Nose vs. mouth breathing – Acute effect of different breathing regimens on muscular endurance

Nose vs. mouth breathing – Acute effect of different breathing regimens on muscular endurance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nose vs. mouth breathing – Acute effect of different breathing regimens on muscular endurance Mgr. František Lörinczi, Marián Vanderka This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2867743/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Feb, 2024 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted 4 You are reading this latest preprint version Abstract Background We know that the way we breathe (weather through the nose or mouth) can influence many aspects of our health and to some extent, sport performance. Does the way of breathing (nose vs. mouth) influence muscular endurance? Methods We conducted an experiment in which we verified the acute effect of different breathing regimens (NN, nasal - inhaling and exhaling through the nose; NM, oro-nasal - inhaling through the nose, exhaling through the mouth; MM, oral - inhaling and exhaling through the mouth) on the muscular endurance performance. 107 young physically active college students (68 males, 39 females) performed repeated bench press testing protocol (repetitions to failure with 60% of body weight for males – BP60, respectively 40% of body weight for females – BP40) with various breathing regimens (NN, NM, MM) in random order. We also measured heart rate, blood oxygen saturation and perceived exertion by Borg scale (RPE). Results In both sexes, no significant differences in number of repetitions, perceived exertion and blood oxygen saturation were shown between the selected breathing modes (ns). We did not record any case of deviation of saturation outside the physiological norm. We noticed significantly lower heart rate values ​​in the male group at BP60 with the NN regimen, compared to NM (p = 0.033) and MM (p = 0.047). These differences, although significant, were lower than the usual statistical deviation (3–4 bpm; 3%) and have only small effect. Conclusion Pure nasal breathing (NN) seems to be just as effective as other two regimens which use the mouth (NM, MM) in context of muscular endurance performance. Based on our findings and the mentioned negative consequences of oral breathing, we recommend using purely nasal breathing during training for muscular endurance. nose mouth breathing muscular endurance bench press Figures Figure 1 Figure 2 Figure 3 Background After the pandemic, the whole society is more conscious about the health of respiratory system and breathing. Many medical studies point to the benefits of nasal breathing. The Nose is for breathing, the mouth is for eating. But still, many people change to mouth breathing during physical activity. Is it more effective, or is it just a maladaptation? Up to this date, we register some studies which deal with the issue of oral vs. nasal breathing in the context of physical performance. However, these studies mainly focus on aerobic or anaerobic endurance performance and not on strength. Although we see many people breathing through the mouth during strength training and we are aware of the negatives of this type of breathing, we have not found any study which would focus on the effects of different types of breathing on strength performance. Our questionnaire shows that around 95% of physically active young people use oral or oronasal breathing during strength training and only 5% use pure nasal breathing. Based on the knowledge of how negatively this type of breathing can affect our health, we are asking one important question: Is it necessary for the improvement of strength performance, or is it just a negative habit we can see in our society because people do not know about the negative aspects of this type of breathing? Mouth breathing If the nose is the organ for breathing, why are we able to breathe through the mouth as well? Probably because of the evolutionary advantage of survival, but chronic oral breathing has some negative aspects and can lead to many diseases. Inhale through the mouth introduces unfiltered, poorly humidified air with the temperature of the external environment into the lungs[ 1 ]. If the temperature is low, cold air can cause severe damage to the respiratory system [ 2 ]. The stereotype of mouth breathing is also connected to a greater incidence of snoring and sleep apnoea [ 3 ], which causes further health problems and social inconvenience [ 4 ]. Dysfunctional mouth breathing can even cause changes in the bone structure and overall facial appearance [ 1 ]. Among the most common and visible changes belong: a narrow face, mouth and nose, which are lengthened in the sagittal plane, higher upper palate, retruded mandible, the elevated position of the hyoid bone, malocclusion, crowded and crooked teeth, secondary halitosis, open bite and dysfunctional jaw joint [ 5 – 10 ]. This all leads to the significant shrinking of nasopharyngeal air space [ 8 ]. In addition to structural changes, we can observe phenomena such as bad breath, dental decay, gum disease, dysfunctions of the facial muscles (mainly around the jaw and lips), trauma to soft tissues in the airways, and enlarged tonsils and adenoids [ 10 – 12 ]. Mouth breathing also has a negative impact on academic achievement and cognitive abilities and relates to a higher prevalence of ADHD [ 13 ]. Even speech can be negatively affected as a consequence of a bad breathing stereotype [ 14 ]. Mouth breathing conducts air mainly to the upper chest, which can be inefficient and tiring [ 15 ]. Because of insufficient mixing of air with blood in the lungs, people feel a stronger urge to breathe, so they are chronically over-breathing, which causes significant losses of CO 2 [ 16 ]. However, this gas is crucially essential for the proper functioning of the body [ 1 ]. Although chemoreceptors are sensitive to higher levels of CO 2 (what causes the urge to breathe), by improving chemosensitivity, we can benefit from higher levels of CO 2, thanks to the Bohr effect, and increase oxygenation of organs and tissues [ 17 ]. By breathing through the mouth (even only exhaling) we lose around 42% more water [ 18 ], and we are drying the oral cavity, which has a negative effect on the dental microbiome [ 19 ]. The feeling of dried oral cavity was confirmed in around half of our respondents during the performance of the tests with oral breathing. Adults with upper airway restrictions have a higher risk of plaque, tooth decay, and periodontitis due to mouth breathing. The microbiome is oxidating, the pH of saliva is changing, and some pathogens can appear [ 20 ]. An unfavourable condition of the oral microflora can even lead to some diseases of the respiratory system because oral and lung microflora are connected [ 21 ]. The estimated number of people who are mouth breathers is still unclear. Two independent Brazilian studies confirmed that more than half of school-aged children breathe through their mouths [ 22 , 23 ]. According to recent study [ 24 ], wrong breathing stereotype may have up to seventy percent of the population. Individuals with cerebral palsy may be affected even more (60–86%) [ 25 ]. The causes of mouth breathing are various, but the most common are allergic rhinitis, hypertrophy of the palate or pharynx, deviation of the nasal septum, or a non-physiological stereotype created artificially during life [ 26 ]. More than half of our probands declared the use of mouth breathing in everyday life (even without performing a sports activity). Around 60% of them use oro-nasal (inhale through the nose, exhale through the mouth) type of breathing during low-intensity exercise and warm-up. Circa 11% use pure oral breathing for the same intensity. When it comes to high intensity, 52% of them declare oro-nasal and 45% declare oral breathing. When it comes to strength training, almost 80% of physically active young adolescents use oro-nasal breathing, 15% use oral breathing and only 5 % of our respondens breathe purely through the nose. However, we must note that most studies that point to the negatives of mouth breathing focus on chronic and long-term use of mouth breathing, and we cannot say with certainty how the health and physiological aspects are affected today if we use this regimen of breathing in a time-limited period of training. Because not only the way we breathe but also the dosage can be even more important. Today, it’s still unclear whether this breathing stereotype used during strength training contributes to the creation of a worse breathing stereotype during ordinary life - therefore we recommend additional research that would confirm or refute these ideas. Nose breathing The nose is a very important organ of breathing and except rare situations, we assume that it can be the only organ by which we can get air into and out of the body. Unlike the oral cavity, the nasal cavity has the function of warming, humidifying, and filtering the inhaled air [ 27 ]. The filtering function consists in trapping large particles with the nose hair and small particles via mucous membranes [ 28 ]. Thanks to cleaner, warmer, and humidified air in the airways, there is a lower probability of getting colds, flu, allergic reaction, hay fever, or irritable coughing [ 1 ]. Even in animals, by exhaling through the nose moisture is trapped in the nasal cavity, which prevents it from drying out and clogging and also prevents from dehydration in a hot environment [ 29 ]. Both inhaling and exhaling through the nose allow the correct position of the tongue, which is against the upper palate, and keep the lips together [ 30 ]. It’s helping to form natural dental arches and straight healthy teeth [ 31 ]. Nasal breathing regulates airflow because of the nose’s intricate structures [ 32 ]. Because of the resistance of nasal airways (which is approximately 50 % higher than the resistane of mouth airways) to the airstream, oxygen uptake can be 10–20% higher [ 33 ]. Thanks to the negative pressure that must be created, there is a higher activation of the diaphragm and other respiratory muscles [ 34 ], which leads to better stabilization of the spine [ 35 , 36 ] and prevent from injuries [ 37 ]. Nitric oxide is a potent bronchodilator and vasodilator and has antiviral and antibacterial effects [ 38 , 39 ]. This gas is generated by the paranasal sinus epithelium and diffused into the nasal cavity, where it is inhaled into the lungs and causes the increasement of oxygen transport through the body [ 40 ]. If nose breathing seems to be healthier based on scientific knowledge, why oro-nasal or oral breathing is used during sport? Does it have some benefits? During rest and light to moderate exercise, pure nasal breathing seems to be sufficient enough to maintain performance [ 41 ]. However, at higher intensities, we can observe people switching to oronasal or oral breathing [ 42 ]. The ratio of mouth and nose usage can vary among individuals of different races and genders [ 43 ]. It seems that both children and adults are using oronasal breathing more frequently both during rest and exercise [ 44 , 45 ] without knowing the consequences. There wasn’t found any significant difference between oral and oronasal breathing in the context of reached level of VO 2 max [ 46 ], so it seems that during higher intensities nasal contribution on breathing has no effect [ 47 , 48 ]. The cause of the transition of the usage of the mouth for breathing during exercise stays unclear. Some theories say about subjective feelings of hypoventilation [ 49 ], lower subjective effort [ 50 ], or lowering turbulences at the airflow of nasal passage [ 51 ]. Although there is a logical argument that breathing through the nose improves air filtration, some studies did not confirm this theory during exercise [ 52 , 53 ]. Another potential benefit of inhaling nitric oxide (NO) while breathing through the nose has been partially refuted because although more NO is created during nasal breathing [ 54 ], more is also exhaled and thus does not lead always to an improvement in cardiorespiratory response [ 54 – 56 ]. However, we have some scientifical knowledge, even authors themselves point to the fact that further evidence is necessary to confirm or refute the effectiveness of nasal breathing during exercise. What seems to be clear is that nasal breathing appears to be important for eliminating bronchoconstriction, leading to better prevention and treatment of asthma [ 57 – 59 ]. Available research demonstrates that nasal breathing during steady submaximal exercise, results in a lower respiration rate, a lower ventilation, lower ventilatory equivalent for both oxygen and carbon dioxide, lower oxygen uptake during a given intensity, a lower level of O 2 and higher CO 2 in exhaled air [ 41 , 47 , 60 – 62 ]. In healthy individuals who are not adapted to nasal breathing can nose breathing cause lower levels of reached VO 2 max and peak work [ 47 ], but no significant difference in maximal anaerobic output was found [ 63 ]. However, in individuals who are adapted to this type of breathing, no significant difference in performance while nasal or oronasal breathing was [ 61 , 62 ]. Authors emphasize the fact that individuals can adapt to higher values of CO 2 . Methods The aim of our study was to determine whether different ways of breathing (nasal/oronasal/oral) have an acute influence on muscular endurance performance. 