinson (10:35)
that looked at the scientific literature, it wasn’t that well understood. So we’ve used some quite technical techniques in our labs, looking at the 3D mapping of where the ribcage moves. And what we see in a healthy breath, if you look at the whole of the ribcage, where that movement starts with a breath in is at the bottom of the ribcage, which…

which kind of makes sense because that’s where your big breathing muscle is your diaphragm, but remember there’s many more breathing muscles than just your diaphragm, but your diaphragm is your big one. And the movement of the lower rib cage is sideways, forwards and back. So basically when we’re looking for an efficient breath, we want the bottom of the rib cage to move first, and there’s a sideways movement and there’s a forwards and backwards movement. Then as we breathe deeper,

The breath still starts in that place, but just get more movement into kind of the mid and upper rate, upper movement, upper areas of the rib cage. So there’s lots of technical ways. So when I’m delivering kind of breathing pattern training sessions, I’ll deliver it quite technically. But ultimately when someone’s trying to do that kind of out and about, it’s trying to just think about one smooth movement and it could be.

There’s different people process it in different ways, but it could be, need to breathe sideways or I need to relax my shoulders to allow my lower rib cage to move from the bottom or.

it could be, you know, try not to have any tension in your upper chest when you’re trying to breathe in. So there’s lots of different kind of thought processes, but ultimately, you’ve got to try and simplify it because if you start to go, we need to need to be, right, we need to then move the rib cage sideways, forwards and back. Whilst you’re thought all those thoughts, you’re probably about four breaths too late down the line and you’re feeling breathless because you haven’t taken a breath or you haven’t taken a breath. So there’s lots of…

the little tricks and techniques we can do to help support that. But it can get quite complex because there’s probably about seven different physiological systems that feed into the way you kind of breathe. And then you’ve got the kind of psychology anxiety issue about that as well that can also affect it. And then your breathing will then kind of affect those different systems as well. So it can be quite complex as to how we kind of unpick an individual that might have a breathing pattern disorder. Because not everyone has, it kind of has.

developed one in the same way. So there are different ways we can kind of go through it. I guess going back to the question is kind of how should someone breathe? We kind of simplify it. What it is is basically that lower rib cage starts the movement. We go in sideways, forwards and back. It’s a nice smooth movement all the way through to where we feel we need to finish the breath in. And then we haven’t talked about much is the breath out, which is as important if not.

more important, but that breath out needs to be controlled, relaxed and smooth. Okay, if we start to breathe out too fast, that starts to impact kind of the sympathetic nervous system, which starts to get us all excited and wants to kind of increase your breathing rate. Whereas if we breathe out nice and kind of relaxed and allow for the recoil of the chest wall, that kind of activates the other part of the nervous system that helps to just.

keep everything calm and calm and controlled. So the breath out is really important that we don’t overly force the air out as well.

Patrick Obolgogiani (13:45)
Yeah, that’s a beautiful summary. It almost reminds me of

like when I first, I remember some years ago, did like a running practice. You know, you would think like humans, we know how to run or walk. And then when you go to like act professional look, and then teach you to use your hands, right. And so forth, you kind of, it feels so awkward in the beginning when you’re like, like, is this how you’re supposed to run? You need to like pay attention to every single muscle and everything else. So you probably hear the same thing where like, we, I know how to breathe, but then

mechanically, if you’d like to pay attention, that’s being a bit awkward at the beginning. Then maybe as you mentioned, it’s trying to kind of have these little almost like heuristics, like, hey, relax your chest. I know remember to do this and slowly maybe these thoughts accumulating these little patterns that then help you go from A to Z.

John Dickinson (14:32)
Oh yeah,

Yeah, I I kind of liken it to, it’s just like, I basically, I liken it to breathing is, know, no one’s, no, very few of us get taught how to breathe. We basically are born, we start breathing and we just keep on doing it. And it’s just, I liken it to a similar way to kind of walking, you know, most of us kind of find our own walking gait, we figure out how to walk and we just walk and some of us walk really efficiently and we’ve got a really smooth walking gait that doesn’t…

putting risk of injury. And then we got others that kind of move okay, and there’s a little bit of something not quite right, but there’s no issue with movement. And some of us walk in a way that actually potentially causes injury and causes limitations of how far people can go. And breathing pattern’s a bit similar to that, where some people have really efficient movement, and they just get on with things and don’t even think about the breathing. Most of us probably have some form of

slight inefficiency, but it doesn’t really limit what we can do. And then we’ve got the kind of the point where that movement starts to limit what we can do in terms of how far we can push our bodies. And what you should say is for most individuals, they’re kind of exercise classes or they’re trying to do a 5K or something like that, if they’re finding their breathing is kind of what’s limiting their kind of ability to push on, potentially that is.

cause from some form of breathing pattern disorder because to do those kind of most activities that we do during exercise, unless we go and absolutely flat out for a prolonged period of time, our respiratory system’s probably not gonna be the limiting system for us. So we’re feeling that my legs can go a bit faster but my breathing won’t let me, then it’s likely that maybe the breathing’s kind of holding an individual back a little bit and that might be where little gains can be made in terms of kind of finding efficiencies in their breathing pattern.

