The Sport of Breathing
Athletes are in peak physical condition but something is stopping many from reaching their true potential - the way they breathe. Professor John Dickinson at the University of Kent researches how asthma and dysfunctional breathing can impact the health and performance of athletes.
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00:29 [Music]
00:39 Athletes are in peak physical condition and their commitment to their craft is unparalleled.
00:45 The field of sport is so competitive they would do anything to beat the best, win medals and etch their name in sporting history.
00:53 For many though, there's something missing, stopping them from being at the height of their potential.
00:58 And that is that they don't know how to breathe.
01:01 Now of course they can breathe, but there are techniques, patterns and in some cases undiagnosed asthma that they have yet to learn about.
01:09 This is one subject Professor John Dickinson is researching.
01:13 He works in the field of sports science at the University of Kent and has helped to develop methods to enhance the performance for each of the athletes that he's worked with.
01:22 Some of our work has demonstrated that over 20% of elite athletes have a condition and that actually increases up to almost 70% in certain populations like swimmers.
01:32 Put that in comparison to the UK population where 9% of the UK population have an asthmatic condition.
01:37 And that sort of puts in context that a lot of athletes are more likely to experience respiratory problems than non-athletes.
01:42 What we're hoping to do with this research is really change the way that athletes' respiratory health is managed.
01:48 20-30 years ago it still wasn't really very well managed at all and even now athletes aren't really getting the best service of care possible.
01:56 Although we now know what the best service of care may look like, which has still not got a gold standard test for.
02:03 So we can start to use our research to help inform the next wave of improvements in respiratory care, not just in the UK but around the world.
02:10 He is trained with the very best, including the England football team, elite tennis players preparing for the US Open, rugby players, boxers, track athletes, cyclists and even extreme sports people.
02:23 He has shared what he knows to the English Institute of Sport and to doctors and physios of sporting stars.
02:29 One of these up-and-coming athletes is Georgia Coates, member of the GB swimming team.
02:34 This help has not only spurred her on towards the Olympics, but it's uncovered something she didn't even know was there.
02:40 So it's quite intense. I train 10 times a week, normally 2 times a day, 2.5 hour swim sessions and then also 3 gym sessions as well.
02:51 I was almost confused about what was going on. I was struggling with breathing a lot in hard sets and even just low level training as well.
02:59 I got on an inhaler which helped a little bit, but there were still some difficulties that I found.
03:05 Seeing the doctor and things like that, they realised it might be dysfunctional breathing.
03:09 My pattern was completely wrong, but using the PowerBreathe and the K5, from filming in the pool, I've seen the difference, but also a change in racing a lot better.
03:19 It's not the limiting factor now and it definitely was before.
03:23 All the help and feedback that I've got from John Dickerson, I'll definitely use for the rest of my career.
03:29 A crucial element to any sporting team is their physio.
03:34 John has been funnelling his knowledge onto these practitioners to further widen the amount of people who know how to deal with respiratory problems.
03:42 After diagnosing one athlete and putting them on a breathing pattern retraining plan, their success story led to an Olympic medal.
03:50 This was an athlete who had quite significant breathing dysfunction leading up to the Rio Olympic Games.
03:55 They weren't able to train normally because of this and certainly weren't able to perform in competition to their full ability.
04:03 Both important to have people on the ground informed, such as myself, who are working with them day to day, but they really valued the opinion of an expert such as John.
04:12 Ultimately, the athlete did go on to successfully win an Olympic medal at the Games.
04:17 Really, the proof is in the pudding in terms of performance.
04:21 Having a respiratory problem can be distressing for athletes, so getting their diagnosis can calm their anxiety.
04:28 Training more people to help the athlete work through a condition will help the sport exponentially and already has for Team GB swimmers.
04:36 Often if somebody does have a problem with their breathing pattern it would be the physios who would probably be expected to or left to help manage that.
04:44 Whereas I hear a lot around the network of different sports that actually people aren't fully comfortable necessarily and it's not something that a lot of physios are trained in.
04:52 A significant bulk of the basis of our strategy is based on what John has both taught us in terms of his interactions with individual athletes and through our athlete health screening.
05:02 Alongside another physiotherapist in the EIS have been developing some interactive educational tools for basically which is going to be shared with EIS physiotherapists and athlete health practitioners across all sports.
05:16 After testing large groups of athletes to see if they've developed exercise-induced asthma, most elites have developed mild to moderate cases, some even having severe cases and they didn't know it.
05:29 However, some are more at risk.
05:31 Compare swimming to say boxing. Swimmers are more susceptible to respiratory conditions and the prevalence of asthma is 70%.
05:39 Boxers are exposed to high breathing rates but this isn't necessarily for a long period of time and they have a ventilated room to train in.
05:47 For swimmers they spend what could be five hours a day, six days a week in the pool.