107 physically active individuals (68 males, 39 females) voluntarily participated in the study (see Table 1 for characteristics). All participants completed 3 repeated measurements in random order for each individual. In between test days was at least 72 hours rest period and at least 24 hours before testing, participants were asked to not have any physical training. Participants were also asked not to practise any type of training for improving muscular endurance, during the study (between measurements). Table 1 Characteristics of research sample age (yr) height (cm) body mass (kg) men (n = 68) 22.40 ± 1.45 181.07 ± 6.44 77.74 ± 9.53 women (n = 39) 21.63 ± 1.60 168.75 ± 5.37 63.55 ± 6.38 Protocol All procedures were performed at the Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia. Our effort was to keep the conditions as stable as possible for repeated measurements (temperature, warm up, time of the day, weight on a barbell, grip width, pace of repetitions). After familiarization, during which participants tried testing protocol with individually natural breathing regimen, all subjects performed 3 repetitions of bench press testing protocol in random order. The test can be described as repetitions to failure on bench press with olympic barbell with resistance – 60% of body weight for men (BP60) and 40% for women (BP40). Grip width and the pace of repetitions was intraindividual (as was natural for proband) but had to be kept in all 3 measurements the same. The pace of repetitions was circa 1011 and grip width was between biacromial and 1.5 times biacromial width. Bench press exercise is naturally considered as valid for the detection of the strength of upper limbs and trunk muscles and by performing more than 20 repetitions we can state that result shows us quality of muscular endurance. During familiarization participants performed given tests with their natural breathing regimens 2 times. We evaluated reliability of BP60 as significant (p < 0.001) and good (ICC = 0.894) and reliability of BP40 as significant (p < 0.001) and good (ICC = 0.934). ICC coefficient was interpreted by Portney (2009) [ 64 ]. After 3 repeated measurements, we performed control retest with those individuals, who had one out of three results significantly different, to exclude the negative effect of unexpected confounding variables. Right after the test, blood oxygen saturation was measured by a pulse oxymeter (Viatom Oxymeter PC-60FW), heart rate by chest strap heart rate monitor and perceived exertion by Borg Scale (RPE). In the end of the study all participants completed a questionnaire aimed at their breathing stereotypes and feelings while performing tests. Under the NN condition, participants had medical kinesio tape placed over their mouths, in order to prevent any oral breathing. MM condition was controlled by nose clip which was placed on the participant’s nose to prevent any nasal breathing. For NM condition were participants asked to inhale through the nose and exhale through the mouth. Fulfilment of this condition was checked by the examiner during the test. Statistical analysis For statistical analysis, we used SPSS program. To analyse data from repeated measurements we used the method ANOVA, since our data were verified with positive results about their normality of distribution by Kolmogorov-Smirnov test, resp. Shapiro-Wilk test. The statistical significance was set at p < 0.05 and p < 0.01 levels. Effect size was expressed in significant cases by Cohen's d [ 65 ]. Results Using the ANOVA method, we did not find any significant differences (ns) in the number of repetitions, nor in the perceived exertion and blood oxygen saturation in the bench press tests (BP60, BP40) in both sexes between different breathing regimens (see Table 2 ). The only significant differences we recorded at heart rate values at the male group. There were significantly lower values ​​in the NN regimen compared to the other two breathing regimens (NN < NM, p = 0.033, d = 0.32; NN < MM, p = 0.047, d = 0.30) with small effect in both cases. Table 2 Results and differences in BP60/BP40 (reps, heart rate, Borg scare) between selected breathing regimens (NN, NM, MM) Group NN NM MM Wilks' lambda F p-value η2 Significant differences Repetitions (reps; x ± s) Men 28.38 ± 7.50 28.66 ± 7.20 28.85 ± 6.84 0.965 1.20 ns (0.31) 0.035 Women 34.26 ± 12.82 33.79 ± 11.22 34.77 ± 12.89 0.937 1.25 ns (0.30) 0.063 Heart rate (bpm; x ± s) Men 123.21 ± 15.83 127.69 ± 16.92 126.97 ± 16.65 0.871 4.87 < 0.05* (0.006) 0.144 NN < NM (p = 0.033; d = 0.32) NN < MM (p = 0.047; d = 0.30) Women 127.33 ± 15.38 128.05 ± 18.07 127.54 ± 17.14 0.998 0.04 ns (0.96) 0.002 Borg scale (score; x ± s) Men 15.57 ± 1.20 15.46 ± 1.26 15.75 ± 1.27 0.961 1.35 ns (0.27) 0.039 Women 15.41 ± 1.20 15.31 ± 1.24 15.23 ± 1.27 0.988 0.224 ns (0.80) 0.012 In both sexes, we found no significant differences (ns) in the number of repetitions in bench press tests (BP60, BP40), with selected breathing modes (NN, NM, MM) (see Fig. 1 ). The differences between the mean values ​​were less than 1 repetition on average. However, we have to admit that at some individuals pure nasal breathing led to lowering the performance outcomes. In male group, we demonstrated significantly lower heart rate values ​​after the BP60 test with the NN regimen compared to the other two regimens that use the mouth (NN < NM, 123.21 ± 15.83 bpm vs. 127.69 ± 16.92 bpm, dif. 4.48 bpm (4%), p = 0.047, d = 0.32; NN < MM, 123.21 ± 15.83 bpm vs. 126.97 ± 16.65 bpm, dif. 3.76 bpm (3%), p = 0.047, d = 0.30) (see Fig. 2 ). Differences were significant, but practically much lower than statistical deviations and Cohen’s d shows only small effect. In addition, this phenomenon was not confirmed in the female group. We did not find any significant differences (ns) in the subjective perceived exertion using the Borg scale (RPE) in both sexes during bench press testing protocols (BP60, BP40) (see Fig. 3 ). The differences between the mean values ​​were less than 1 point of the scale. During the entire research, we did not notice any significant drop in blood oxygen saturation from the physiological norm (95–99%) in any proband during the testing protocol. Average SPO 2 values ​​for both sexes were around 98%, with the lowest value recorded being 95%. Using the ANOVA method, we found no significant differences between various breathing modes (ns). Since we did not record any values ​​that would detect hypoxemia, we did not include this indicator in the results section in graphical form. Based on our measurements, we can say that muscular endurance performance, regardless of whether it is carried out with any breathing regimen (NN, NM, MM), does not cause a decrease in blood oxygen saturation below the level of the physiological norm. Discussion The main goal of our study was to find out if and how different breathing regimens (NN, NM, MM) acutely affect muscular endurance performance. Nowadays we can observe a very frequent use of oral or oro-nasal breathing pattern during strength training (up to 95% of our probands declared that). We were interested in whether this breathing pattern is necessary for maintaining a certain level of strength endurance, if we know that these ways of breathing have certain negatives from a physiological point of view and can lead to some health issues. Is mouth breathing necessary during strength training, or is it more appropriate to use pure nasal breathing, since we know its health benefits? Although in the past several researchers focused on the issue of breathing from the point of view of the nose vs. mouth, none of the studies were directly related to strength abilities. Our study is thus original and very up to date. After the COVID-19 pandemic, associated with respiratory disease, society is more interested in computerization regarding the prevention and treatment of respiratory problems. Although, based on the available studies, we know about the negatives of breathing through the mouth, we can still observe in fitness centres the persistent trend of using oral or oronasal breathing during strength training. Other positives of our work lie in the larger research sample, which includes both genders, and thus we can make recommendations, based on our results, for the group of healthy young physically active adults. Through our research, we have demonstrated that purely nasal breathing (NN) appears to be just as effective for muscular endurance work as breathing regimens that use the mouth (NM, MM). It is so probably because respiratory gas exchange is not limited in any of the selected breathing modes to such an extent that it would have a negative effect on the achieved performance. In both sexes, we did not notice any significant differences (ns) in performance caused by different breathing modes in the monitored tests (BP60/BP40). Also, subjective perceived exertion and blood oxygen saturation, were not significantly affected (ns) by the selected breathing regimens. The only differences we noticed were attached to the physiological response of the body. By performing both inhales and exhales through the nose (NN), we recorded in the male group significantly lower values of heart rate ​​ compared to the NM (p = 0.033; d = 0.32) and MM (p = 0.047; d = 0.30). Although significant differences were confirmed, only small effect was shown and these differences were not confirmed at the female group. Based on our findings, we can say that the pure nasal way of breathing can potentially cause lower physiological stress on the cardiovascular system. A potential cause may lie in the greater amount of NO and CO 2 in the bloodstream during nasal breathing, which leads to vasodilatation and better oxygenation of the tissues and thus less need for the heart to work in such an effort. But further studies are necessary to confirm out theory. We also must admit that heart rate, as an indicator of the body's internal response to physical activity, is not the most stable and reliable parameter, because this parameter can be significantly influenced by several confounding variables that were not part of our research (such as women’s menstrual cycle, level of motivation, etc.). This fact could cause that significant differences in heart rate values were not detected in all the cases in both sexes. We also found out that it is not possible to reach a state of hypoxemia during strength-endurance exercise if the exerciser maintains breathing, regardless of the way of breathing (NN, NM, MM). The results