Patrick Obolgogiani (16:25)
Yeah. What they’re to ask you, cause you kind of mentioned anxiety and stress, like the fact that you kind of starting being more anxious about the fact that you’re doing it wrong and, and so forth. like overall, I imagine that with athletes as well, you have people that, you know, it’s pretty high pressure when you’re going in the pool. mean, some of them, of course, get into the zone, so they don’t even think about it, but I’m sure there’s some people that are doing a penalty in the premier league and it’s like, it’s,

there or not, and you have huge pressure, and which then might lead some people into kind of hyperventilation. That’s like a, breathing issue, but ultimately it’s about your mental state. And I guess I’m just curious to hear like, what have you learned about the link between the breathing and our kind of head state, mental state, and then what have been helpful ways to teach those athletes around using breathing to potentially calm your nervous system down.

John Dickinson (17:18)
Yeah, I mean, this is kind of, there’s an area here of research that really needs to develop because there’s not real kind of strong evidence to support what I’m gonna say, but I’m gonna sort of base it on kind of the way I work with athletes. I mean, there’s some evidence to back up what, but a lot of the research that we need to do is kind of in this space. So that anxiety stress, and it’s kind of, it can work in different ways. So.

Patrick Obolgogiani (17:30)
Really? Okay.

John Dickinson (17:47)
A lot, sometimes it’s about expectation. So for example, I work with some athletes who will go, I’ve been running, I’m fine running on the flat, but as soon as I hit a hill, my breathing goes, and when we kind of look at what they’re trying to do, it’s almost as if like psychologically they’re saying, right, and I’m hitting this hill, so now I need to breathe harder to help me get up the hill. And it’s kind of that, they’ve kind of developed this kind of like habit of breathing faster to get up the hill when actually they don’t necessarily need to breathe as fast or as hard.

as what they like to. So it’s kind of that part of it could be an expectation or stress about actually I need to keep my pace up the hill so I need to breathe harder. And so just that extra stress. Sometimes it might be an athlete who is maybe in a race and someone shoots off when they’re not expecting it and they go, I’ve got to catch them up, got to catch them up. And then maybe they’re expecting to beat that person in the race. And then there’s that kind of, to catch them up instead of kind of just.

picking up the pace and relaxing my breath into that harder work. There’s that tension and there’s that I need to breathe fast. So sometimes with athletes it’s that as they wanna push harder, they feel that they need to almost like take hold of their breathing to go faster. But actually in reality, it’s almost the opposite. Yes, they need to push their body a bit harder to maybe go a bit faster. But the part you need to kind of relax that breathing into that hard work.

rather than trying to breathe deep and fast. Because ultimately, if you try and over breathe or you try and really drag the air in from your shoulders, it’s probably like to have the opposite effect. And you probably like to put more energy into your breathing and the quality of the breath in terms of the depth, how much volume of air you can breathe per breath will likely drop. And so therefore, you’ll have the opposite kind of response. But it’s about an athlete trusting that relaxation process and relying on their kind of their automated systems can just

just breathe a bit deeper and a bit faster for them rather than taking it over. So that’s one aspect of kind of the psychological stress around it. then like you kind of, you mentioned there about, know, some athletes can get themselves in the zone and things, but if an athlete experienced a bit of breathlessness in the past, sometimes just experience it once or twice, then it becomes a bit of a problem because they then get in the water and go, or they get, you know, going to do whatever sport they’re to do. And they go, maybe

am I gonna get breathless again this time? And there’s that kind of like little bit of worry, little bit of kind of stress in there going, is it gonna happen today? Is it not gonna happen today? And because they’re a little bit more on edge, they’re a little bit more aware of their breathing and because of that, they start to maybe try and take a bit more control of their breathing. And so you got that kind of built up previous experience of bad things happening. And so a lot of the time it’s trying for us to work with athletes to unpick that previous experience and it’s

I say I work quite a bit with individuals who have breathlessness, have experienced long COVID. And it’s the same thing with them, you they might have got a breathless going, you know, walking across a car park once. And then suddenly there’s that little bit of thought process in mind about a parked in the car, I’ve got to go 500 meters across the car park to get to the shops. Am I gonna make it? Because I might have to stop halfway through and they’re very, very cautious about the way they’re breathing. And so…

is trying to get that psychological reset with them. And it’s not difficult because we’re not computers. We’re not just able to just go, just hit the reset button and everything’s going to be fine again. It takes a bit of time to kind of build the confidence that the way that a good breath works will not result in that experience in the future. So there is that kind of mentality shift. And a lot of the time, when I’m helping individuals, we do work

together with psychologists because I’m not a psychologist myself. And sometimes people need a bit more than just reassurance and a bit more than just the confidence that I can give them. They might need to work through some mental sort of training techniques to just try and help them feel more confident about delivering the kind of good breathing breath that they’ve been practicing when they’ve been going through breathing during processes.

