Free Webinar Weds 9th Nov 2011 (1pm EST, 6pm GMT)

Don't forget to register for my free webinar tomorrow - http://humankinetics.wordpress.com/2011/10/21/breathing-strong-the-easy-way-to-perform-better/

A bit about my book…a story of heresy and heavy breathing

You can obtain more information about breathing training at www.breathestrong.com, where you can also find out about my comprehensive guide to breathing and exercise “Breathe Strong, Perform Better” (published by Human Kinetics Inc.). Visit the ‘Breathe Strong’ Amazon store by clicking here.

On Weds November 9^th 2011,  I’m presenting a FREE 60-minute webinar that’s been orgainsed by the publisher of my book, Human Kinetics Inc. Entitled, "Breathing Strong, the Easy Way to Improve Performance", the Webinar starts at 1pm EST, which is 5pm UK time. I plan to talk about the many roles of breathing muscles in sport and exercise, how these vital muscles limit exercise performance, and how specific breathing muscle training overcomes these limitations. To register, just follow this link – http://humankinetics.wordpress.com/2011/10/21/breathing-strong-the-easy-way-to-perform-better

In preparing for my webinar, it occurred to me that I should perhaps post a Blog entry about my book, Breathe Strong, Perform Better, only a snapshot of which I will provide in my webinar. Please feel free to leave any comments or feedback about Breathe Strong, Perform Better at this Blog site.

How it all began…

Almost 20 years ago, I began to question the universally held belief (among sport scientists) that breathing did not limit exercise performance. The magnitude of this heresy cannot be overstated, and the shift in thinking that has occurred over those 20 years has been nothing short of seismic. Now, specific training of the breathing muscles is an integral part of conditioning in elite sport, and it has filtered to the grassroots level in a huge range of sport and fitness settings. So obvious is the logic of breathing muscle training—and so impressive are its outcomes—that it has become one of those “no-brainers” that so often arise with the benefit of 20/20 hindsight. Just as we now wonder how our grandparents didn’t understand the importance of fluid balance during exercise, people now wonder why it’s taken until the first decade of the 21st century for breathing muscles to be considered an integral part of the conditioning process.

Although huge strides have now been made, we still have a way to go, because even the most progressive and enlightened of scientists and coaches still don’t fully appreciate how fundamentally the breathing muscles contribute to performance and movement in sports. In other words, the need for breathing to be considered as an integral part of functional training is not widely understood. Nor should it be, because the science that underpins this is relatively new and highly specialised.

Who’s it for…?

Breathe Strong, Perform Better seeks to plug the knowledge gap alluded to above. It gives non-specialists access to information that is normally the preserve of scientists, professional coaches, and elite athletes. The book is for anyone who wants to optimise the many benefits that arise from improving the physical performance of the breathing muscles. 

Don't be fooled by the cover, it's not just for cyclists; in fact it covers activities as diverse as running and weight training. Whether you are an Olympic contender, a coach of high-level athletes, or a fitness enthusiast who just wants to make your workouts more comfortable, this book contains something for you, or someone you know (Christmas is coming!).

The book will therefore be of interest to the following:

•       Athletes and recreationally active people
•      Coaches, sport scientists, and sports medicine practitioners
•      Physical therapists, rehabilitation professionals, and personal trainers

I'm very proud to say that the Foreward to my book is by one of Britain's greatest Olympians, Sir Matthew Pinsent. In his Foreward he says of breathing training, “Advances in sport science knowledge are few and far between, but numbered amongst these rarities is the discovery that breathing has such a profound influence upon performance that it merits specific training”.

Breathe Strong, Perform Better is a distillation of almost 20 years of research and practical experience of breathing training. It is based on world-leading scientific research, and describes cutting-edge applications of breathing training for a wide range of sports and fitness activities, including techniques that have been applied to athletes who were (or have become) world or Olympic champions. The book provides readers with the knowledge they need to get the best possible results from breathing training and get better results from their other training by optimising the breathing muscle contribution to that training.

Why should you be interested…?

If you’ve never heard of breathing muscle training (unlikely as that seems), your first question might be “Why would I want to train my breathing muscles?” The long answer is contained within the pages of Breathe Strong, Perform Better, but the short answer is that whoever you are, training your breathing muscles can make any physical challenge feel easier. So whether you’re participating in a 40K time trial, an interval training session, or a step class, training your breathing muscles will help you breathe easier.