of our study show that there is no significant difference in strength endurance, nor in the perceived exertion between different breathing regimens (NN, NM, MM), but nasal breathing causes lower physiological stress to the body. Nasal breathing brings many health benefits, while oral or oronasal can have a negative effect on several physiological phenomena. The way we breathe can directly or indirectly affect the respiratory system [ 1 , 2 , 8 , 10 – 12 , 15 , 21 , 27 – 29 , 33 , 38 , 39 ], skeleton [ 1 , 5 , 9 ], neuromuscular system [ 34 – 37 ], digestion [ 66 ], cardiovascular system [ 38 – 40 ], oral cavity [ 5 – 10 , 20 , 30 , 31 ] sleep [ 3 ] and many other aspects of life [ 13 , 14 , 18 , 26 ]. Based on these negative associations connected with mouth breathing, it is advisable to breathe through the nose and act preventively against many undesirable pathological phenomena. It should be noted that these types of studies require appropriate familiarization, as we found a significant learning effect and other confounding influences in a few individuals who lacked sufficient experience with strength training realised by selected breathing regimens, which caused non-negligible differences in the results. If this phenomenon persisted after control pretesting, we evaluated this fact as an exclusion criterion for inclusion in the research. To verify the acute and long-term effects of different breathing regimens on parameters of strength, further studies are needed to confirm or refute our findings. In the future, we recommend conducting research that would verify not only the acute but also the long-term effects on parameters of strength, such as maximum strength, hypertrophy, or power output. At the same time, it would be appropriate to monitor individuals, who have been confirmed an acute negative effect of nasal breathing on strength endurance, and to find out whether these individuals can adapt to this way of breathing to such an extent, that it would not further reduce performance. Conclusions Based on our findings, we can say that in the majority of healthy and physically active young recreational athletes, strength-endurance performance is not acutely affected by the various breathing regimens (NN, NM, MM) and therefore we recommend using a purely nasal breathing, which appears to be physiologically healthier. Neither perceived exertion nor blood oxygen saturation seem to be affected by selected breathing conditions. The only potential difference between nasal and mouth breathing during strength-endurance exercise is the lower heart rate during nasal breathing. Pure nasal breathing is just as effective as mouth breathing during in context of muscular endurance performance. Abbreviations BP40 bench press test with olympic barbell with resistance of 60% of body mass (repetitions to failure) BP60 bench press test with olympic barbell with resistance of 40% of body mass (repetitions to failure) MM breathing regimen – both inhale and exhale through the mouth (oral breathing) NM breathing regimen – inhale through the nose and exhale the mouth (oro-nasal breathing) NN breathing regimen – both inhale and exhale through the nose (nasal breathing) Declarations Ethical approval and consent to participate Study was approved by the ethics commission of the Faculty of physical education and sport, Comenius University in Bratislava (under the number 6/2022), and conform to the ethical guidelines of the Declaration of Helsinki 2000. All participants provided witnessed oral informed consent prior to entering the study to both authors. The other research participants were witnesses. Consent for publication Not applicable Availability of data and material The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding This study was funded by the authors' own resources. Author Contributions Both authors listed (FL and MV) have made a direct and intellectual contribution to the work. Acknowledgements Not applicable References Allen A. The health benefits of nose breathing Item Type Article. Nursing in General Practice. 2017. D’Amato M, Molino A, Calabrese G, Cecchi L, Annesi-Maesano I, D’Amato G. The impact of cold on the respiratory tract and its consequences to respiratory health. Clin Transl Allergy. 2018;8:20. Huang TW, Young TH. Novel Porous Oral Patches for Patients with Mild Obstructive Sleep Apnea and Mouth Breathing. Otolaryngology–Head and Neck Surgery.SAGE PublicationsSage CA: Los Angeles, CA; 2014; 152:369–73. Morsy NE, Farrag NS, Zaki NFW, Badawy AY, Abdelhafez SA, El-Gilany AH, et al. Obstructive sleep apnea: Personal, societal, public health, and legal implications. Rev Environ Health De Gruyter. 2019;34:153–69. EMSLIE RD, MASSLER M. Mouth Breathing: I. Etiology and Effects (a Review). J Am Dent Association Elsevier. 1952;44:506–21. Fraga WS, Seixas VM, Santos JC, Paranhos LR, César CP. Mouth breathing in children and its impact in dental malocclusion: a systematic review of observational studies. Minerva Stomatol Edizioni Minerva Medica. 2018;67:129–38. Lee M-J, Kim J-G, Yang Y-M, Baik B-J. Effects of mouth breathing on facial skeletal morphology. J Korean Acad Pediatr Dentistry Korean Acad Pediatr Dentistry. 2012;39:339–47. Chung Leng Muñoz I, Beltri Orta P. Comparison of cephalometric patterns in mouth breathing and nose breathing children. Int J Pediatr Otorhinolaryngol Elsevier. 2014;78:1167–72. Zhao Z, Zheng L, Huang X, Li C, Liu J, Hu Y. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health BioMed Central Ltd. 2021;21:1–14. Triana BEG, Ahlam HA, León IBG. Mouth breathing and its relationship to some oral and medical conditions: physiopathological mechanisms involved. Revista Habanera de Ciencias Médicas. 2016;15:200–12. Basheer B, Sundeep Hegde K, Bhat SS, Umar D, Baroudi K. Influence of mouth breathing on the dentofacial growth of children. J Int Oral Health. 2014;6:50–5. Jefferson Y. Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent Academy of General Dentistry. 2010;58:18–25. quiz 26. Rangeeth BN, Rangeeth P, Rangeeth MBN. Mouth breathing “a habit or anomaly”-a review. JIDAM. 2019. Correa BM, Rossi AG, Roggia B, Toniolo Da Silva AM. Analysis of hearing abilities in mouth-breathing children. Revista CEFAC. 2011;13:668–75. McKeown P, Macaluso M. Mouth Breathing: Physical, Mental and Emotional Consequences. Oral Health. 2017. Schleifer LM, Ley R, Spalding TW. A hyperventilation theory of job stress and musculoskeletal disorders*. Am J Ind Med. John Wiley & Sons, Ltd; 2002;41:420–32. Jensen FB. Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport. Acta Physiol Scand. John Wiley & Sons, Ltd; 2004;182:215–27. Svensson S, Olin AC, Hellgren J. Increased net water loss by oral compared to nasal expiration in healthy subjects. Rhinology. 2006;44:74–7. Al-Awadi RN, Al-Casey M. Oral health status, salivary physical properties and salivary Mutans Streptococci among a group of mouth breathing patients in comparison to nose breathing. J Bagh College Dentistry. 2013;25. Fan C, Guo L, Gu H, Huo Y, Lin H. Alterations in Oral–Nasal–Pharyngeal Microbiota and Salivary Proteins in Mouth-Breathing Children. Front Microbiol Frontiers Media S A. 2020;11:2472. Bassis CM, Erb-Downward JR, Dickson RP, Freeman CM, Schmidt TM, Young VB, et al. Analysis of the upper respiratory tract microbiotas as the source of the lung and gastric microbiotas in healthy individuals. mBio. Volume 6. American Society for Microbiology; 2015. De Menezes VA, Leal RB, Pessoa RS, Pontes RMES. Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife, 2005. Braz J Otorhinolaryngol Elsevier. 2006;72:394–8. Abreu RR, Rocha RL, Lamounier JA, Francisca Â, Guerra M. Prevalence of mouth breathing among children. J Pediatr (Rio J) Sociedade Brasileira de Pediatria. 2008;84:467–70. Bonuck KA, Chervin RD, Cole TJ, Emond A, Henderson J, Xu L, et al. Prevalence and Persistence of Sleep Disordered Breathing Symptoms in Young Children: A 6-Year Population-Based Cohort Study. Sleep. Volume 34. Oxford Academic; 2011. pp. 875–84. Barrionuevo NL, Solís FF. Anomalías dentó maxilares y factores asociados en niños con parálisis cerebral. Rev Chil Pediatr Sociedad Chilena de Pediatría. 2008;79:272–80. Kuroishi RCS, Garcia RB, Valera FCP, Anselmo-Lima WT, Fukuda MTH. Deficits in working memory, reading comprehension and arithmetic skills in children with mouth breathing syndrome: analytical cross-sectional study. Sao Paulo Medical Journal Associação Paulista de Medicina - APM. 2014;133:78–83. Ferneini EM, Goupil MT, McNulty MA, Niekrash CE. Applied head and neck anatomy for the facial cosmetic surgeon. Applied Head and Neck Anatomy for the Facial Cosmetic Surgeon. Springer International Publishing; 2020. pp. 1–256. Ozturk AB, Damadoglu E, Karakaya G, Kalyoncu AF. Does Nasal Hair (Vibrissae) Density Affect the Risk of Developing Asthma in Patients with Seasonal Rhinitis? Int Arch Allergy Immunol. Volume 156. Karger Publishers; 2011. pp. 75–80. Zimmer C. The Importance of Noses. Discover. 1994. Caixeta ACP, Andrade I, Bahia Junqueira Pereira T, Paiva Franco L, Gonçalves Becker HM. Quiroga Souki B. Dental arch dimensional changes after adenotonsillectomy in prepubertal children. Am J Orthod Dentofac Orthop Mosby. 2014;145:461–8. Liu ZJ, Shcherbatyy V, Gu G, Perkins JA. Effects of tongue volume reduction on craniofacial growth: A longitudinal study on orofacial skeletons and dental arches. Arch Oral Biol Pergamon. 2008;53:991–1001. Trabalon M, Schaal B. It Takes a Mouth to Eat and a Nose to Breathe: Abnormal Oral Respiration Affects Neonates’ Oral Competence and Systemic Adaptation. Int J Pediatr Hindawi Limited. 2012;2012:1–10. Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev Pergamon. 2022;135:104576. Trevisan ME, Boufleur J, Soares JC, Haygert CJP, Ries LGK, Corrêa ECR. Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: A cross-sectional study. J Electromyogr Kinesiol Elsevier. 2015;25:463–8. Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV et al. Stabilizing function of the diaphragm: Dynamic MRI and synchronized spirometric assessment. J Appl Physiol. American Physiological Society Bethesda, MD; 2010 ;109:1064–71. Nelson N. Diaphragmatic Breathing The Foundation of Core Stability. Strength Cond J. 2012;34:34–40. Huxel Bliven KC, Anderson BE. Core Stability Training for Injury Prevention. Sports Health. Volume 5. Los Angeles, CA: SAGE PublicationsSage CA; 2013. pp. 514–22. Ali-Ahmad D et al. Replication of respiratory syncytial virus is inhibited in target cells generating nitric oxide in situ. Front Bioscience-Landmark. 2003. Martina A, Jana P, Anna S, Tomas B. Nitric oxid - Important messenger in human body. Open J Mol Integr Physiol Scientific Research Publishing. 2012;2012:98–106. Arnal JF, Flores P, Rami J, Murris-Espin M, Bremont F, Pasto L, Aguilla M, et al. Nasal nitric oxide concentration in paranasal sinus inflammatory diseases. Eur Respiratory J Eur Respiratory Soc. 1999;13:307–12. LaComb CO, Tandy RD, Lee SP, Young JC, Navalta JW. Oral versus Nasal Breathing during Moderate to High Intensity Submaximal Aerobic Exercise. Int J Kinesiol Sports Sci Australian Int Acad Centre. 2017;5:8–16. Dallam G, Kies B. The Effect of Nasal Breathing Versus Oral and Oronasal Breathing During Exercise: A Review. J Sports Res Conscientia Beam. 2020;7:1–10. Bennett WD, Zeman KL, Jarabek AM. Nasal contribution to breathing with exercise: Effect of race and gender. J Appl Physiol American Physiological Society. 2003;95:497–503. Becquemin MM, Bertholon JF, Bouchikhi A, Malarbet JL, Roy M. Oronasal Ventilation Partitioning in Adults and Children: Effect on Aerosol Deposition in Airways. Radiat Prot Dosimetry Oxford Academic. 1999;81:221–8. Niinimaa V. Oronasal airway choice during running. Respir Physiol Elsevier. 1983;53:129–33. Meir R, Zhao GG, Zhou S, Beavers R, Davie A. The acute effect of mouth only breathing on time to completion, heart rate, rate of perceived exertion, blood lactate, and ventilatory measures during a high-intensity shuttle run sequence. J Strength Cond Res NSCA National Strength and Conditioning Association. 