Patrick Obolgogiani (21:57)
Yeah. Yeah, makes a lot of sense. One thing I wanted to kind of talk to you about is this link between breathing and longevity. A lot of people are interested in that kind of health span increasing that. And I feel like the breathing aspect has been a little bit missing from the conversation. I mean, it’s kind of indirectly the talk about it through the VO2 max as a capacity of your, of your kind of exercise system, so to speak. But maybe there’s different angles we could look at this, but one maybe is this

idea that think Peter and other popularized this, this zone two training. doing this like low intensity training, you know, a couple hours a week. and that basically the way you could measure that is whether you can talk while you’re doing it is like one way to assess if you’re in that zone. I guess I’m just overall curious to hear how do you, how are you thinking about zones in general? And how do you think kind of breathing links to maybe assessing which, which zone you’re in, if at all.

John Dickinson (22:30)
training.

Yeah, I mean, I think that sort of attitude has used for quite a while in terms of, know, if you can talk easily, you’re probably like in zone one or two. And then as you start to get zone three, four, you might be, you know, zone three, might be able to get a short sentence out, but not maybe kind of talk forever. you know, zone four, fives, they’re basically just get on with on with the running. I think in terms of whether you, if you’re doing kind of zone two stuff, think what that allows you to do is,

It’s, you know, in athlete work terms, that’s kind of like a recovery, recovery runs and things. Obviously, if you’re doing it for prolonged period of time, there might be kind of training for things like endurance, endurance sports. How that links to doing that kind of stuff a couple of times a week for longevity and, you know, kind of aging and those sort of things. I mean, it’s not gonna, it’s probably not gonna hurt as long as it’s not painful to exercise for that length of time. But I think the…

the evidence said, know, to do it two week to two days a week, will add on X amount of, I guess it’s longevity in terms of is it about living longer or longevity about quality of life until we die. It’s likely to have that, certainly like to have that ability to increase quality of life because that’s gonna kind of, those kind of benefits again, definitely work in your cardiovascular system as much as your respiratory system, because the two work really close hand in hand together.

And it’s likely that if you’re kind of, you know, you’re exercising for a prolonged, you know, an hour or two in that zone two level, that you’re going to be really working your cardiovascular system. you know, that heart is going to be pumping the blood around. It’s as much as it’s going to be making sure that the heart’s working well, it’s also going to be probably making sure all the blood vessels are, you know, working efficiently as well. So there’s definitely sort of links to it. I mean, let’s say we’ve been using it for,

I think within that training world, when heart rates went around and things, when people that have heart rate monitors, it would be kind of like recovery run that you should be able to talk. If you push yourself away, you’re struggling to talk, that’s probably getting into a bit of a trend. And if we go to the point where we can’t talk, that’s kind of into those anaerobic type zones.

It’s definitely got something, there’s definitely something in it. I wouldn’t like to sit here and go, well, if you can do that twice a week, it’s gonna add five years to your life. I wouldn’t say the evidence is there at the moment.

Patrick Obolgogiani (25:20)
Yeah, yeah, no, makes sense. Another one that’s kind of been talked about more and more is this idea of nose breathing. think particularly Patrick Mckeown and others have like, you know, really pushed for the idea that you might even want to tape as some people are taping their mouth and it’s adding value. And I have heard some warnings from like, for example, Matthew Walker recently in his podcast talked about that for some people it might not be the best idea. So I’m sure there’s nuance there, but overall, like it does seem like athletes

don’t always adhere to this, like even, you know, in swimming you can’t really do nose breathing. So I’m just curious to hear from your experience, like how important is it to nose breathe and, and, know, what’s the impact of doing mouth breathing during heavy exercise, if any.

John Dickinson (26:02)
Yeah, well, mean, my kind of take on it is if you can breathe through your nose, breathe through your nose, and basically for most of us that means at rest, if we can breathe through our nose, we should, and there’s basically health benefits for it. The three key ones are your nose, so your upper airway passages as the air goes through your nose to the back of your throat is that the air gets warmed, it gets humidified, and it gets filtered.

So it means that once the air actually gets into your lower airways, it’s in a good condition for gas exchange, so the exchange of oxygen into our body and taking CO2 out of our body. It’s in that kind of prime state. If we’re breathing through our mouths, it means that the air going into our lower airways, it bypasses this warming and humidifying and filtering process. And so the lower airways have to do a lot more of that kind of filtering and warming and humidifying.

If we’re gonna do that at rest, then it gets that, you you’re getting that unconditioned air going into your lower airways a lot frequently. So if you can breathe through your nose at rest, that’s, you know, I think everyone will probably say do it, okay? Now, the difficulty becomes that our airway passages through our nose are only so big. So when we start to exercise, there will become a point, and it will be different for everybody, that.

the gaps that the air’s gotta go through in your nasal passages, they aren’t large enough to allow you to appropriately ventilate your lungs to allow you to do the work you’re doing. So they will come a point, and for most people it’s somewhere between that zone two, zone three we just talked about, where they have to kind of start breathing through their mouth. Now, if you think about how long you exercise for,

An athlete maybe does it, an endurance athlete maybe does it for five hours a day. Probably, you know, a keen exerciser maybe does it for an hour and a half a day. And somebody who’s maybe just a bit physically active maybe does it for half an hour a day. But when you actually kind of look at that, whole big spectrum of the day, it’s only a small portion of the day compared to the other part of day. I think predominantly, if we’re kind of, when we need to go, you know, for an even-impedant athlete,

When they need to go to mouth breathing, do it, that’s fine. But as soon as they can switch back to nasal breathing, go to there. That’s kind of my take on it. I wouldn’t overly force the nasal breathing during exercise because I think if you do that, you’re likely to be compromising the ability to ventilate your body

Patrick Obolgogiani (28:41)
Right. Yeah, that makes sense. So it’s more important to think about what you do outside the exercise rather than just like forcing it maybe during maybe speaking of breathing patterns, like we’ve did already speak about some of the common, let’s say maybe wrong is the wrong word, like suboptimal breathing patterns, like, you know, not using or like tightening your chest, not using the diaphragm muscle in the right way, but what other

like breathing patterns, if you noticed, in either athletes or non-athletes that you work with, but, you know, they’ve not been conscious of it and it’s been impacting their life in some way.