Breathe Strong, Perform Better is also a response to an important development that has taken place in rehabilitation and conditioning over recent years—the rise of functional training. The application of functional training techniques to a wide range of settings has become mainstream, but it lacks a vital component. The missing link in functional training is the integration of breathing and the contribution of breathing muscles to functional movements. Breathe Strong, Perform Better provides this link, and it explains how to achieve the best results for specific sports and fitness settings. Functional breathing training will therefore reduce the risk of injury, because it enables the breathing muscles to accommodate their role in helping to stabilise the body’s core more effectively.

Breathe Strong, Perform Better is intended to answer all your questions about breathing training, whether those questions are scientific or highly applied. Your questions might include the following: What are the benefits to performance? What’s the best equipment to use? How long will it take? What’s the best training regimen? How do I ensure that I get results? How do I know I’ve improved? How does it work? How do I train functionally for my sport? In addition to answering these questions, the book contains case studies that illustrate how different people came to try breathing muscle training, how they approached it, and the results they achieved.

Why I became interested in breathing…

I’m often asked why I became interested in the fairly obscure subject of breathing. As is often the case with scientists, my interest originated from my own experience and my desire to understand what was happening and why. As a student in the early 1980s, my life was dominated by two things: my interest in human physiology and my love of competitive sport. These two interests were not unconnected. As a mediocre rower, I was always let down by the apparent inability of my breathing to keep pace with the demands of racing (or training for that matter). 

One of my crewmates once commented that I sounded as though someone had taken me by the throat at 500 meters and hadn’t let go. I felt severely limited by my breathing, but everything I’d been taught about the limitations to exercise performance told me that breathing was not a limiting factor to my performance (see Blogs 2 to find out how wrong this was).

[There are two points to note from this photo’ of my competitive rowing days, 1) I’m so old that it’s in black and white, 2) the expression on my face tells you everything you need to know about why I became interested in breathing…my lungs were in my mouth!]

For some time, I accepted the common belief that breathing does not limit exercise performance. However, my personal (mostly excruciating) experience eventually propelled me on a quest to understand more about breathing, about the conditions under which it becomes limiting, and especially about how we might overcome these limitations. The rest, as the saying goes, is history. My quest for understanding has been a fascinating journey that has led me beyond exercise physiology and into territory that has broadened my horizons. Like so much of science, the journey began as a bit of a detective story, where snippets of evidence from seemingly unrelated areas were pieced together, eventually providing that final “eureka” moment when everything fell into place. Breathe Strong, Perform Better enables its readers to share in what I’ve learned on my journey; the many tangents from my original path are reflected in the breadth of applications for breathing training that now exist (breathing muscle training is not just for mediocre, breathless rowers!). Some of these applications are medical and are beyond the scope of Breathe Strong, Perform Better (except asthma), but the number of applications in sport has amazed even me. I’ll be addressing the medical applications of breathing training in a new book that I am currently working on with the publisher Elsevier (out in early 2013).

Exercise scientists are arguably unique among scientists, because we are usually practitioners in what we study. Unlike, say, an astrophysicist who has no experience of going into space, exercise scientists know exactly what the challenges of sport competition are, because they have almost certainly taken part in competitive sport at some time. In other words, exercise scientists have the ability to view things from both sides of the fence. One of the most gratifying compliments that I ever received was from a coach who told me, “You have an excellent feel for the practical application of research to [elite] sport.” This ability is reflected in my experience of applying the knowledge and insight I have gained as a scientist to the task of providing innovative, evidence-based advice on how to get the best results from breathing training. Breathe Strong, Perform Better enables everyone to benefit from this, as well as from the feedback I’ve gained from the athletes, coaches, and other practitioners whom I’ve worked with over the past 15 years.

A bit about the contents…

Breathe Strong, Perform Better is divided into two parts. The first part explains some of the science and theory of breathing, while the second part is a practical guide on how to get the most out of breathing training. Although these sections are inevitably interlinked, it is not necessary to read the science in order to benefit from the practical guidance. The theoretical section (part I) provides information on the theoretical building blocks that support the practice (part II). Accordingly, readers can dip in and out of part I based on their need and interest. For example, coaches are quite rightly suspicious of snake oil sellers who peddle potions and gadgets “guaranteed” to improve performance. Therefore, most coaches will want to review the section describing the underpinning theory and evidence of the ergogenic effect of breathing muscle training before committing themselves (or their athletes) to putting it into practice.

