How long can a person hold their breath?
Dec 11, 2021INSIGHT
On 15th March 1959, Robert Foster (USA) voluntarily held his breath for 13 minutes and 42 seconds under 3.05 metres of water in a swimming pool in California, setting the first world record for the longest time breath held voluntarily by a male.
On 27th March 2021, Budimir Šobat claimed the latest voluntary breath-hold world record with a time of 24 minutes and 37 seconds; almost doubling Mr Foster's record from 1959. From athletes to amateurs, games involving breath-holding are known to have existed for millennia. So arises the question, what affects breath-holding capability? This article considers the factors known and suspected from a topic that has received sustained academic attention for over 50 years.
Age. Around 80% of fatal and non-fatal drowning cases involved those under 30 years old. The physiological contribution to the disproportionate effect of underwater blackout cases on the 16-30 age bracket is not well understood. The prevailing theory is that psychological, and not physiological factors, are the primary driver behind this effect, although there is little research into any effects of age on physiological predisposition.
Schagatay (1996) identified that bradycardia can be influenced by age. Diving bradycardia is more pronounced in children aged 4–12 months (Goksor, 2002) and may have survival value during hypoxic episodes proximal to birth, but it is clear the urge to surface weakens with age (Schagatay, 1998). The urge to surface is more pronounced during exercise than during rest (Butler, 1987; Stromme, 1970).
Altitude. Greater altitude is also thought to improve breath-holding capability due to the oxygen conservation effect caused by selective vasoconstriction, decreased heart rate and decreased cardiac output provided swimmer work rate does not change although this has not been confirmed by any other major study (Bjusrtrom, 1987).
Diet and physical activity. Lindholme (2007) investigated the effect of diet on an observed increased prevalence of underwater blackout cases in pool users who had significantly modified their diet prior to blackout whilst submerged.
Prolonged exercise and fasting were identified as increasing the risk of hypoxia and syncope due to exercise-induced changes in lipid metabolism. The relationship between eating disorders and obesity with hypoxic blackout is not sufficiently understood, however needs to be given urgent attention considering the proximity of swimming pools to community health facilities. A relationship between risk-taking behaviour and patients with eating disorders and body dysmorphia is known to be prevalent, with risk-taking a key component of hypoxic training culture.
Duration. The duration that an individual can hold their breath is known to be influenced by psychological, physiological and environmental factors. The impact of physiological factors on breath-holding capability is less well understood (Delahoche, 2005; Delapille, 2001; Hong, 1963; Pan, 1997).
Hyperventilation. Hyperventilation, a respiratory exchange ratio higher than the respiratory quotient, before submersion reduces carbon dioxide stores in the blood and tissue
Dihl (2000) found that both students hyperventilated prior to submerging. Both experienced anoxic convulsions caused by interruption to oxygen supply to metabolically active neurones particularly in the cerebral cortex. These are known in cyanotic breath-holding in early childhood (Stephenson, 2001). Movements may be regarded as a brainstem-release phenomenon in which primitive movements can occur, particularly multifocal arrhythmic myoclonic jerks (Lempert, 1994).
Hyperventilation is defined as ventilation in excess of metabolic demand achieved most easily by taking very deep and/or rapid breaths. Hyperventilation lowers carbon dioxide levels extending the time during which there is no signal to breathe until carbon dioxide rises to the level where the urge to breathe becomes overwhelming. Any additional oxygen brought in during excessive breathing has minimal effect in offsetting the body metabolism demands on oxygen. During extended periods without breathing, ongoing oxygen depletion may result in an inability to swim, support brain function and cause loss of consciousness. Hypoxemia (low blood oxygen levels) is accelerated by an increased rate of oxygen consumption of active underwater swimming.
Highly trained swimmers can develop and tolerate significantly lower levels of oxygen after swimming at maximum effort and are at greater risk of the effects of hyperventilation than untrained swimmers (Spanoudaki et al, 2004). Hyperventilation also raises blood pH (due to a decrease in unbound calcium ions) which reduces oxygen delivery to the brain further causing dizziness and faintness despite adequate oxygen levels in the blood supply to the brain. Calcium is involved in neurotransmitter signal cascade and reduced transmission can lead to loss of motor control (Daly, 1979). This abrupt shift in tissue chemistry causes numbness and tingling at the extremities occurring commonly with anxiety attacks and often described in underwater blackout cases (Craig, 1961).
This results in a state of relative hypocapnia while oxygen stores, mostly in the lungs, may have increased only by a modest 250–300 millilitres (capable of supporting an additional 10–60 seconds of breath-holding, depending on physical exertion). The carbon dioxide-driven desire to return to the surface to breathe is overridden by conscious effort until loss of consciousness occurs without forewarning due to weak respiratory stimulus from hypoxia (Craig, 1961; Craig, 1976; Lindholme, 2009).