John Dickinson (29:15)
Yeah, I think it’s not, everyone doesn’t, not everyone does this and usually breathing pattern sort of kind of present, can present in different ways. But I guess I’ll talk you through the common ones we see. One we see is individuals what we do, do what we call, is called apical breathing, which basically using the shoulders a lot. there’s a lot of, if someone, you know, and a lot of the time when we ask someone just take a deep breath in, the first thing people will do is go up here with it and they’ll try and use their shoulders to pull the air in.

And what that does, actually locks a lot of your rib cage up, so your rib cage won’t expand kind of sideways as well as it could do. And so we end up kind of almost kind of getting maybe two thirds of the air in that we actually need. So that’s one thing. Another thing that people do that’s a bit funky is if you actually kind of watch their abdomen and their chest, when they breathe in, they sort of push their abdomen out first, and then there’s a little bit of a delay and then they lift their rib cage.

Patrick Obolgogiani (29:51)
Mmm.

John Dickinson (30:13)
we kind of see that the top of the abdomen and the rib cage don’t move together and they kind of one bit moves and the other bit moves. And we call that kind of asynchrony in the breath. And again, that has a similar response to the apical breathing where you kind of get parts of the rib cage get locked up a little bit and it doesn’t expand particularly well. So we see that kind of funky thing going on quite a bit. Other things we see are breath holding. So,

Sometimes people will exercising and they might kind of, and then hold their breath for whatever reason, and then kind of breathe out or they’ll hold their breath at the end of the exhalation and then breathe in. And really, if we’re trying to breathe really, really efficiently, there should really be, we’re either breathing in or we’re breathing out. We don’t really stop. kind of, you see, know, and if we’re at rest, doing a really nice slow breath in and a nice slow breath out. If we’re exercising.

we’re happy with just doing it frequently, but obviously with a bit more frequency to it. So we want that kind of nice smooth breath rather than jerky breath. Other times we see people are inconsistent with their breath depth. So they’ll sometimes do a small breath, a small breath, and then a big breath, and then a small breath and a big breath. So there’s kind of inconsistency with the kind of volumes that they’re breathing. All the ones are that…

if they haven’t taken a sort of satisfying breath in, obviously the brain’s going, need more air. So what they do is breathe out really fast and then breathe, try and breathe the air back in again. And again, that process of rapidly forcing the air out, one, it kind of fixes a few parts, gets quite a lot of tension around the rubrication, it becomes quite difficult to expand it properly. But also that fast breath out excites this kind of sympathetic nervous system, which gets us ready for kind of more kind of fight or fight.

fight or flight kind of activity. And again, that riles up the breathing pattern, the need to breathe. So that’s not particularly great. And then other things that people will do that kind of, it’s not particularly helpful is the way they hold their posture. Now, and what I mean by that is your respiratory muscles and especially your diaphragm, as much as it’s a breathing muscle, it can be used for postural control.

And if we over-fix around the diaphragm and the other respiration muscles and over-rely on them to hold posture, then they are less willing to fully expand that rib cage because it will destabilise the body. And so if we’re holding posture inappropriately, then that can lead to this breathing pattern disorder. there’s lots of different things that people do with the way they control their respiration muscles.

that make it an inefficient breath. Like I said, some people do this and they don’t have a problem, but other people, they do it and it does cause a difficulty and they report symptoms in their ventilation.

Patrick Obolgogiani (33:01)
Yeah, I’m just listening to you and trying to figure out like which ones can we pick up with the Alveos One device. And it sounds like some of them we probably will be able to like, know, if you breathing depth will be seen the waveform, some of them might be more difficult, unless we would be accelerometer, we can maybe pick up if you’re moving it in the ways and then correlate that with the sound and say, hey, that might not be the right movement we want to see. But that would be something really fun to work with is finding those moments when it’s maybe, hey,

John Dickinson (33:28)
Yeah,

Patrick Obolgogiani (33:29)
reminding people to breathe.

John Dickinson (33:29)
exactly. And you’ll be able to pick up kind of the consistency of breath probably because of the movement of it. And you’d probably be able to pick up the speed as well in terms of, is the inhalation overly fast compared to the exhalation and things? So I think there’ll be things that we had to pick up that might help individuals just point them in the right direction in terms of how to control their breath, how to calm their breath and be able to breathe more efficiently.

Patrick Obolgogiani (33:35)
Yes.

Yeah. Why should people care? Like, I guess for someone who struggled before, it is pretty obvious like when you can’t breathe, it is hard to live normally. But if you had to like pinpoint like what are the consequences of like suboptimal breathing, you can pick whichever of those patterns. What does it matter?