2014;28:950–7. Morton AR, King K, Papalia S, Goodman C, Turley KR, Wilmore JH. Comparison of maximal oxygen consumption with oral and nasal breathing. Aust J Sci Med Sport. 1995;27:51–5. Chinevere TD, Faria EW, Faria IE. Nasal splinting effects on breathing patterns and cardiorespiratory responses. J Sports Sci Taylor & Francis. 2010;17:443–7. Saibene F, Mognoni P, Lafortuna CL, Mostardi R. Oronasal breathing during exercise. Pflugers Arch Springer-Verlag. 1978;378:65–9. Niinimaa V, Cole P, Mintz S, Shephard RJ. The switching point from nasal to oronasal breathing. Respir Physiol Elsevier. 1980;42:61–71. Fregosi RF, Lansing RW. Neural drive to nasal dilator muscles: influence of exercise intensity and oronasal flow partitioning. J Appl Physiol American Physiological Society. 1995;79:1330–7. Bennett WD, Zeman KL, Jarabek AM. Nasal contribution to breathing and fine particle deposition in children versus adults. J Toxicol Environ Health - Part A: Curr Issues. 2008;71:227–37. Hynes B, Silverman F, Cole P, Corey P. Effects of Ozone Exposure: A Comparison between Oral and Nasal Breathing. Archives of Environmental Health: An International Journal Taylor & Francis Group. 2010;43:357–60. Yasuda Y, Itoh T, Miyamura M, Nishino H. Comparison of Exhaled Nitric Oxide and Cardiorespiratory Indices between Nasal and Oral Breathing during Submaximal Exercise in Humans. Jpn J Physiol The physiological society of japan. 1997;47:465–70. Phillips CR, Giraud GD, Holden WE. Exhaled nitric oxide during exercise: site of release and modulation by ventilation and blood flow. J Appl Physiol American Physiological Society. 1996;80:1865–71. Bizjak DA, Schams P, Bloch W, Grau M, Latsch J. The intranasal AlaxoLito Plus Nasal Stent: Improvement of NO-induced microrheology and oxygen uptake during exercise? Respir Physiol Neurobiol. Volume 269. Elsevier; 2019. p. 103260. Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF. The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. Am Rev Respir Dis Am Rev Respir Dis. 1978;118:65–73. Mangla PK, Menon MPS. Effect of nasal and oral breathing on exercise-induced asthma. Clinical & Experimental Allergy.John Wiley & Sons, Ltd; 1981;11:433–9. Kirkpatrick MB, Sheppard D, Nadel JA, Boushey HA. Effect of the Oronasal Breathing Route on Sulfur Dioxide-Induced Bronchoconstriction in Exercising Asthmatic Subjects. American Review of Respiratory Disease; 1982. Garner DP, Scheett TP, McDivitt EJ. The effects of mouthpiece use on gas exchange parameters during steady-state exercise in college-aged men and women. J Am Dent Association Elsevier. 2011;142:1041–7. Hostetter K, Mcclaran SR. Triathlete Adapts to Breathing Restricted to the Nasal Passage Without loss in VO2max or vVO2max. J Sport Hum Perform. 2016;4:1–7. Dallam GM, McClaran SR, Cox DG, Foust CP. Effect of Nasal Versus Oral Breathing on Vo2max and Physiological Economy in Recreational Runners Following an Extended Period Spent Using Nasally Restricted Breathing. International Journal of Kinesiology and Sports Science. Volume 6. Australian International Academic Centre; 2018. pp. 22–9. Recinto C, Efthemeou T, Boffelli PT, Navalta JW. Effects of Nasal or Oral Breathing on Anaerobic Power Output and Metabolic Responses. Int J Exerc Sci Western Kentucky University. 2017;10:506. Portney LGross, Watkins MP. Foundations of clinical research: applications to practice. Pearson/Prentice Hall; 2009. COHEN J. Statistical power analysis for the behavioural sciences. Hillsdale, NJ: L Erlbaum Associates; 1998. Swarthout K. Oral and systemic effects of breathing patterns: Nasal breathing vs. mouth Breath. 2022. Additional Declarations No competing interests reported. Supplementary Files prlohaarticlenosevsmouthmuscularendurance.docx Cite Share Download PDF Status: Published Journal Publication published 09 Feb, 2024 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted Editorial decision: Major revision 09 May, 2023 Editor assigned by journal 09 May, 2023 Submission checks completed at journal 27 Apr, 2023 First submitted to journal 27 Apr, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2867743","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":195698511,"identity":"fc0c8413-3d8a-4fd0-8419-4beed8616f74","order_by":0,"name":"Mgr. František Lörinczi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIie3RsWrDMBCA4RMCebnWq4KgfoUzgXYoJa/iUPDsqWRyFQzpmDVd+hiZVQTJkjdolhDw3CmTh0pp3UBRIGMH/WBznPmwhQFisX9Yov2dACRwfRyAc+MGd4EIEvSPzJGwnojiAgI9+d7Rz+4MUbbdf1b1zUCz6X5SbbPsBQ+qcgOkqyJIrss7MmSHCliTb6jNp83VUi3coGVpQmSEcCsNmfEbsNlAky04dwTJMi0THSKIycGR+vmXCI6tJyOdrs8Q9G/hheoJchSejDWEP8yRJ7khm7827iyO5AsuhvdI7eNMluHjY7KUk67O5Lp53+nOZtnc7j6w2z7M0xWFyCn+dxH+K7FYLBa7pC95zFbe5OTDmAAAAABJRU5ErkJggg==","orcid":"","institution":"Comenius University in Bratislava","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mgr.","middleName":"František","lastName":"Lörinczi","suffix":""},{"id":195698513,"identity":"bb94c871-5109-43c6-8b1b-3b61785f8302","order_by":1,"name":"Marián Vanderka","email":"","orcid":"","institution":"Comenius University in Bratislava","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Marián","middleName":"","lastName":"Vanderka","suffix":""}],"badges":[],"createdAt":"2023-04-27 09:14:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2867743/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2867743/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13102-024-00840-6","type":"published","date":"2024-02-09T15:01:22+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":36538547,"identity":"ea3f49eb-0acf-42a1-9c0d-9eccdaeb53a8","added_by":"auto","created_at":"2023-05-02 18:58:08","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":287490,"visible":true,"origin":"","legend":"\u003cp\u003eResults and differences in the number of repetitions in bench press tests (BP60, BP40) reached by selected breathing regimens (NN, NM, MM)\u003c/p\u003e","description":"","filename":"1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2867743/v1/49ad3afcc8f974a2766d2c69.jpeg"},{"id":36538545,"identity":"113bd74d-ca3e-46b5-ac35-77795903d59f","added_by":"auto","created_at":"2023-05-02 18:58:08","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":337810,"visible":true,"origin":"","legend":"\u003cp\u003eResults and differences in heart rate values after bench press tests (BP60, BP40) reached by selected breathing regimens (NN, NM, MM)\u003c/p\u003e","description":"","filename":"2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2867743/v1/fa4c6a7e592204a3a4501098.jpeg"},{"id":36538548,"identity":"af91edea-ccaf-4e40-87e6-7f54a4e05d08","added_by":"auto","created_at":"2023-05-02 18:58:08","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":246261,"visible":true,"origin":"","legend":"\u003cp\u003eResults and differences in perceived exertion during bench press tests (BP60, BP40) reached by selected breathing regimens (NN, NM, MM)\u003c/p\u003e","description":"","filename":"3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2867743/v1/393db9f861b9c120d892d95b.jpeg"},{"id":51005695,"identity":"e43a85ee-86f0-406a-87e5-fd78d146c46a","added_by":"auto","created_at":"2024-02-12 15:11:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":530586,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2867743/v1/00da532c-ab48-4c0b-948e-5e570dee1f95.pdf"},{"id":36538820,"identity":"e146ef28-9060-47b7-839f-9db2e3ac5b47","added_by":"auto","created_at":"2023-05-02 19:06:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1684453,"visible":true,"origin":"","legend":"","description":"","filename":"prlohaarticlenosevsmouthmuscularendurance.docx","url":"https://assets-eu.researchsquare.com/files/rs-2867743/v1/1f4851247d696eea46ec263f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nose vs. mouth breathing – Acute effect of different breathing regimens on muscular endurance","fulltext":[{"header":"Background","content":"\u003cp\u003eAfter the pandemic, the whole society is more conscious about the health of respiratory system and breathing. Many medical studies point to the benefits of nasal breathing. The Nose is for breathing, the mouth is for eating. But still, many people change to mouth breathing during physical activity. Is it more effective, or is it just a maladaptation? Up to this date, we register some studies which deal with the issue of oral vs. nasal breathing in the context of physical performance. However, these studies mainly focus on aerobic or anaerobic endurance performance and not on strength. Although we see many people breathing through the mouth during strength training and we are aware of the negatives of this type of breathing, we have not found any study which would focus on the effects of different types of breathing on strength performance. Our questionnaire shows that around 95% of physically active young people use oral or oronasal breathing during strength training and only 5% use pure nasal breathing. Based on the knowledge of how negatively this type of breathing can affect our health, we are asking one important question: Is it necessary for the improvement of strength performance, or is it just a negative habit we can see in our society because people do not know about the negative aspects of this type of breathing?\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eMouth breathing\u003c/h2\u003e \u003cp\u003eIf the nose is the organ for breathing, why are we able to breathe through the mouth as well? Probably because of the evolutionary advantage of survival, but chronic oral breathing has some negative aspects and can lead to many diseases. Inhale through the mouth introduces unfiltered, poorly humidified air with the temperature of the external environment into the lungs[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. If the temperature is low, cold air can cause severe damage to the respiratory system [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The stereotype of mouth breathing is also connected to a greater incidence of snoring and sleep apnoea [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which causes further health problems and social inconvenience [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Dysfunctional mouth breathing can even cause changes in the bone structure and overall facial appearance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Among the most common and visible changes belong: a narrow face, mouth and nose, which are lengthened in the sagittal plane, higher upper palate, retruded mandible, the elevated position of the hyoid bone, malocclusion, crowded and crooked teeth, secondary halitosis, open bite and dysfunctional jaw joint [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This all leads to the significant shrinking of nasopharyngeal air space [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In addition to structural changes, we can observe phenomena such as bad breath, dental decay, gum disease, dysfunctions of the facial muscles (mainly around the jaw and lips), trauma to soft tissues in the airways, and enlarged tonsils and adenoids [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Mouth breathing also has a negative impact on academic achievement and cognitive abilities and relates to a higher prevalence of ADHD [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Even speech can be negatively affected as a consequence of a bad breathing stereotype [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Mouth breathing conducts air mainly to the upper chest, which can be inefficient and tiring [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Because of insufficient mixing of air with blood in the lungs, people feel a stronger urge to breathe, so they are chronically over-breathing, which causes significant losses of CO\u003csub\u003e2\u003c/sub\u003e [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, this gas is crucially essential for the proper functioning of the body [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although