Land vs. Water. Breath-holding capability is longer in water when compared to capability on land (Sterba, 1985). This is thought due to the increased pressure created by being surrounded by water.
Mental health. Schipke (2001) suggested that stress will further increase the sympathetic nervous stimulus. Tachycardia prior to breath-holding is well known (Ferridno, 1997; Sanchez, 1983; Schagatay, 1996) and is thought to be caused by anxiety ahead of breath-holding. This is consistent with our understanding of fear in relation to the fight or flight response.
Nature vs. nurture. Research has struggled to provide a valid study of whether the physiological capability is largely determined congenitally or susceptible to interventions by the individual. This has been problematic because psychological factors impact physiological performance, limiting the scope for new results from experimentation.
Peer pressure. Fitz-Clarke (2006) reported that symptomatic hypoxia is common in breath-holding diving competitions. Dihl (2000) showed that two medical students competing in breath-holding competitions the goal being to swim as far underwater as possible. Little is understood about how socio-communicative disorders, such as Autistic Spectrum Disorder and Tourette's Syndrome or learning disability affects hypoxic blackout prevailing in respect of peer pressure. To date, no known datasets have been published on the topic of these conditions.
Temperature. Water temperature is known to impact breath-holding capability. Lower water temperature is known to enhance breath-holding capability (Kinoshita, 2006). This is partly due to greater oxygen consumption in warmer waters demonstrated by increased general fatigue and dizziness (Holmer and Bergh, 1974).
High ambient air temperatures also increase blood flow to the skin and consequently away from the brain and muscles. Air and water temperature affect metabolic response by decreasing oxygen volume during expiration by 13% at 33°C when compared with 26°C Bradycardia can be influenced by water temperature (Schagatay, 1996).
There are no significant papers on the effect of illness and religious swimwear which may also have an effect on body temperature; although it would be consistent with contemporary understanding of the effect on body temperature of those two components.
Training. The evidence is inconclusive on whether hypoxic training leads to any physiological improvement in breath-holding capability (Truijens et al. 2003). Fitness level and swimming ability are known to improve breath-holding capability. Whilst improvements in breath-holding capability have been observed in those who have undertaken sustained hypoxic training regimes, the prevailing view attributes the improvement to psychological rather than physiological factors (Sperling, 2008). Hentsch and Ulmer (1984) identified a psychological dimension that plays an important role in breath-holding capability which has been reinforced by multiple studies.
Counsilman developed the concept of hypoxic training for swimmers as a mechanism of replicating high-altitude training used by runners and cyclists. It was thought that reducing breaths may increase a swimmer’s speed by decreasing drag associated with breathing. Subsequent research has proven that sea-level hypoxic training does not produce any physiological change in swimmers (Truijens et al 2003). Sperling in 2008 wrote that hypoxic training remains ‘popular’ with swimmers and coaches because it teaches swimmers to be ‘disciplined’ in maintaining strong technique in low oxygen, high-stress situations.
Alentejano (2010) concluded that psychological factors were a more significant driver behind the urge to breathe in non-professional swimmers than in professional swimmers. For professional swimmers, Alentajano’s study reported physiological drivers as being more significant, suggesting an individual learns through underwater breath-holding experience to consciously override the psychological response. This is consistent with Ulmer (1984) who reported that 31% of swimmers stopped breath-holding due to psychological drivers. Hentsch and Ulmer (1984) were able to show in a second study that 30% of swimmers (predominantly at elite level) were able to resist the unpleasant feeling of involuntary respiratory movements indicating a learnt higher psychological tolerance
Marshall (2010) observed that heart rate recovery times were indifferent between a group of fifteen synchronised swimmers and a control group who undertook the same underwater swim. Marshall indicated that this implied greater efficiency in the use of oxygen by the synchro group as opposed to the control, owing to their longer duration underwater observed during the swim. However, the study was not able to conclude this was the case and the number of subjects was small.
Highly trained swimmers can develop and tolerate significantly lower levels of oxygen after swimming at maximum effort and are at greater risk of the effects of hyperventilation than untrained swimmers (Spanoudaki et al, 2004). Alentejano (2010) suggests that lower stress and decreased heart rate may explain the physiological and psychological improvements generated by breath-holding training.
Marshall (2010) confirmed similar results by Pan (1997), Chang (1996) Sterba (1985) and Stewart (2005) in that those trained in breath-holding could hold their breath for longer than the control group. Training of synchronised swimmers has been recognised as increasing psychological tolerance by the reduction of fear associated with breath-holding, increasing the ability to withstand the urge to breathe for longer (Hentsch and Ulmer, 1984).