John Dickinson (34:13)
Again, I think it depends on the individual. I think breathing pattern disorders, they can develop things like anxiety and stress because if you’re always kind of breathless or you’re always experiencing breathlessness, when you’re out and about, know, it’s not the greatest place to be going, oh, I might, you know, I’ve got to walk up some stairs now and I’m, you know, it might kind of ruin my day. It might kind of totally wipe me out. So there’s that kind of, kind of,

anxiety stress issue with it. think having a better breathing pattern reduces that anxiety and stress. From an exercise point of view, we know that actually breathing in an inefficient way increases the cost of your, it increases the cost of how much energy you put into your breathing. So if you’re thinking about kind of high intensity exercise, if you’re an efficient breather, we estimate about 12 % of your energy consumption goes into your breathing.

where it’s if you’re an inefficient breather, about 18 % of your total energy cost goes into your breathing. So if you’re trying to exercise and trying to push your body as hard as you can, you probably want to be trying to put as little energy into your breathing as you can because obviously you want most of the energy to be going into the muscles that are pushing you forwards or pushing you to do what you want to do. So there is that angle of the more efficient we can make the breath,

then the more energy can be used elsewhere. And the other flip side of that as well is we know that if the respiratory muscles are overworked, they can start to become fatigued, what’s more important is before they get to that point, what happens is that if they start to become overworked for the activity you’re doing, they send feedback to your brain and your brain kind of processes it.

and your brain goes, know what, we can’t keep exercising like this because your respiratory muscles are a key thing to us staying alive. So to basically protect your respiratory system, what we’re gonna do is we’re gonna basically slow you down. And so what the brain then does is it stops sending blood, or as much blood, to the muscles that are working, and that means they have to go anaerobic. And once they go anaerobic, they’re gonna fatigue quickly and you’re gonna slow down.

And so basically having a poor breathing pattern during exercise, it’s called the, what’s it called? The respiratory muscle mechanoreflex. So it’s respiratory mechanoreflex. Now it happens to everyone at a given point, but if you’ve got an efficient breathing pattern, it rarely happens at all. Whereas if you’ve got an inefficient breathing pattern, it’ll happen quite frequently at rides, of exercise intensities that you think you probably should be able to do without kind of feeling.

early onset fatigue and having to back off the intensity that you’re working at. And so there’s lots of different reasons why an individual might want to kind of improve or have an efficient breathing pattern. Yeah, so probably the other one as well, probably the other one for athletes is a lot of these athletes we work with, going back to that postural thing, will continue to complain of having tight shoulders and tight backs.

and they can constantly go back to their physio, because you’re having their back released or their shoulders kind of worked on. And a lot of that is caused from their, partly their posture control, but a poor breathing pattern. So if you’re constantly having to shift your shoulders up to breathe, you’re overworking these muscles here that aren’t really designed to do that. And that’s why they keep getting tight. And so an improved breathing pattern will reduce the stress that you put on those.

Patrick Obolgogiani (37:17)
Mmm.

John Dickinson (37:42)
larger muscles like your deltoids in your shoulders and things that might be getting tight because you’re overusing them to keep, to breathe. therefore if you improve the posture control, improve where you’re getting that breathing pattern from, decrease the activation in your muscles, in your shoulders and in your back, that tightness starts to go away you don’t need to keep going back to the physio. So there’s loads of different kinds of reasons that we got. I think we’ve only got an hour for the podcast, so I won’t keep talking about them.

Patrick Obolgogiani (38:09)
sure. One that I would love to go deeper into is like, there’s people have fortunately become much more conscious of the way they sleep. Probably Matthew Walker’s work has been part of that and people have wearables for that and so forth. But has there been science and research into how does breathing influence the way we sleep, whether it’s like the way we breathe throughout the whole day or maybe like doing something in the evening and how that

relates to the quality, the sleep depth and so forth. Because obviously we have things like sleep apnea, which I don’t even claim to fully understand, but they’re almost disorders, But is there any other links between breathing and our sleep quality?

John Dickinson (38:50)
I think again, I think it’s where science, so I think it’s been lots of work done on kind of breathing during sleep and there’s been a little bit of work done on kind of breathing efficiencies during the day. But how improving your breathing during the day impacts your sleep quality, I think is probably not quite there fully understood. Because once you go to sleep, your breathing then is being kind of maintained by your of your spirit centre into what your brain, you’re not thinking about it, but it goes on.

And so for some people, could be that they can actually kind of control their breathing better during the day. And then when they go to sleep, their kind of respiratory center kind of clicks in. What I would say though, the more you practice that kind of controlled, efficient breath during the day and relaxed breath, it’s likely to have an impact on terms of kind of quality of breathing you’ll do while you’re sleeping. I think when it comes down to quality of sleep,

the more relaxed our breathing is, the more likely we are to get better quality of sleep. So this is kind of where all this research with kind of sleep apnea comes in, because if the breathing’s erratic, we’re not getting up, you know, the oxygen in our body starts to kind of fluctuate quite a bit. And then that doesn’t allow the brain to kind of, go into all the different sleep modes it needs to go through during the night to get optimal recovery for the body. And so if the breathing’s erratic during your sleep, that’s going to impact your quality of recovery. So.