The theoretical building blocks include aspects of the relevant anatomy and physiology of the respiratory muscles and other associated muscles. As a part of this discussion, the rationale for specific breathing muscle training is established. This includes a description of the respiratory system as a source of exercise limitation, as well as a description of the most common chronic condition that affects athletes—asthma. The role of breathing muscles in functional movements is also explained, because this provides the rationale for functional breathing training. Consideration is also given to breathing patterns during different exercise modalities. From this scene setter, we move on to consider how breathing muscles limit training and competition. This information is subdivided into specific sporting contexts, providing insights into the range of benefits that can be derived in these contexts. The rationale for functional breathing training is also presented, before moving on to consider how breathing muscles respond to training, which sets the scene for a description of the performance benefits of breathing muscle training in a range of sports.

The practical section of the book (part II) begins by guiding readers through generic aspects of the most widely used form of breathing training—that is, inspiratory resistance training. The general principles of training are considered, as well as different methods of training (resistance versus endurance) and proprietary equipment. Foundation training¹ is described, as well as guidance on principles such as posture and breathing technique. There is also a step-by-step guide to getting started with Foundation training. Finally, there are four chapters that introduce some functional training techniques, each taking a sport-specific approach. These chapters are supplemented by case studies and narratives from advanced users that contain top tips for optimal results. The insights from these elements will help you see how creatively inspiratory muscle training can be applied.

My aim in writing Breathe Strong, Perform Better was to provide the wider public with the knowledge, insight, and confidence to tailor breathing muscle training creatively to the specific needs of their own applications. If, as a result, I have made myself obsolete as an expert on breathing training, then as the saying goes, “my work here is done.”

 ________________________________________________

1. Foundation Training refers to the fist four to six weeks of specific, isolated resistance training of the breathing muscles. By using a device that can be likened to a dumbbell for your breathing muscles (e.g., the POWERbreathe®), the strength, power and endurance of these muscles can be increased. A typical training regimen consists of 30 breaths, inhaling against a moderate intensity load, twice per day. Training sessions last less than two minutes, and can be undertaken virtually anywhere, making this one of the quickest and easiest training adjuncts around.

 

Look out for the FREE Breathe Strong Foundation Training App on iTunes at the end of November '11.

Don’t forget to register for my Webinar on Weds November 9^th - "Breathing Strong, the Easy Way to Improve Performance". It starts at 1pm EST, which is 5pm UK time. To register, just follow this link – http://humankinetics.wordpress.com/2011/10/21/breathing-strong-the-easy-way-to-perform-better

If you found my Blog interesting, please come back for further articles and news, as well as my musings on all things breathing and sport related. Also, don’t forget that you can obtain more information about breathing training at www.breathestrong.com, where you can also find out about my comprehensive guide to breathing and exercise “Breathe Strong, Perform Better” (published by Human Kinetics Inc.). Scroll to the bottom of this page to visit the ‘Breathe Strong’ Amazon store.

Breathing Strong in the Saddle

You can obtain more information about breathing training at www.breathestrong.com, where you can also find out about my comprehensive guide to breathing and exercise “Breathe Strong, Perform Better” (published by Human Kinetics Inc.). Scroll to the bottom of this page to visit the ‘Breathe Strong’ Amazon store.

On Friday September 30^th, I’m presenting a 30-minute seminar at the Cycle Show Expo at the NEC (www.cycleshow.co.uk, Cycle Arena, 12.30pm). The title of my talk is "Breathing Strong in the Saddle: Improve Your Riding the Easy Way". In this Blog, I’m going to give you a sneak preview of what I’ll have to say at the Cycle Show next week.

I’m going to approach the seminar by considering two sides of the same coin - the limitations that breathing muscles impose upon cycle performance, and vice versa.  Why vice versa? Because the body position in cycling presents a number of problems that aren’t present in other sports, especially for time trialists and triathletes who are using aerobars. We all know that minimizing frontal area minimises aerodynamic drag, but this benefit has a cost (see www.bikeradar.com/racing/article/aero-position-isnt-everything-31165 for a very interesting article on this), and much of that cost is borne, by the breathing muscles.