chemoreceptors are sensitive to higher levels of CO\u003csub\u003e2\u003c/sub\u003e (what causes the urge to breathe), by improving chemosensitivity, we can benefit from higher levels of CO\u003csub\u003e2,\u003c/sub\u003e thanks to the Bohr effect, and increase oxygenation of organs and tissues [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. By breathing through the mouth (even only exhaling) we lose around 42% more water [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and we are drying the oral cavity, which has a negative effect on the dental microbiome [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The feeling of dried oral cavity was confirmed in around half of our respondents during the performance of the tests with oral breathing. Adults with upper airway restrictions have a higher risk of plaque, tooth decay, and periodontitis due to mouth breathing. The microbiome is oxidating, the pH of saliva is changing, and some pathogens can appear [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. An unfavourable condition of the oral microflora can even lead to some diseases of the respiratory system because oral and lung microflora are connected [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe estimated number of people who are mouth breathers is still unclear. Two independent Brazilian studies confirmed that more than half of school-aged children breathe through their mouths [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. According to recent study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], wrong breathing stereotype may have up to seventy percent of the population. Individuals with cerebral palsy may be affected even more (60\u0026ndash;86%) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The causes of mouth breathing are various, but the most common are allergic rhinitis, hypertrophy of the palate or pharynx, deviation of the nasal septum, or a non-physiological stereotype created artificially during life [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. More than half of our probands declared the use of mouth breathing in everyday life (even without performing a sports activity). Around 60% of them use oro-nasal (inhale through the nose, exhale through the mouth) type of breathing during low-intensity exercise and warm-up. Circa 11% use pure oral breathing for the same intensity. When it comes to high intensity, 52% of them declare oro-nasal and 45% declare oral breathing. When it comes to strength training, almost 80% of physically active young adolescents use oro-nasal breathing, 15% use oral breathing and only 5 % of our respondens breathe purely through the nose.\u003c/p\u003e \u003cp\u003eHowever, we must note that most studies that point to the negatives of mouth breathing focus on chronic and long-term use of mouth breathing, and we cannot say with certainty how the health and physiological aspects are affected today if we use this regimen of breathing in a time-limited period of training. Because not only the way we breathe but also the dosage can be even more important. Today, it\u0026rsquo;s still unclear whether this breathing stereotype used during strength training contributes to the creation of a worse breathing stereotype during ordinary life - therefore we recommend additional research that would confirm or refute these ideas.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eNose breathing\u003c/h2\u003e \u003cp\u003eThe nose is a very important organ of breathing and except rare situations, we assume that it can be the only organ by which we can get air into and out of the body. Unlike the oral cavity, the nasal cavity has the function of warming, humidifying, and filtering the inhaled air [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The filtering function consists in trapping large particles with the nose hair and small particles via mucous membranes [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Thanks to cleaner, warmer, and humidified air in the airways, there is a lower probability of getting colds, flu, allergic reaction, hay fever, or irritable coughing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Even in animals, by exhaling through the nose moisture is trapped in the nasal cavity, which prevents it from drying out and clogging and also prevents from dehydration in a hot environment [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Both inhaling and exhaling through the nose allow the correct position of the tongue, which is against the upper palate, and keep the lips together [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. It\u0026rsquo;s helping to form natural dental arches and straight healthy teeth [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Nasal breathing regulates airflow because of the nose\u0026rsquo;s intricate structures [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Because of the resistance of nasal airways (which is approximately 50 % higher than the resistane of mouth airways) to the airstream, oxygen uptake can be 10\u0026ndash;20% higher [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Thanks to the negative pressure that must be created, there is a higher activation of the diaphragm and other respiratory muscles [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], which leads to better stabilization of the spine [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and prevent from injuries [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Nitric oxide is a potent bronchodilator and vasodilator and has antiviral and antibacterial effects [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This gas is generated by the paranasal sinus epithelium and diffused into the nasal cavity, where it is inhaled into the lungs and causes the increasement of oxygen transport through the body [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e If nose breathing seems to be healthier based on scientific knowledge, why oro-nasal or oral breathing is used during sport? Does it have some benefits? During rest and light to moderate exercise, pure nasal breathing seems to be sufficient enough to maintain performance [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. However, at higher intensities, we can observe people switching to oronasal or oral breathing [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The ratio of mouth and nose usage can vary among individuals of different races and genders [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. It seems that both children and adults are using oronasal breathing more frequently both during rest and exercise [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] without knowing the consequences. There wasn\u0026rsquo;t found any significant difference between oral and oronasal breathing in the context of reached level of VO\u003csub\u003e2\u003c/sub\u003emax [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], so it seems that during higher intensities nasal contribution on breathing has no effect [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. The cause of the transition of the usage of the mouth for breathing during exercise stays unclear. Some theories say about subjective feelings of hypoventilation [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], lower subjective effort [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], or lowering turbulences at the airflow of nasal passage [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough there is a logical argument that breathing through the nose improves air filtration, some studies did not confirm this theory during exercise [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Another potential benefit of inhaling nitric oxide (NO) while breathing through the nose has been partially refuted because although more NO is created during nasal breathing [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], more is also exhaled and thus does not lead always to an improvement in cardiorespiratory response [\u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. However, we have some scientifical knowledge, even authors themselves point to the fact that further evidence is necessary to confirm or refute the effectiveness of nasal breathing during exercise. What seems to be clear is that nasal breathing appears to be important for eliminating bronchoconstriction, leading to better prevention and treatment of asthma [\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAvailable research demonstrates that nasal breathing during steady submaximal exercise, results in a lower respiration rate, a lower ventilation, lower ventilatory equivalent for both oxygen and carbon dioxide, lower oxygen uptake during a given intensity, a lower level of O\u003csub\u003e2\u003c/sub\u003e and higher CO\u003csub\u003e2\u003c/sub\u003e in exhaled air [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn healthy individuals who are not adapted to nasal breathing can nose breathing cause lower levels of reached VO\u003csub\u003e2\u003c/sub\u003emax and peak work [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], but no significant difference in maximal anaerobic output was found [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. However, in individuals who are adapted to this type of breathing, no significant difference in performance while nasal or oronasal breathing was [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Authors emphasize the fact that individuals can adapt to higher values of CO\u003csub\u003e2\u003c/sub\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003e The aim of our study was to determine whether different ways of breathing (nasal/oronasal/oral) have an acute influence on muscular endurance performance.\u003c/p\u003e \u003cp\u003e107 physically active individuals (68 males, 39 females) voluntarily participated in the study (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for characteristics). All participants completed 3 repeated measurements in random order for each individual. In between test days was at least 72 hours rest period and at least 24 hours before testing, participants were asked to not have any physical training. Participants were also asked not to practise any type of training for improving muscular endurance, during the study (between measurements).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of research sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eage (yr)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eheight (cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebody mass (kg)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emen (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e181.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e77.74\u0026thinsp;\u0026plusmn;\u0026thinsp;9.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewomen (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e168.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e63.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eProtocol\u003c/h2\u003e \u003cp\u003eAll procedures were performed at the Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia. Our effort was to keep the conditions as stable as possible for repeated measurements (temperature, warm up, time of the day, weight on a barbell, grip width, pace of repetitions).