I say that the research isn’t really there and for me to go, if actually you’re really efficient breathing during the day, you’re not gonna have a problem at night because then that’s not there. However, intuitively you go, well, actually if we can improve your breathing and we can reduce that kind of stress on your breathing during the day, it’s likely to have an improvement in sleeping. And I’ve worked with several individuals where that’s been the case where

especially these individuals with kind of longer COVID kind of issues, not all of them, but some of them have said, actually I’m sleeping much better now because my breathing’s a bit more relaxed and I’m not waking up in middle of the night. But that’s on individual cases, it’s not on a controlled research trial with massive people to back you up.

Patrick Obolgogiani (41:04)
Sure. Still like anecdotal cases, they do matter. What about the metabolism of guys? Like I’ve read somewhere, how the oxygen and breathing has a pretty big role to play in the way we kind of process food and turn it into energy. Like, do you know of any research around like linking basically breathing patterns and your metabolism or basically how you’re able to take nutrition?

John Dickinson (41:18)
I’m turning into your lander.

Patrick Obolgogiani (41:31)
and ingest that.

John Dickinson (41:34)
Not that I’ve seen. I mean, don’t think there’s nothing out there. It’s not nothing I’ve come across. But no, I it’s an interesting concept. mean, obviously your stomach’s sat right underneath your diaphragm. if you’re, know, potentially that can influence, know, potentially the way your diaphragm behaves and the way you’re breathing might influence the way that the kind of the food sort of passes through the stomach.

Patrick Obolgogiani (41:36)
Okay.

Yeah, I need to look into that.

John Dickinson (42:03)
But then also, like I said, your spirit system affects seven different systems or so. And part of that is the nervous system. And part of that, you know, part of that, you know, you’ve got the parasympathetic and the sympathetic. And so they’re talk to each other. They’re gonna talk to you, the entire nervous system within your digestive system. So there’s, potentially is a link, but again, I’ve not really seen, you know, I’ve not really read or heard too much about it.

Patrick Obolgogiani (42:26)
Yeah, makes sense.

Yeah, cool. I’m curious as a, you know, you’re a breathing scientist, like just listening into you, I become much more conscious of how I’m breathing. Like, do you have any daily breathing routines or exercises that you kind of swear by to do every morning, John?

John Dickinson (42:44)
Yeah, not I mean me personally I don’t I that’s not I don’t kind of live my life like that, but I probably do but without that kind of going right here’s my five minutes brief brief time and I I probably when I actually try and teach individuals this that I try and say Some people having kind of you know, they’re five or ten minutes in the morning to do their breathing exercises that works for them I’ve got a couple of kids

do this job and I do all those other things. So usually for me to be consistent with five or 10 minutes of a day to fit that in is difficult for me. But what I try and do is when I’m in the gym or when I’m doing particular activity, that will be my breathing time. So for example, if I’m doing some stretching activity or I do try and do kind of a 10 minute yoga session in the morning and when I’m doing that,

that’s my time to really kind of think about my breathing. And so I try and think about if I’m doing those kind of basic, I’m not the most flexible person in the world, but I’m doing some kind of basic yoga poses, I will be thinking of making sure my posture’s good. And if my arms is the side or up in the air or I’m sort of down with dog and whatever, I should still be able to get that lower rib cage moving. So I kind of try and, I always kind of challenge myself and go, whichever kind of posture I’m in,

I should be able to get that lower rib cage moving nice and smoothly. And that’s kind of probably something I do maybe just with our habit rather than going, you know, this is my kind of breathing hygiene kind of routine, if you want to call it that. it’s, but again, and that’s probably what I try and do with the athletes I work with. I try and say, cause I know people like athletes are very busy and a lot of people are really busy, but if you can build these kind of good habits with breathing pattern into a

what you already do during the day. so you make, you I personally probably made my stretching is my kind of breathing time, if you like. But I was always, I was already, you know, I’ve been doing kind of like basic yoga things for a long time. But it could be that, you know, an athlete might go actually in my cool down or in my warmup before I go in, go and do whatever activity to do. I’ll build five minutes of that or when I do my stretching, that’s my time to really kind of zone in on my breathing.

For other people, and I’ve sort of said, it could be if they’re about the house and they may be boiling a kettle and say, well, actually, every time you boil a kettle, that’s the time to zone in on your breathing. And that makes it more achievable because I think sometimes if you, maybe you really are trying to make that change with your breathing pattern. And I think when you’re really motivated to do it, you will find five or 10 minutes a day to kind of do it. But after four, five, six weeks, it becomes quite difficult to maintain.

that thing. So if they can pick that everyday activity, it means they’ve probably done it three or four times a day. And so they’re not lying in bed going, oh, forgot my breathing exercises today. And so I try and build this kind of like practice of breathing pattern into an everyday activity. So we don’t get to that point where, you you’ve gone three or four days and you haven’t been able to find your five or 10 minutes to practice your breathing pattern. Sometimes though, I do use a bit of that breathing pattern work, you know, if I’m trying to chill out.

So, you know, if I had a bit of a stressful day, know, sort of trying get myself asleep, actually just working on big expansion in the chest, but then a really slow breath out does just help to calm everything down and you can sort of drift off. So you can use it in different ways, but I wouldn’t say I’m a, yeah, I haven’t got a breathing diary. You can check me to make sure I’ve done my breathing exercise every day.