Schagatay (2000) concluded that training reduced anxiety and increased self-confidence, resulting in longer breath-holding times. Bradycardia, where an adult has a resting heart rate under 60 bpm, can be influenced by breath-holding training (Schagatay, 1996). Bradycardia can be influenced by lung volume, levels of physical activity. However, there is a psychological glass ceiling provided by physiological capability which then determines breath-holding duration (Hentsch, 1984).
References
Alentejano, T., Marshall, D., Bell, G. (2008). A time-motion analysis of Elite Solo Synchronized Swimming. International Journal of Sports Physiology and Performance. 3(1), 31–40.
Andersson, J. and Schagatay, E. (1997). Effects of lung volumes and involuntary breathing movements on the human diving response. European Journal of Applied Physiology. 77(1–2), 19–24.
Andersson, J., Biasoletto-Tjellstrom, G., Schagatay, E. (2008) Pulmonary gas exchange is reduced by the cardiovascular diving response in resting humans. Respiratory Physiology and Neurobiology. 160(3), pp. 320–324.
Andersson, J., Evaggelidis, L. (2008). Arterial oxygen saturation and diving response during dynamic apneas in breath-hold divers. Scandinavian Journal of Medicine and Sports Science. 21.
Andersson, J., Linér, M., Fredsted, A., Schagatay, E. (2004). Cardiovascular and respiratory responses to apneas with and without face immersion in exercising humans. Journal of Applied Physiology 96, 1005–1010.
Andersson, J., Linér, M., Rünow, E., Schagatay, E. (2002). Diving response and arterial oxygen saturation during apnea and exercise in breath-hold divers. Journal of Applied Physiology 93(3), 882–886.
Andersson, J., Liner, M., Runow, E., Schagatay, E. (2002). Diving response and arterial oxygen saturation during apnea and exercise in breath-hold divers. Journal of Applied Physiology. 93, pp. 882–886.
Arnold (1985). Extremes in human breath-hold, facial immersion bradycardia. Undersea Biomedical Research. 12(2), 183–190.
Bjurstrom, R. and Schoene, R. (1987). Control of ventilation in elite synchronized swimmers. Journal of Applied Physiology. 63(3), 1019–1024.
Boyd, C., Levy, A., McProud, T., Huang, L., Raneses, E., Olson, C., (2015). Fatal and nonfatal drowning outcomes related to dangerous underwater breath-holding behaviours - New York State, 1988-2011. Morbidity and Mortality Weekly Report. 64(19), 518-521.
Butler, P., Woakes, A. (1987). Heart rate in humans during underwater swimming with and without breath-hold. Respiratory Physiology. 69, 387–399.
Davies, B., Donaldson, G., Joels, N. (1995). Do the competition rules of synchronized swimming encourage undesirable levels of hypoxia? British Journal of Sports Medicine. 29(1), 16–19.
Delapille, P., Verin, E., Tourny-Chollet, C., Pasquis, P. (2001). Breath holding time. Effects of non-chemical factors in divers and non-divers. European Journal of Physiology. 442(4), 588–594.
Fielding, R., Pia, F.A., Wernicki, P., Markenson, D. (2009). Scientific review. Avoiding hyperventilation. International Journal of Aquatic Research and Education. 3, 432–447.
Fitz-Clarke, J. (2006). Adverse events in competitive breath-hold diving. Undersea & Hyperbaric Medicine. 33, 55–62.
Hentsch, U. and Ulmer, V. (1984). Trainability of underwater breath-holding time. International Journal of Sports Medicine. 5, 343–347.
Holmér, I. and Bergh, U. (1974). Metabolic and thermal response to swimming in water at varying temperatures. Journal of Applied Physiology. 37, 702–705.
Hong, S., Lin, Y., Lally, D., Yim, B., Kominami, N., Hong, P., Moore, T. (1971). Alveolar gas exchanges and cardiovascular functions during breath holding with air. Journal of Applied Physiology. 30(4), 540–547.
Hong, S., Rahn, D., Kang, D., Song, S., Kang, B. (1963). Diving pattern, lung volumes and alveolar gas of the Korean diving woman (Ama). Journal of Applied Physiology. 18(3), 457–465.
Kinoshita, T., Nagata, S., Baba, R., Kohmoto, T., Iwagaki, S. (2006). Cold-water face immersion per se elicits cardiac parasympathetic activity. Circulation Journal. 70(6), 773–776.
Kumar, K. and Ng, K. (2010). Don’t hold your breath: Anoxic convulsions from coupled hyperventilation–underwater breath-holding. The Medical Journal of Australia. 192, 663–664.
Lempert, T., Bauer, M., Schmidt, D., (1994). Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Annals of Neurology. 36, 233-237.