Aerobars – A double-edged sword

Research suggests that cyclists who are inexperienced in the use of aerobars exhibit detrimental effects on their breathing and mechanical efficiency compared to cycling in the upright position (www.ncbi.nlm.nih.gov/pubmed/14514538). For example, compared with upright cycling, aerobars resulted in a lower maximal oxygen uptake and lower maximal ventilation. In addition, breathing appeared to be constrained, such that breath volume was lower and breathing frequency was higher. This is a very inefficient breathing pattern; indeed, the study found that mechanical efficiency was lower when using aerobars, i.e. the same amount of cycling work required more energy.

The explanation for these findings resides in the influence of a crouched body position on inspiratory muscle mechanics during cycling. First, there is an effect on diaphragm movement caused by the large organs of the abdominal compartment (stomach, liver, and gut). These organs lie immediately below the main inspiratory muscle, the diaphragm, and they are effectively a noncompressible mass (visceral mass) that must be pushed out of the way by the descending diaphragm. When a cyclist is crouching forward, the abdominal organs press against the diaphragm, impeding its movement; the volume of the abdomen is also reduced, which means there is less space to accommodate movement of the visceral mass during breathing (see figure below - from "Breathe Strong, Perform Better", Human Kinetics).

Impediments to diaphragm movement during cycling.
From "Breathe Strong, Perform Better", Human Kinetics 

The abdominal wall, which normally bulges forward during inhalation, is also stiffer because it contributes to core stabilization, increasing diaphragm work still further. In addition, the extreme hip flexion brings the thighs closer to the abdominal wall, where they can also impede its outward movement during inhalation. These effects conspire to impede the free movement of the diaphragm and rib cage muscles, increasing inspiratory muscle work. Second, if cyclists are forced to adopt a higher breathing frequency (because breathing deeply is too uncomfortable in the crouched position), inspiratory flow rate must be higher. This forces the inspiratory muscles to work in a region of their force–velocity relationship where fatigue and effort perception are greater (find out about the force-velocity relationship and other properties of muscles here - http://muscle.ucsd.edu/musintro/props.shtml). Because studies appear to show that the aerobar position has fewer detrimental effects in cyclists who have used aerobars for a prolonged period, it appears likely that the inspiratory muscles adapt to the increased demands imposed by aerobars. A shortcut to this adaptation is to train the inspiratory muscles so that they are able to cope with the mechanical changes induced by the aerobar posture (visit www.breathestrong.com for information on how train the inspiratory muscles).

Now it’s time to consider the other side of the breathing/cycling coin, i.e., the limitation that breathing muscles impose upon cycling performance. There are two components to this; first, we need to consider the performance implications of the fact that breathing muscles are an integral part of the core stabilisation system; second, we need to consider the metabolic repercussions of breathing muscle work during cycling.

The core – The seat of your power

In most sports, including cycling, the core provides the foundation from which force is generated. The stabilising action of the core is very important for the production of cycling power. This is illustrated by the fact that external stabilisation of the trunk (i.e., relieving the core muscles of the need to stabilise the trunk) significantly reduces the metabolic cost of cycling (www.ncbi.nlm.nih.gov/pubmed/16258182). The effect is greatest at pedaling speeds that induce the highest pedal forces. In other words, cyclists expend a lot of energy stabilizing their trunk in order to optimise power production.

If the core provides the foundation from which force is generated during the pedal stroke, and if the stability of the core is influenced by breathing, a question then arises regarding the best time to breathe during the pedal cycle. Because a complete respiratory cycle (breathing in and out) occurs only once every two or three pedal revolutions, it is inevitable that force will not always be exerted on the pedals during, for example, an exhalation. To date, no studies have examined the potential benefits of breathing during particular phases of the pedal stroke, and this is probably because it’s unlikely to have a large impact on performance. However, more than just performance should be considered. Exerting force on the pedals during the pedal downstroke requires the coordination of more than just the leg muscles. The stability of the upper body also needs to be maintained in order to ensure that it provides a stable foundation and that spinal movements are controlled. If a vital part of this stabilizing system is otherwise engaged (in breathing), the potential exists for impaired function of the core.