Patrick Obolgogiani (46:21)
Yeah. Cool. Since you mentioned gym, I’m curious because like, if you look at the gym, bro, science or whatever, you have like the people that, know, oh, that’s a matter. You just kind of hold your breath during whatever reps you’re doing. And then you have like others who are much more particular about either like doing the breathe in when you’re going down, let’s say with a squat and then breathe out when you’re going back up. And then you have even people that say never hold your breath, like try to continuous breathing throughout the whole exercise with that rhythm.

Which camp do you follow and is there any evidence to back anything up here from science?

John Dickinson (46:53)
Yeah,

well, again, science isn’t there. However, I would, again, I teach, and probably those latter two ones you talked about, is you can either use the breath kind of through the movement or try and just breathe when you need to breathe, regardless of what part of the moment you’re in. And the reason I say that, from a breathing pattern point of view, is that if we get into breath holding during kind of strength work,

That teaches the body that when you do that particular movement, you need to be bracing through your respiratory muscles. So you start to teach yourself to learn to use your respiratory muscles to brace to do the activity. And an example of this is, when I work with lot of individuals, I ask them to go, just go down there and hold a plank for me. Now, can you breathe with a good breath during that plank? And a lot of them will go, nope.

because what I do is I hold my breath when I’m on the plank and I’m really stiff around here. And basically at the event they’ve taught themselves to hold the plank with a lot of tension around their rib cage. And actually the whole point of the plank is to kind of really work the muscles around the pelvis area. So working the glutes and the abdomen and the lower back and things to hold. So if, know, especially when you’re doing things like core work, the idea is not to hold your breath at all. It’s to basically, you should be breathing in or breathing out.

during all of that core work. And probably the only time I say maybe it’s beneficial to hold your breath. If you are a, you know, really going for it on the power lifting, you know, you’re really kind of doing those one, two rep, absolute flat out breaths. So piece of work where you’re really getting, but trying to get everything up, then maybe that breath hold is good for those type of like one rep, two rep, absolute beastie type maneuvers. But for most of us in the gym where we’re kind of working on sort of eight to 12 reps.

sort of thing, I would be more in the camp of you should really be breathing through those. Whether you actually do it with the breath, so you’re kind of breathing in as you go down on a squat and breathe out as you go up, that’s fine because you’re still breathing as you do it. Or whether you’re just breathing at any point, it’s fine. Probably depends on how heavy the weight is as you’re doing it. But breathing through the exercises, I would be all on that rather than breath holding. Don’t do that because it teaches your body.

to basically brace around your rib cage, which ultimately is probably gonna teach it to hold your posture a lot around your rib cage.

Patrick Obolgogiani (49:20)
Yeah. Are there other like myths that you feel are very common in the public space around breathing that we could maybe use the moment to bust or at least speak to?

John Dickinson (49:30)
Yeah, well, think a lot of time I see people say, hands up here to recover. That doesn’t help. Because I think the P teaches kind of like put your hands on your head and sort of thing that we, you know, we did sort of 20, 30 years ago, that probably makes it harder to breathe, I think, rather than not. And again, because it lifts your shoulders up, it gets you quite tight around the rib cage. So anything that can relax. So if you’re struggling to breathe, after you’ve done a really tough piece of work,

First thing to do is try and can I stand in a good posture to actually allow my rib cage to do. If you can’t, one of the best things to do is find a wall or something to lean on, take the posture control off you. That will work better. And if you can’t find anything to lean on, just lie on the floor and look at the sky and that’ll probably help. So those types of things are better to recall with rather than sort of sticking your hands in funny places. Yeah, I mean, that’s probably the one I see the most when I’m working with athletes and people say, you know, you do this, I do that sort of thing.

Patrick Obolgogiani (50:25)
John, we’ve covered a lot of ground, I think your work over 20 years has covered much more ground. Is there any particular piece of research that you’ve done that you’re particularly proud of or you find might be useful to mention here, given that there’s so much around breathing that people don’t know about? What’s an area that you feel might be useful to talk about still today?

John Dickinson (50:45)
I think probably the bits I’m probably most proud of, I’ll kind of highlight in the, you know, one of the things I do see that maybe is a bit of a myth buster is that athletes are more likely to have breathing problems than the general population. And since we kind of identified that, you know, in terms of kind of athletes being more aware about it, or all the GB athletes who are part of the Olympic sort of

they now have a screen because of that work. you know, people go, why would an athlete, why would a football player be more likely to have an asthma problem than somebody watching from the stand? And the reason for that isn’t because, there isn’t anything more about, but it’s more about exposure to what causes an asthmatic issue. So, you know, an athlete will breathe more, greater volume of air from the environment.

and it will be colder, drier, potentially they’re getting more pollution into their lungs than an individual who doesn’t exercise very much. And if they do that, they’re more likely to cause kind of damage to their airway, and then they’re gonna have this asthmatic response. it kind of makes sense when you talk through it. The reason why athletes are more likely to get things like asthma is because they have greater exposures to dry air and kind of polluted air, which drives asthmatic issues. And we know that happens in individuals that live.