05:52 This environment can also have a high chloramine concentration which can cause an inflammatory process which might cause an athlete to develop an asthma condition over a long period of time.
06:03 Very different to recreational swimming of course and Dr. Guy Evans has been working with John on the world-class program for three years hoping to improve athletes' respiratory health.
06:12 My primary goal is to make sure that we have fit and healthy athletes and if we have fit and healthy athletes they will generally perform well.
06:19 And approximately half of our swimmers would require inhaler therapy for asthma.
06:25 Often a swimmer will come on to the world-class program having seen their GP, maybe being told that they have asthma, they've tried a few inhalers and really never got to the bottom of their symptoms.
06:37 Similarly we have some who come on program who've been told that they have asthma and actually when we do the testing we realise that it's not in fact asthma, it's one of the other two disorders.
06:47 One of these is ILO, exercise induced laryngeal obstruction.
06:53 This requires a different treatment focusing on breathing patterns instead of medication and before this an athlete would have suffered with an undiagnosed respiratory condition.
07:03 So spotting this potential misdiagnosis is imperative to their performance and well-being as it's the number one reason why they would miss training.
07:11 Now when you think about injury, often in a pool environment we can get our athletes doing other things in the water.
07:19 If they've hurt their ankle they can use a pool buoy and they can swim with their upper body, if they've hurt their shoulder they can do a kick session.
07:25 If an athlete is ill or they've got a flare of asthma they can't train so actually they tend to miss bigger chunks through illness rather than injury.
07:34 Minimising this is really important to us. We know when we look back through our own data that athletes who adhere to approximately 90% or more of their training in a year are likely to be the most successful athletes on our programme.
07:48 So it's clear that the research into these respiratory issues in athletes is making a difference and there's potential to go further.
07:57 We spoke to the British Swimming Team before the global coronavirus pandemic so for them and many others in sport, their dreams were put on hold.
08:05 COVID-19 is a virus that affects your lungs and airways so it has become more important than ever to continue testing.
08:13 We've managed to find ways to support athletes remotely so I've done a lot of video consultations with athletes.
08:18 And what we found is that some athletes who did contract COVID have actually got symptoms that related to long COVID and are still struggling to recover.
08:26 We're working with them to try and understand how that's affecting their respiratory system but we're also interested about the way they change their breathing patterns as well.
08:34 It's fair to say that the sporting world was turned upside down throughout the coronavirus pandemic with many sporting events in 2020 being cancelled, namely the Tokyo Olympics, the London Marathon and big tennis tournaments like Wimbledon.
08:48 The Lawn Tennis Association houses elite players who luckily were allowed to continue training early in the first lockdown.
08:56 One LTA athlete we caught up with was Harriet Dart.
08:59 Throughout the pandemic, the tennis star used all the advice John gave her and she looked forward to the big things that were coming up next.
09:06 We did a range of different exercises and I continue to practice these each day. I'm continuously looking out for my respiratory health and this has helped me a lot with my tennis career and in general life.
09:19 When my breathing is better, my shoulder positioning is in a lot better place and I can focus more on my game.
09:29 I have hopes for good chances in the Grand Slams and with the help of all these exercises for my breathing, I really think that I can eliminate a lot of my injuries in the upper limb.
09:44 It doesn't seem like there's much room for improvement for elite athletes but actually in many cases, using the way you breathe to your advantage can be the difference between winning or losing.
09:56 A lot of these athletes have had a lifetime of breathing a certain way but also have already reached pretty impressive goals and therefore trying to retrain is quite a challenge.
10:07 So with quite a few of our athletes that have been given exercises through John, we try and obviously incorporate them in their day-to-day rehabilitation but also we try and incorporate them when they're actually performing on the elite platform.
10:19 And so some of our athletes have utilised the exercises for kind of helping with performance, helping physiologically but also psychologically.
10:29 John's even collaborated with researchers in Norway who have changed their practices based on data produced here at the University of Kent.
10:37 John's research has also informed the treatment of asthma in competition, having worked with the anti-doping agency to change policy.
10:45 Something like your typical blue inhaler, if used out of line with the rules above therapeutic levels, it can give some an advantage.
10:53 The anti-doping research has enabled John to educate athletes about the appropriate use of asthma therapy to protect lung health within the rules.
11:02 We've demonstrated that if athletes are dehydrated and they take doses within the water limit, their actual level of the drug in the urine can go above the decision thresholds that water use.
11:12 So effectively what we're doing is we're ensuring that athletes are able to have as good a respiratory health as possible and also compete on a level playing field with their non-asthmatic counterpart.
11:23 There's still plenty to do to improve the quality of care in respiratory health in athletes, something that's often overlooked.
11:31 But with this research, athletes will have the potential to reach the peak of their sport without limits all across the world.
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