\u003c/p\u003e \u003cp\u003eAfter familiarization, during which participants tried testing protocol with individually natural breathing regimen, all subjects performed 3 repetitions of bench press testing protocol in random order. The test can be described as repetitions to failure on bench press with olympic barbell with resistance \u0026ndash; 60% of body weight for men (BP60) and 40% for women (BP40). Grip width and the pace of repetitions was intraindividual (as was natural for proband) but had to be kept in all 3 measurements the same. The pace of repetitions was circa 1011 and grip width was between biacromial and 1.5 times biacromial width. Bench press exercise is naturally considered as valid for the detection of the strength of upper limbs and trunk muscles and by performing more than 20 repetitions we can state that result shows us quality of muscular endurance. During familiarization participants performed given tests with their natural breathing regimens 2 times. We evaluated reliability of BP60 as significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and good (ICC\u0026thinsp;=\u0026thinsp;0.894) and reliability of BP40 as significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and good (ICC\u0026thinsp;=\u0026thinsp;0.934). ICC coefficient was interpreted by Portney (2009) [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. After 3 repeated measurements, we performed control retest with those individuals, who had one out of three results significantly different, to exclude the negative effect of unexpected confounding variables. Right after the test, blood oxygen saturation was measured by a pulse oxymeter (Viatom Oxymeter PC-60FW), heart rate by chest strap heart rate monitor and perceived exertion by Borg Scale (RPE). In the end of the study all participants completed a questionnaire aimed at their breathing stereotypes and feelings while performing tests.\u003c/p\u003e \u003cp\u003e Under the NN condition, participants had medical kinesio tape placed over their mouths, in order to prevent any oral breathing. MM condition was controlled by nose clip which was placed on the participant\u0026rsquo;s nose to prevent any nasal breathing. For NM condition were participants asked to inhale through the nose and exhale through the mouth. Fulfilment of this condition was checked by the examiner during the test.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eFor statistical analysis, we used SPSS program. To analyse data from repeated measurements we used the method ANOVA, since our data were verified with positive results about their normality of distribution by Kolmogorov-Smirnov test, resp. Shapiro-Wilk test. The statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 levels. Effect size was expressed in significant cases by Cohen's d [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eUsing the ANOVA method, we did not find any significant differences (ns) in the number of repetitions, nor in the perceived exertion and blood oxygen saturation in the bench press tests (BP60, BP40) in both sexes between different breathing regimens (see Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The only significant differences we recorded at heart rate values at the male group. There were significantly lower values ​​in the NN regimen compared to the other two breathing regimens (NN\u0026thinsp;\u0026lt;\u0026thinsp;NM, p\u0026thinsp;=\u0026thinsp;0.033, d\u0026thinsp;=\u0026thinsp;0.32; NN\u0026thinsp;\u0026lt;\u0026thinsp;MM, p\u0026thinsp;=\u0026thinsp;0.047, d\u0026thinsp;=\u0026thinsp;0.30) with small effect in both cases.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults and differences in BP60/BP40 (reps, heart rate, Borg scare) between selected breathing regimens (NN, NM, MM)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eNM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWilks' lambda\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eη2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSignificant differences\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRepetitions\u003c/b\u003e (reps; x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e28.38 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 7.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.66 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 7.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e28.85 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 6.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ens (0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e34.26 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 12.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.79 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 11.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e34.77 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 12.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ens (0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHeart rate\u003c/b\u003e (bpm; x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e123.21\u0026thinsp;\u0026plusmn;\u0026thinsp;15.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127.69\u0026thinsp;\u0026plusmn;\u0026thinsp;16.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e126.97\u0026thinsp;\u0026plusmn;\u0026thinsp;16.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05* (0.006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNN\u0026thinsp;\u0026lt;\u0026thinsp;NM \u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.033;\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.32)\u003c/p\u003e \u003cp\u003eNN\u0026thinsp;\u0026lt;\u0026thinsp;MM \u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.047; \u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e127.33\u0026thinsp;\u0026plusmn;\u0026thinsp;15.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128.05\u0026thinsp;\u0026plusmn;\u0026thinsp;18.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e127.54\u0026thinsp;\u0026plusmn;\u0026thinsp;17.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ens (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBorg scale\u003c/b\u003e (score; x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e15.57 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.46 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15.75 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ens (0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e15.41 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.31 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15.23 \u003c/p\u003e \u003cp\u003e\u0026plusmn; 1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ens (0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn both sexes, we found no significant differences (ns) in the number of repetitions in bench press tests (BP60, BP40), with selected breathing modes (NN, NM, MM) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The differences between the mean values ​​were less than 1 repetition on average. However, we have to admit that at some individuals pure nasal breathing led to lowering the performance outcomes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn male group, we demonstrated significantly lower heart rate values ​​after the BP60 test with the NN regimen compared to the other two regimens that use the mouth (NN\u0026thinsp;\u0026lt;\u0026thinsp;NM, 123.21\u0026thinsp;\u0026plusmn;\u0026thinsp;15.83 bpm vs. 127.69\u0026thinsp;\u0026plusmn;\u0026thinsp;16.92 bpm, dif. 4.48 bpm (4%), p\u0026thinsp;=\u0026thinsp;0.047, d\u0026thinsp;=\u0026thinsp;0.32; NN\u0026thinsp;\u0026lt;\u0026thinsp;MM, 123.21\u0026thinsp;\u0026plusmn;\u0026thinsp;15.83 bpm vs. 126.97\u0026thinsp;\u0026plusmn;\u0026thinsp;16.65 bpm, dif. 3.76 bpm (3%), p\u0026thinsp;=\u0026thinsp;0.047, d\u0026thinsp;=\u0026thinsp;0.30) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Differences were significant, but practically much lower than statistical deviations and Cohen\u0026rsquo;s d shows only small effect. In addition, this phenomenon was not confirmed in the female group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe did not find any significant differences (ns) in the subjective perceived exertion using the Borg scale (RPE) in both sexes during bench press testing protocols (BP60, BP40) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The differences between the mean values ​​were less than 1 point of the scale.\u003c/p\u003e \u003cp\u003eDuring the entire research, we did not notice any significant drop in blood oxygen saturation from the physiological norm (95\u0026ndash;99%) in any proband during the testing protocol. Average SPO\u003csub\u003e2\u003c/sub\u003e values ​​for both sexes were around 98%, with the lowest value recorded being 95%. Using the ANOVA method, we found no significant differences between various breathing modes (ns). Since we did not record any values ​​that would detect hypoxemia, we did not include this indicator in the \u003cspan refid=\"Sec7\" class=\"InternalRef\"\u003eresults\u003c/span\u003e section in graphical form. Based on our measurements, we can say that muscular endurance performance, regardless of whether it is carried out with any breathing regimen (NN, NM, MM), does not cause a decrease in blood oxygen saturation below the level of the physiological norm.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main goal of our study was to find out if and how different breathing regimens (NN, NM, MM) acutely affect muscular endurance performance. Nowadays we can observe a very frequent use of oral or oro-nasal breathing pattern during strength training (up to 95% of our probands declared that). We were interested in whether this breathing pattern is necessary for maintaining a certain level of strength endurance, if we know that these ways of breathing have certain negatives from a physiological point of view and can lead to some health issues. Is mouth breathing necessary during strength training, or is it more appropriate to use pure nasal breathing, since we know its health benefits?\u003c/p\u003e \u003cp\u003eAlthough in the past several researchers focused on the issue of breathing from the point of view of the nose vs. mouth, none of the studies were directly related to strength abilities. Our study is thus original and very up to date. After the COVID-19 pandemic, associated with respiratory disease, society is more interested in computerization regarding the prevention and treatment of respiratory problems. Although, based on the available studies, we know about the negatives of breathing through the mouth, we can still observe in fitness centres the persistent trend of using oral or oronasal breathing during strength training. Other positives of our work lie in the larger research sample, which includes both genders, and thus we can make recommendations, based on our results, for the group of healthy young physically active adults.\u003c/p\u003e \u003cp\u003eThrough our research, we have demonstrated that purely nasal breathing (NN) appears to be just as effective for muscular endurance work as breathing regimens that use the mouth (NM, MM). It is so probably because respiratory gas exchange is not limited in any of the selected breathing modes to such an extent that it would have a negative effect on the achieved performance. In both sexes, we did not notice any significant differences (ns) in performance caused by different breathing modes in the monitored tests (BP60/BP40). Also, subjective perceived exertion and blood oxygen saturation, were not significantly affected (ns) by the selected breathing regimens. The only differences we noticed were attached to the physiological response of the body. By performing both inhales and exhales through the nose (NN), we recorded in the male group significantly lower values of heart rate ​​ compared to the NM (p\u0026thinsp;=\u0026thinsp;0.033; d\u0026thinsp;=\u0026thinsp;0.32) and MM (p\u0026thinsp;=\u0026thinsp;0.047; d\u0026thinsp;=\u0026thinsp;0.30). Although significant differences were confirmed, only small effect was shown and these differences were not confirmed at the female group. Based on our findings, we can say that the pure nasal way of breathing can potentially cause lower physiological stress on the cardiovascular system. A potential cause may lie in the greater amount of NO and CO\u003csub\u003e2\u003c/sub\u003e in the bloodstream during nasal breathing, which leads to vasodilatation and better oxygenation of the tissues and thus less need for the heart to work in such an effort. But further studies are necessary to confirm out theory. We also must admit that heart rate, as an indicator of the body's internal response to physical activity, is not the most stable and reliable parameter, because this parameter can be significantly influenced by several confounding variables that were not part of our research (such as women\u0026rsquo;s menstrual cycle, level of motivation, etc.). This fact could cause that significant differences in heart rate values were not detected in all the cases in both sexes.