Lindholm, P. (2007). Loss of motor control and/or loss of consciousness during breath-hold competitions. International Journal of Sports Medicine. 28, 295–299.
Lindholm, P. and Gennser, M. (2005). Aggravated hypoxia during breath-holds after prolonged exercise. European Journal of Applied Physiology. 93, 701–707.
Linhold, P. and Lundgren, C. (2009). The physiology and pathophysiology of human breath-hold diving. Journal of Applied Physiology. 106, 284-292.
Moran, D., Leung, M., Wyman, P., and Williams, D. (2008). Saint Edward State Park Carole Ann Wald: Swimming pool injury investigation report Seattle: Incident Public Health Seattle & King County.
Pan, A., He, J., Kinouchi, Y., Yamaguchi, H., Miyamoto, H. (1997). Blood flow in the carotid artery during breath-holding in relation to diving bradycardia. European Journal of Applied Physiology and Occupational Physiology. 75(5), 388–395.
Pendergast, D., Lindholm, P., Wylegala, J., Warkander, D., Lundgren, C. (2006). Effects of respiratory muscle training on respiratory CO2 sensitivity in SCUBA divers. Undersea and Hyperbaric Medical Society. 33, 447-453
Pollock, N. (2006). Development of the DAN breath-hold incident database. In: Breath-Hold Diving. Proceedings of the Undersea and Hyperbaric Medical Society/Divers Alert Network Workshop, edited by Lindholm P, Pollock N, and Lundgren C. Durham, NC: Divers Alert Network, pp. 46–55.
Richardson, M., Bruijn, R., Holmberg, H., Björkund, G., Haughey, H., Schagatay, E. (2005). Increase of haemoglobin concentration after maximal apneas in divers, skiers and untrained subjects. Canadian Journal of Applied Physiology. 30(3), 276–281.
Sanchez, J. and Sebert, P. (1983). Sex differences in cardiac responses to breath-holding during dynamic and isometric exercises. European Journal of Applied Physiology. 50, 429–444.
Schagatay, E. and Andersson, J. (1998). Diving response and apneic time in humans. Undersea and Hyperbaric Medicine. 25, 13–19.
Schagatay, E. and Holm, B. (1996). Effects of water and ambient air temperatures on human diving bradycardia. European Journal of Applied Physiology. 73(1), 1–6.
Schagatay, E., Andersson, J., Hallén, M., Palsson, B. (2001). Physiological and genomic consequences of intermittent hypoxia selected contribution: Role of spleen emptying in prolonging apnea in humans. Journal of Applied Physiology. 90(4), 1623–1629.
Schagatay, E., Haughey, H., Reimers, J. (2005). Speed of spleen volume changes evoked by serial apneas. European Journal of Applied Physiology. 93(4), 447–452.
Schagatay, E., Kampen, M., Emanuelsson, S., Holm, B. (2000). Effects of physical and apnea training on apneic time and the diving response in humans. European Journal of Applied Physiology. 82(3), 161–169.
Schipke, J. and Pelzer, M. (2001). Effect of immersion, submersion and scuba diving on heart rate variability. British Journal of Sports Medicine. 35(3), 174–180.
Spanoudaki, S., Maridaki, M., Myrianthefs, P., Baltopoulos, P. (2004). Exercise-induced arterial hypoxemia in swimmers. Journal of Sports Medicine and Physical Fitness. 44, 342-348.
Sperling, J. (2008). Risk management., Coming up for air. Aquatics International. Available from: http://www.aquaticsintl.com/2008/feb/0802_rm.html (accessed 15 March 2020).
Stephenson, J. (2001). Anoxic seizures: self-terminating syncopes. Epileptic Disorders. 3, 3-6.
Sterba, J. and Lundgren, C. (1985). Diving bradycardia and breath-holding time in man. Undersea Biomedical Research. 12(2), 139–150.
Stewart, I., Bulmer, A., Sharman, J., Ridgway, L. (2005) Arterial oxygen desaturation kinetics during apnea. Medicine & Science in Sports & Exercise. 37(11), 1871–1876.
Stromme, S., Kerem, D., Elsner, R. (1970). Diving bradycardia during rest and exercise and its relation to physical fitness. Journal of Applied Physiology. 28, 614–621.
Truijens, M., Toussaint, H., Dow, J., Levine, B. (2003). Effects of high-intensity hypoxic training on sea-level swimming performances. Journal of Applied Physiology. 94, 733–743.
Yamamura, C., Tsukashima, Y., Matsui, N., & Kitagawa, K. (2000). Physiological loads in the team technical and free routines of synchronized swimmers. Medicine and Science in Sports and Exercise. 32(6), 1171–1174.
Citation. Jacklin, D. 2021. Breath-holding capability. From athletes to amateurs. Water Incident Research Hub, 11 December.