At high pedal rates (greater than 70 rpm), the forces transmitted to the pedals are relatively small compared to the maximum force-generating capacity of the muscles involved; therefore, the competition between the postural role of the trunk muscles and their role in breathing is not as problematic as it is in sports such as rowing. However, during steep hill climbing, pedal rates drop, and pedal forces increase. During climbing, cyclists may find it advantageous to synchronise breathing and pedal cadence; indeed, this tends to occur intuitively, especially on very steep climbs. Notwithstanding this, evidence from elite cyclists suggests that the most important aspect of breathing and pedal synchrony is keeping a steady rhythm for each and maintaining a 1:3 ratio (1 breath for every 3 pedal revolutions). This ratio will optimise the efficiency and comfort of breathing, but a cyclist needs to work at maintaining the ratio; the reason that cyclists slip into a 1:2 ratio is because their inspiratory muscles are not sufficiently strong and fatigue resistant to maintain breath volume. This is where specific breathing muscle training can help (see "Heavy breathing" improves performance, below).

My book, “Breathe Strong, Perform Better” includes specific guidance on how to optimise breathing training for cycling, as well as how to undertake breathing muscle training using functional training principles in order to optimiase the contribution of breathing muscles to cycling mechanics.

“Heavy breathing” improves performance

Changes in 40km time trial performance after six weeks
inspiratory muscle training (IMT) using POWERbreathe

In considering the metabolic repercussions of breathing muscle work during cycling, we can again turn to the scientific literature. Perhaps the most striking demonstration of these repercussions is considering what happens to cycling performance if we train the breathing muscles (specifically, the inspiratory muscles), using a bit of “heavy breathing” (see www.breathestrong for details). In other words, let’s look at what happens when we minimise any limitations that the breathing muscles impose. We published a research paper on this in 2002 (www.ncbi.nlm.nih.gov/pubmed/12166881), and it remains the most comprehensive and compelling study of inspiratory muscle training (IMT) to date. In a nutshell, we found that six weeks of IMT improved 20km laboratory time trial performance by 3.8% (66 sec) and 40km time trial performance by 4.6% (115sec) (see figure above). 

Improvements in breathing and whole body
 effort sensation after six weeks inspiratory
muscle training (IMT) using POWERbreathe

The cyclists also felt that their breathing and whole body perceived exertion were lower (see figure opposite). In other words, they felt that the same cycling power output was easier. In addition, the exercise-induced fatigue of their inspiratory muscles was abolished after IMT. These changes were made possible by the improvements in strength, power and endurance of the breathing muscles; for example, the peak power output of the cyclists' inspiratory muscles increased by 39%. Find out why performance improved by reading my previous Blog.

So there you have it, a sneak preview of my seminar for the Cycle Show (www.cycleshow.co.uk).

If you found my Blog interesting, please come back for further articles and news, as well as my musings on all things breathing and sport related. Also, don’t forget that you can obtain more information about breathing training at www.breathestrong.com, where you can also find out about my comprehensive guide to breathing and exercise “Breathe Strong, Perform Better” (published by Human Kinetics Inc.). Scroll to the bottom of this page to visit the ‘Breathe Strong’ Amazon store.

How inspiratory muscle training (IMT) improves performance…in a nutshell

You can obtain more information about breathing training at www.breathestrong.com, where you can also find out about my comprehensive guide to breathing and exercise “Breathe Strong, Perform Better” (published by Human Kinetics Inc.). Scroll to the bottom of this page to visit the ‘Breathe Strong’ Amazon store.

So, having cleared the air in my previous Blog, this second instalment provides an introduction to how IMT improves performance, and explains why it has nothing to do with maximal oxygen uptake (VO2max), or inhaling more oxygen (a common misconception).

Let’s start by returning to the question of what people believe they know about the role of breathing in exercise limitation, and why it’s only half of the story. We’ll begin by considering a factor that is synonymous with training and improved performance – maximal oxygen uptake (VO2max). Most lay people  ‘buy into’ IMT because they [incorrectly] assume that IMT increases the amount of oxygen in the blood, thereby increasing VO2max. It’s therefore a surprise to learn that breathing more DOESN’T do any of this (find out why below). On the other hand, sport scientists know that breathing more doesn’t increase VO2max, so they find it hard to understand how on earth IMT can possibly improve performance. So for many people who know about VO2max, the ‘knee-jerk’ response to the concept of IMT is to conclude that it can’t possibly work, i.e., because there is no obvious underlying mechanism. However, IMT improves performance via an entirely different mechanism to VO2max, but one that is, nonetheless, linked to oxygen delivery. I’ll provide more detail in a later Blog, but what follows is the ‘abridged’ version of how IMT improves performance. If you want to know the nitty-gritty detail, then please revisit my Blog, as I’ll be discussing this in due course. In the meantime, you can also find out more in my book, “Breathe Strong, Perform Better” (see www.breathestrong.com or scroll to the bottom of this page to visit the ‘Breathe Strong’ Amazon store).