\u003c/p\u003e \u003cp\u003eWe also found out that it is not possible to reach a state of hypoxemia during strength-endurance exercise if the exerciser maintains breathing, regardless of the way of breathing (NN, NM, MM).\u003c/p\u003e \u003cp\u003eThe results of our study show that there is no significant difference in strength endurance, nor in the perceived exertion between different breathing regimens (NN, NM, MM), but nasal breathing causes lower physiological stress to the body. Nasal breathing brings many health benefits, while oral or oronasal can have a negative effect on several physiological phenomena. The way we breathe can directly or indirectly affect the respiratory system [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], skeleton [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], neuromuscular system [\u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], digestion [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], cardiovascular system [\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], oral cavity [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] sleep [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and many other aspects of life [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Based on these negative associations connected with mouth breathing, it is advisable to breathe through the nose and act preventively against many undesirable pathological phenomena.\u003c/p\u003e \u003cp\u003eIt should be noted that these types of studies require appropriate familiarization, as we found a significant learning effect and other confounding influences in a few individuals who lacked sufficient experience with strength training realised by selected breathing regimens, which caused non-negligible differences in the results. If this phenomenon persisted after control pretesting, we evaluated this fact as an exclusion criterion for inclusion in the research.\u003c/p\u003e \u003cp\u003eTo verify the acute and long-term effects of different breathing regimens on parameters of strength, further studies are needed to confirm or refute our findings. In the future, we recommend conducting research that would verify not only the acute but also the long-term effects on parameters of strength, such as maximum strength, hypertrophy, or power output. At the same time, it would be appropriate to monitor individuals, who have been confirmed an acute negative effect of nasal breathing on strength endurance, and to find out whether these individuals can adapt to this way of breathing to such an extent, that it would not further reduce performance.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBased on our findings, we can say that in the majority of healthy and physically active young recreational athletes, strength-endurance performance is not acutely affected by the various breathing regimens (NN, NM, MM) and therefore we recommend using a purely nasal breathing, which appears to be physiologically healthier. Neither perceived exertion nor blood oxygen saturation seem to be affected by selected breathing conditions. The only potential difference between nasal and mouth breathing during strength-endurance exercise is the lower heart rate during nasal breathing. Pure nasal breathing is just as effective as mouth breathing during in context of muscular endurance performance.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP40\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebench press test with olympic barbell with resistance of 60% of body mass (repetitions to failure)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP60\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebench press test with olympic barbell with resistance of 40% of body mass (repetitions to failure)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e breathing regimen \u0026ndash; both inhale and exhale through the mouth (oral breathing)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebreathing regimen \u0026ndash; inhale through the nose and exhale the mouth (oro-nasal breathing)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebreathing regimen \u0026ndash; both inhale and exhale through the nose (nasal breathing)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy was approved by the ethics commission of the Faculty of physical education and sport, Comenius University in Bratislava (under the number 6/2022), and conform to the ethical guidelines of the Declaration of Helsinki 2000. All participants provided witnessed oral informed consent prior to entering the study to both authors. The other research participants were witnesses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the authors\u0026apos; own resources.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth authors listed (FL and MV) have made a direct and intellectual contribution to the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllen A. The health benefits of nose breathing Item Type Article. Nursing in General Practice. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Amato M, Molino A, Calabrese G, Cecchi L, Annesi-Maesano I, D\u0026rsquo;Amato G. The impact of cold on the respiratory tract and its consequences to respiratory health. Clin Transl Allergy. 2018;8:20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang TW, Young TH. Novel Porous Oral Patches for Patients with Mild Obstructive Sleep Apnea and Mouth Breathing. Otolaryngology\u0026ndash;Head and Neck Surgery.SAGE PublicationsSage CA: Los Angeles, CA; 2014; 152:369\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorsy NE, Farrag NS, Zaki NFW, Badawy AY, Abdelhafez SA, El-Gilany AH, et al. Obstructive sleep apnea: Personal, societal, public health, and legal implications. Rev Environ Health De Gruyter. 2019;34:153\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEMSLIE RD, MASSLER M. Mouth Breathing: I. Etiology and Effects (a Review). J Am Dent Association Elsevier. 1952;44:506\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFraga WS, Seixas VM, Santos JC, Paranhos LR, C\u0026eacute;sar CP. Mouth breathing in children and its impact in dental malocclusion: a systematic review of observational studies. Minerva Stomatol Edizioni Minerva Medica. 2018;67:129\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee M-J, Kim J-G, Yang Y-M, Baik B-J. Effects of mouth breathing on facial skeletal morphology. J Korean Acad Pediatr Dentistry Korean Acad Pediatr Dentistry. 2012;39:339\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung Leng Mu\u0026ntilde;oz I, Beltri Orta P. Comparison of cephalometric patterns in mouth breathing and nose breathing children. Int J Pediatr Otorhinolaryngol Elsevier. 2014;78:1167\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Z, Zheng L, Huang X, Li C, Liu J, Hu Y. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health BioMed Central Ltd. 2021;21:1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTriana BEG, Ahlam HA, Le\u0026oacute;n IBG. Mouth breathing and its relationship to some oral and medical conditions: physiopathological mechanisms involved. Revista Habanera de Ciencias M\u0026eacute;dicas. 2016;15:200\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasheer B, Sundeep Hegde K, Bhat SS, Umar D, Baroudi K. Influence of mouth breathing on the dentofacial growth of children. J Int Oral Health. 2014;6:50\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJefferson Y. Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent Academy of General Dentistry. 2010;58:18\u0026ndash;25. quiz 26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRangeeth BN, Rangeeth P, Rangeeth MBN. Mouth breathing \u0026ldquo;a habit or anomaly\u0026rdquo;-a review. JIDAM. 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorrea BM, Rossi AG, Roggia B, Toniolo Da Silva AM. Analysis of hearing abilities in mouth-breathing children. Revista CEFAC. 2011;13:668\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKeown P, Macaluso M. Mouth Breathing: Physical, Mental and Emotional Consequences. Oral Health. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchleifer LM, Ley R, Spalding TW. A hyperventilation theory of job stress and musculoskeletal disorders*. Am J Ind Med. John Wiley \u0026amp; Sons, Ltd; 2002;41:420\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJensen FB. Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport. Acta Physiol Scand. John Wiley \u0026amp; Sons, Ltd; 2004;182:215\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSvensson S, Olin AC, Hellgren J. Increased net water loss by oral compared to nasal expiration in healthy subjects. Rhinology. 2006;44:74\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Awadi RN, Al-Casey M. Oral health status, salivary physical properties and salivary Mutans Streptococci among a group of mouth breathing patients in comparison to nose breathing. J Bagh College Dentistry. 2013;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan C, Guo L, Gu H, Huo Y, Lin H. Alterations in Oral\u0026ndash;Nasal\u0026ndash;Pharyngeal Microbiota and Salivary Proteins in Mouth-Breathing Children. Front Microbiol Frontiers Media S A. 2020;11:2472.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassis CM, Erb-Downward JR, Dickson RP, Freeman CM, Schmidt TM, Young VB, et al. Analysis of the upper respiratory tract microbiotas as the source of the lung and gastric microbiotas in healthy individuals. mBio. Volume 6. American Society for Microbiology; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Menezes VA, Leal RB, Pessoa RS, Pontes RMES. Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife, 2005. Braz J Otorhinolaryngol Elsevier. 2006;72:394\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbreu RR, Rocha RL, Lamounier JA, Francisca \u0026Acirc;, Guerra M. Prevalence of mouth breathing among children. J Pediatr (Rio J) Sociedade Brasileira de Pediatria. 2008;84:467\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonuck KA, Chervin RD, Cole TJ, Emond A, Henderson J, Xu L, et al. Prevalence and Persistence of Sleep Disordered Breathing Symptoms in Young Children: A 6-Year Population-Based Cohort Study. Sleep. Volume 34. Oxford Academic; 2011. pp. 875\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrionuevo NL, Sol\u0026iacute;s FF. Anomal\u0026iacute;as dent\u0026oacute; maxilares y factores asociados en ni\u0026ntilde;os con par\u0026aacute;lisis cerebral. Rev Chil Pediatr Sociedad Chilena de Pediatr\u0026iacute;a. 2008;79:272\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuroishi RCS, Garcia RB, Valera FCP, Anselmo-Lima WT, Fukuda MTH. Deficits in working memory, reading comprehension and arithmetic skills in children with mouth breathing syndrome: analytical cross-sectional study. Sao Paulo Medical Journal Associa\u0026ccedil;\u0026atilde;o Paulista de Medicina - APM. 2014;133:78\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerneini EM, Goupil MT, McNulty MA, Niekrash CE. Applied head and neck anatomy for the facial cosmetic surgeon. Applied Head and Neck Anatomy for the Facial Cosmetic Surgeon. Springer International Publishing; 2020. pp. 1\u0026ndash;256.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzturk AB, Damadoglu E, Karakaya G, Kalyoncu AF. Does Nasal Hair (Vibrissae) Density Affect the Risk of Developing Asthma in Patients with Seasonal Rhinitis? Int Arch Allergy Immunol. Volume 156. Karger Publishers; 2011. pp. 75\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimmer C. The Importance of Noses. Discover. 1994.