in either dry environments or they live in polluted environments, is a higher prevalence of asthma. So that’s why athletes are more likely to have a respiratory-like asthma. But what I’m also proud of as well is that the research that we’ve done to highlight that not every breathing problem is asthma. And so we’ve kind of started to explain that when I first started to tell athletes, well, maybe asthma is not the problem you’ve got.

and we start to talk about it’s the way you’re breathing. A lot of coaches, a lot of scientists that I work with, we were a little bit, what are you talking about? We just breathe, don’t we? But now, I think it is the last sort of 10 years or so, the amount of support individuals get for things like breathing patterns or it is certainly ramped up. And it’s not just in elite athletes we see it. We also see it in the NHS where…

you know, there’s more support now, there’s more of spiritual physio is actually delivering support for breathing pattern disorders, whereas in the past, they’d be put down as difficult to manage asthma or unexplained breathlessness that we don’t, you know, haven’t got a clue what’s going on. So that’s another area where I’m really kind of proud that the kind of collection of work that we’ve done has, you know, it’s not been the only bit of research that’s been done around the world, but it’s certainly added to that.

and growing evidence of kind of what a breathing pattern disorder is. And on the flip side, what an efficient breathing pattern is, because that’s the ultimate thing to know, because then we can teach people to get back towards that. And also that kind of work now, you it’s sort of, it’s quite nice to see that that works, know, been a bit of a, it’s started to work like the alveus device, you know, and things. So you start to actually see products come out in the market.

try and help improve individuals and to understand their breathing patterns based on some of the, know, partly based on some of the research stuff that we’ve done with the athletes. So there’s lots of kind of things that I’m really kind of proud that we’ve been able to do and help explain and hopefully it’s been going to be a benefit to lots of people going forward.

Patrick Obolgogiani (54:11)
John, if people want to kind of keep track of what you’re working on and the research that you’re doing, what’s the best place for them to go to?

John Dickinson (54:18)
You can probably, quite easy to find if you kind of typed in University of Kent or John Dickinson, my kind of profile page pops up there. We usually keep all the research that we publish on the, it’s called a Kent academic repository, but basically all the research is free to access on there. And obviously if you want to contact me, my email address is on there as well. So pretty easy to find.

Patrick Obolgogiani (54:41)
Great. From my side, John, I think you are one of the first kind of serious scientists who kind of took us seriously at Alveos So thank you for that trust from my side. And yeah, I look forward to working with you to build something truly meaningful. And I think we’re on this shared mission to raise awareness around how to make this better with or without our products and so forth. it seems to be, do actually know how prevalent is the breathing pattern disorder? Is there any statistics globally?

John Dickinson (55:08)
Well,

we don’t know because there’s not really a proper test for it. It’s estimated to be somewhere between 20 to 40 % of people.

Patrick Obolgogiani (55:14)
Right.

20 to 40 percent.

We’ve got our work cut out for us.

John Dickinson (55:25)
⁓

Exactly, that’s only an estimate based on questionnaires and based on self-reported stuff. We need an objective test really to get some good numbers for it.

Patrick Obolgogiani (55:36)
Yeah. Yeah. And also like, at least the way I think about it, like you have this like minus one, zero, plus one, and zero is when you’re doing diseases, you kind of have a neutral position, right? Um, and you’re like, you know, when you get out of asthma, you kind of go to zero and you say you’re healed or you’re, you’re cured or whatever. Um, but then like there’s this whole spectrum of going to plus one. What is the optimal? think that’s what your work has really showed us. Like there is this spectrum and probably none of us are at the peak.

John Dickinson (55:39)
Thanks, Bobby.

Patrick Obolgogiani (56:05)
what is possible when it comes to our muscles and our breathing pattern. you know, who knows what that will unlock in terms of the energy levels, health and other benefits. So that’s also something to keep in mind. Like if you’re not here, you’re like not in minus one, there might be still ways to go to improve, which is something also exciting, I think, for me, at least.

John Dickinson (56:24)
Yeah, yeah, I mean, think when I look at it, it’s kind of, know, are we trying to get people from feeling breathless? mean, at the moment, probably where we are is trying to get people, trying to reach out to the people that are feeling that breathing’s stopping them taking part in activity, whether that be walking the stairs or doing exercise or limiting the exercise they do, because I would say that’s sort of dysfunctional, to the point where they become, actually, their breathing doesn’t affect them too much.

And then I guess the next point is then is once everyone’s there, then it’s kind of, can we open up the door to kind of get everyone really, really efficient. But again, it comes back to the analogy around kind of running or walking. If you’re running or walking with dysfunction, of the works did make them run without dysfunction or run without to the point where it doesn’t limit their performance. However, they still, if you actually analyze them, might have a dysfunctional-ish.

but it’s not limiting their running anymore and that’s probably where we’re trying to work to most people to get them. Then it’s kind of, well once we’ve done that, are there those kind of optimisation in the breathing that for people that maybe don’t complain of a breathing problem but they still may be able to get some gains in their breathing.

Patrick Obolgogiani (57:37)
Yeah, yeah, well said. Awesome. Thank you for the work you do, John Thank you for tuning in today. And if you’re listening, I’ll speak to you all soon. Have a lovely week.