How IMT improves performance

Over the course of the past decade, an important cardiovascular reflex has been discovered. The reflex originates from the breathing muscles, and when it’s activated, it causes blood flow to the limbs to be restricted (a process known as vasoconstriction). Impairment of blood flow to exercising muscles reduces the delivery of oxygen and nutrients, as well as impairing the removal of metabolic by-products such as lactic acid. The reflex is activated when the breathing muscles are forced to work hard, or for prolonged periods, and it’s triggered by build-up of metabolic by-products in the breathing muscles (for this reason, it’s called a metaboreflex). The impairment of blood flow and oxygen delivery to limb muscles resulting from activation of the metaboreflex causes them to fatigue more quickly, thereby impairing performance. Research has now shown that the intensity of breathing work required to activate the metaboreflex can be increased by IMT. In other words, athletes can work harder, and longer before the metaboreflex causes blood flow to be directed away from their limbs. The result is that IMT improves performance in a wide range of sports and exercise modalities because it preserves oxygen delivery and metabolite removal from exercising muscles. It’s that simple, and that profound.

In addition to influencing the metaboreflex, IMT also makes breathing feel easier. Because the inspiratory muscles are stronger and more powerful after IMT, they are able to undertake the work of breathing more ‘comfortably’. In other words, the muscles are operating at a lower percentage of their maximum capacity, which makes the activity feel easier. For the same reason, being stronger also increases the endurance of the inspiratory muscles, delaying fatigue, and making breathing feel easier. Finally, because breathing feels easier, and because the limb muscles are better supplied with blood (delivering oxygen and removing metabolites), leg discomfort, and the sense of effort associated with exercise (perceived exertion) is also lower – athletes feel as though they are not working as hard.

Now you know how IMT does work, let’s finish by explaining why IMT does not increase VO2max.

Why breathing doesn’t limit VO2max

The transport of oxygen to the working muscles involves four stages:

1. Alveolar ventilation—Delivery of atmospheric air to the alveoli (breathing).

2. Pulmonary diffusion—Transfer of oxygen from the alveoli to the capillary blood.

3. Transport by the blood—Collection and delivery of oxygen in combination with the blood from the lungs to the muscles.

4. Tissue diffusion—Transfer of oxygen from the muscle capillary blood to the muscle cells.

There is no active transport of oxygen at any point in its journey from lungs to tissues. The entire journey occurs via a process of passive diffusion. During diffusion, oxygen moves from an area of high concentration (the atmosphere) to one of lower concentration (the muscle). The rate and efficiency of diffusion are directly related to the size of the gradient. Think of a river flowing downhill; the steeper the gradient of the hill, the faster the water flows.

In theory, any one of the four listed stages could limit the transport of oxygen. In practice, for people with healthy lungs who are at sea level (not at an altitude where the oxygen gradient is reduced), steps 1 and 2 operate with almost 100 percent efficiency in terms of their purpose, which is to oxygenate the blood fully before it leaves the lungs. Steps 1 and 2 are the only steps in the transport of oxygen that can be influenced by breathing, and because the blood is almost 100 percent saturated with oxygen when it leaves the lungs, increasing breathing cannot improve oxygen transport (the oxygenation of the blood is already almost 100 percent). In other words, breathing more cannot increase maximal oxygen uptake, and this is why people sometimes incorrectly jump to the conclusion that IMT cannot possibly improve performance. This is incorrect, so spread the word!

If you found my first blog interesting, please come back for further articles and news, as well as my musings on all things breathing and sport related. Also, don’t forget that you can obtain more information about breathing training at www.breathestrong.com, where you can also find out about my comprehensive guide to breathing and exercise “Breathe Strong, Perform Better” (published by Human Kinetics Inc.). Scroll to the bottom of this page to visit the ‘Breathe Strong’ Amazon store.