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaixeta ACP, Andrade I, Bahia Junqueira Pereira T, Paiva Franco L, Gon\u0026ccedil;alves Becker HM. Quiroga Souki B. Dental arch dimensional changes after adenotonsillectomy in prepubertal children. Am J Orthod Dentofac Orthop Mosby. 2014;145:461\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu ZJ, Shcherbatyy V, Gu G, Perkins JA. Effects of tongue volume reduction on craniofacial growth: A longitudinal study on orofacial skeletons and dental arches. Arch Oral Biol Pergamon. 2008;53:991\u0026ndash;1001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrabalon M, Schaal B. It Takes a Mouth to Eat and a Nose to Breathe: Abnormal Oral Respiration Affects Neonates\u0026rsquo; Oral Competence and Systemic Adaptation. Int J Pediatr Hindawi Limited. 2012;2012:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev Pergamon. 2022;135:104576.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrevisan ME, Boufleur J, Soares JC, Haygert CJP, Ries LGK, Corr\u0026ecirc;a ECR. Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: A cross-sectional study. J Electromyogr Kinesiol Elsevier. 2015;25:463\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV et al. Stabilizing function of the diaphragm: Dynamic MRI and synchronized spirometric assessment. J Appl Physiol. American Physiological Society Bethesda, MD; 2010 ;109:1064\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNelson N. Diaphragmatic Breathing The Foundation of Core Stability. Strength Cond J. 2012;34:34\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuxel Bliven KC, Anderson BE. Core Stability Training for Injury Prevention. Sports Health. Volume 5. Los Angeles, CA: SAGE PublicationsSage CA; 2013. pp. 514\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli-Ahmad D et al. Replication of respiratory syncytial virus is inhibited in target cells generating nitric oxide in situ. Front Bioscience-Landmark. 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartina A, Jana P, Anna S, Tomas B. Nitric oxid - Important messenger in human body. Open J Mol Integr Physiol Scientific Research Publishing. 2012;2012:98\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArnal JF, Flores P, Rami J, Murris-Espin M, Bremont F, Pasto L, Aguilla M, et al. Nasal nitric oxide concentration in paranasal sinus inflammatory diseases. Eur Respiratory J Eur Respiratory Soc. 1999;13:307\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaComb CO, Tandy RD, Lee SP, Young JC, Navalta JW. Oral versus Nasal Breathing during Moderate to High Intensity Submaximal Aerobic Exercise. Int J Kinesiol Sports Sci Australian Int Acad Centre. 2017;5:8\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDallam G, Kies B. The Effect of Nasal Breathing Versus Oral and Oronasal Breathing During Exercise: A Review. J Sports Res Conscientia Beam. 2020;7:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBennett WD, Zeman KL, Jarabek AM. Nasal contribution to breathing with exercise: Effect of race and gender. J Appl Physiol American Physiological Society. 2003;95:497\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecquemin MM, Bertholon JF, Bouchikhi A, Malarbet JL, Roy M. Oronasal Ventilation Partitioning in Adults and Children: Effect on Aerosol Deposition in Airways. Radiat Prot Dosimetry Oxford Academic. 1999;81:221\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiinimaa V. Oronasal airway choice during running. Respir Physiol Elsevier. 1983;53:129\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeir R, Zhao GG, Zhou S, Beavers R, Davie A. The acute effect of mouth only breathing on time to completion, heart rate, rate of perceived exertion, blood lactate, and ventilatory measures during a high-intensity shuttle run sequence. J Strength Cond Res NSCA National Strength and Conditioning Association. 2014;28:950\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorton AR, King K, Papalia S, Goodman C, Turley KR, Wilmore JH. Comparison of maximal oxygen consumption with oral and nasal breathing. Aust J Sci Med Sport. 1995;27:51\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChinevere TD, Faria EW, Faria IE. Nasal splinting effects on breathing patterns and cardiorespiratory responses. J Sports Sci Taylor \u0026amp; Francis. 2010;17:443\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaibene F, Mognoni P, Lafortuna CL, Mostardi R. Oronasal breathing during exercise. Pflugers Arch Springer-Verlag. 1978;378:65\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiinimaa V, Cole P, Mintz S, Shephard RJ. The switching point from nasal to oronasal breathing. Respir Physiol Elsevier. 1980;42:61\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFregosi RF, Lansing RW. Neural drive to nasal dilator muscles: influence of exercise intensity and oronasal flow partitioning. J Appl Physiol American Physiological Society. 1995;79:1330\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBennett WD, Zeman KL, Jarabek AM. Nasal contribution to breathing and fine particle deposition in children versus adults. J Toxicol Environ Health - Part A: Curr Issues. 2008;71:227\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHynes B, Silverman F, Cole P, Corey P. Effects of Ozone Exposure: A Comparison between Oral and Nasal Breathing. Archives of Environmental Health: An International Journal Taylor \u0026amp; Francis Group. 2010;43:357\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYasuda Y, Itoh T, Miyamura M, Nishino H. Comparison of Exhaled Nitric Oxide and Cardiorespiratory Indices between Nasal and Oral Breathing during Submaximal Exercise in Humans. Jpn J Physiol The physiological society of japan. 1997;47:465\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips CR, Giraud GD, Holden WE. Exhaled nitric oxide during exercise: site of release and modulation by ventilation and blood flow. J Appl Physiol American Physiological Society. 1996;80:1865\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBizjak DA, Schams P, Bloch W, Grau M, Latsch J. The intranasal AlaxoLito Plus Nasal Stent: Improvement of NO-induced microrheology and oxygen uptake during exercise? Respir Physiol Neurobiol. Volume 269. Elsevier; 2019. p. 103260.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF. The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. Am Rev Respir Dis Am Rev Respir Dis. 1978;118:65\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMangla PK, Menon MPS. Effect of nasal and oral breathing on exercise-induced asthma. Clinical \u0026amp; Experimental Allergy.John Wiley \u0026amp; Sons, Ltd; 1981;11:433\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirkpatrick MB, Sheppard D, Nadel JA, Boushey HA. Effect of the Oronasal Breathing Route on Sulfur Dioxide-Induced Bronchoconstriction in Exercising Asthmatic Subjects. American Review of Respiratory Disease; 1982.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarner DP, Scheett TP, McDivitt EJ. The effects of mouthpiece use on gas exchange parameters during steady-state exercise in college-aged men and women. J Am Dent Association Elsevier. 2011;142:1041\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHostetter K, Mcclaran SR. Triathlete Adapts to Breathing Restricted to the Nasal Passage Without loss in VO2max or vVO2max. J Sport Hum Perform. 2016;4:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDallam GM, McClaran SR, Cox DG, Foust CP. Effect of Nasal Versus Oral Breathing on Vo2max and Physiological Economy in Recreational Runners Following an Extended Period Spent Using Nasally Restricted Breathing. International Journal of Kinesiology and Sports Science. Volume 6. Australian International Academic Centre; 2018. pp. 22\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRecinto C, Efthemeou T, Boffelli PT, Navalta JW. Effects of Nasal or Oral Breathing on Anaerobic Power Output and Metabolic Responses. Int J Exerc Sci Western Kentucky University. 2017;10:506.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePortney LGross, Watkins MP. Foundations of clinical research: applications to practice. Pearson/Prentice Hall; 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCOHEN J. Statistical power analysis for the behavioural sciences. Hillsdale, NJ: L Erlbaum Associates; 1998.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSwarthout K. Oral and systemic effects of breathing patterns: Nasal breathing vs. mouth Breath. 2022.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"nose, mouth, breathing, muscular endurance, bench press","lastPublishedDoi":"10.21203/rs.3.rs-2867743/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2867743/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe know that the way we breathe (weather through the nose or mouth) can influence many aspects of our health and to some extent, sport performance. Does the way of breathing (nose vs. mouth) influence muscular endurance?\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003e We conducted an experiment in which we verified the acute effect of different breathing regimens (NN, nasal - inhaling and exhaling through the nose; NM, oro-nasal - inhaling through the nose, exhaling through the mouth; MM, oral - inhaling and exhaling through the mouth) on the muscular endurance performance. 107 young physically active college students (68 males, 39 females) performed repeated bench press testing protocol (repetitions to failure with 60% of body weight for males \u0026ndash; BP60, respectively 40% of body weight for females \u0026ndash; BP40) with various breathing regimens (NN, NM, MM) in random order. We also measured heart rate, blood oxygen saturation and perceived exertion by Borg scale (RPE).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn both sexes, no significant differences in number of repetitions, perceived exertion and blood oxygen saturation were shown between the selected breathing modes (ns). We did not record any case of deviation of saturation outside the physiological norm. We noticed significantly lower heart rate values ​​in the male group at BP60 with the NN regimen, compared to NM (p\u0026thinsp;=\u0026thinsp;0.033) and MM (p\u0026thinsp;=\u0026thinsp;0.047). These differences, although significant, were lower than the usual statistical deviation (3\u0026ndash;4 bpm; 3%) and have only small effect.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePure nasal breathing (NN) seems to be just as effective as other two regimens which use the mouth (NM, MM) in context of muscular endurance performance. Based on our findings and the mentioned negative consequences of oral breathing, we recommend using purely nasal breathing during training for muscular endurance.\u003c/p\u003e","manuscriptTitle":"Nose vs. mouth breathing – Acute effect of different breathing regimens on muscular endurance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-02 18:58:03","doi":"10.21203/rs.3.rs-2867743/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-05-09T15:10:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-05-09T14:44:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-04-27T14:06:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2023-04-27T09:05:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8206d789-ad5d-492a-aa09-2c2331a6989f","owner":[],"postedDate":"May 2nd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-02-12T15:05:36+00:00","versionOfRecord":{"articleIdentity":"rs-2867743","link":"https://doi.org/10.1186/s13102-024-00840-6","journal":{"identity":"bmc-sports-science-medicine-and-rehabilitation","isVorOnly":false,"title":"BMC Sports Science, Medicine and Rehabilitation"},"publishedOn":"2024-02-09 15:01:22","publishedOnDateReadable":"February 9th, 2024"},"versionCreatedAt":"2023-05-02 18:58:03","video":"","vorDoi":"10.1186/s13102-024-00840-6","vorDoiUrl":"https://doi.org/10.1186/s13102-024-00840-6","workflowStages":[]},"version":"v1","identity":"rs-2867743","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2867743","identity":"rs-2867743","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}