From laboratory to Amazon.com and the NHS – How breathing training joined the mainstream
Submitting InstitutionBrunel University
Unit of AssessmentSport and Exercise Sciences, Leisure and Tourism
Summary Impact TypeTechnological
Research Subject Area(s)
Medical and Health Sciences: Human Movement and Sports Science
Summary of the impact
Research by Alison McConnell and colleagues has underpinned the creation
of a new category of exercise training and rehabilitation; "breathing
training" improves exercise tolerance and reduces perceived exertion.
McConnell invented the market-leading POWERbreathe® breathing trainer, and
since joining Brunel (2000), has led further new product developments via
Knowledge Transfer Partnerships (KTP) and consultancy. Research by
McConnell and her team underpins marketing by POWERbreathe® and several
"copycat" products serving UK and overseas markets. Impacts include: 1.
physiological benefits to individual users globally, from elite athletes
to patients; and 2. commercial benefits to POWERbreathe International
Ltd., its supply chain, and to new international businesses serving the
breathing training market created by POWERbreathe®.
McConnell's research on inspiratory muscle training (IMT) began in the
early 1990s, with the most influential outputs published since joining
Brunel in 2000. Research took a sequential path: 1. describing
physiological responses to inspiratory muscle training (IMT); 2.
elucidating underlying mechanisms; 3. using insights gained in 2 to inform
new product development. The research has underpinned the marketing and
development of "breathing training" products by POWERbreathe® and by new
entrants to the breathing training market. Fundamental to commercial
success has been the group's leading contribution to: 1. evidence that IMT
is ergogenic and 2. elucidation of underlying mechanisms. Two independent
meta-analyses confirming the efficacy of IMT in healthy adults rely
heavily upon the group's work. In the Illi et al. study (Sports Med
42, 707-724, 2012), the group contributed half of the data that
were meta-analysed. The following summarises the important research
insights underpinning impact.
The rationale for IMT is underpinned by evidence of respiratory muscle
overload during exercise, which manifests as respiratory muscle fatigue,
and/or as respiratory muscle metaboreflex activation. Group members
(McConnell, Romer, Volianitis, Griffiths, Lomax, Ross, Taylor)
have each published evidence of post-exercise respiratory muscle fatigue
in healthy adults (e.g., #1, 2, 5). Linked to this rationale is evidence
that prior fatigue of respiratory muscles hastens exercise intolerance and
limb fatigue (McConnell, Romer, Lomax, Taylor; e.g., #6). This
evidence supports the marketing proposition that IMT solves a real-world
The group has also provided evidence that IMT is ergogenic and reduces
inspiratory muscle fatigue (McConnell, Romer, Volianitis, Griffiths;
e.g.,#1, 2, 5), but that expiratory muscle training is not ergogenic
(McConnell, Griffiths; e.g., #2). Descriptive insights are
underpinned by the elucidation, and the exclusion, of underlying
mechanisms; the group was the first to implicate the inspiratory muscle
metaboreflex in ergogenicity (Romer, McConnell; #1), and the first to
provide evidence supporting this mechanism (McConnell, Lomax; #4).
Mechanistic clarity has also been provided by excluding involvement of
maximal oxygen uptake and lactate threshold (McConnell, Romer). Evidence
of efficacy is exploited to support marketing claims, whilst mechanistic
insight enhances credibility. The group was also the first to show that
acute, non-fatiguing inspiratory muscle loading ("warm-up") improves
inspiratory muscle function (McConnell, Volianitis, Lomax, Ross;
e.g., #3) via central and peripheral processes (McConnell, Ross;
#3). Functionally, inspiratory "warm-up" enhances exercise performance and
reduces breathing effort (McConnell, Volianitis), providing a further
Most recently, McConnell has explored IMT in patients, demonstrating
that: 1. IMT improves exercise tolerance and reduces dyspnoea, as well as
reducing the oxygen cost of exercise in asthmatics (#5 and REF2); and 2.
acute inspiratory loading attenuates bronchoconstriction after deep
inhalation in asthmatics (see REF2). Novel applications of IMT to enhance
postural balance are also supported (see REF2). Romer contributed to
evidence that oxygen uptake kinetics are hastened by IMT. The group has
also characterised (mechanically and physiologically) the training
stimulus delivered during IMT, using these insights to inform development
of new, improved products (see section 4) (#6 and REF2).
Brunel employees: McConnell (Reader & Professor; 2000>),
Romer (Senior Lecturer and Reader; 2004>), Volianitis (Lecturer;
2004-07), Ross (Lecturer; 2005-08), Taylor (Research Associate; 2007-09)
PhD students (Awarded): Griffiths (2010), How
(2010), Lomax (2007), Ross (2005), Taylor (2007)
References to the research
5. Turner LA, Mickleborough TD, McConnell AK, et al. (2011). Effect of
inspiratory muscle training on exercise tolerance in asthmatic
individuals. Med Sci Sports Exerc 43, 2031-2038.
Research grants —
1. Knowledge Transfer Partnerships 12/09/05 to 31/10/07 — Project grant —
Title: Development of a computerised, electro-mechanical inspiratory
muscle assessment and training system
2. Knowledge Transfer Partnerships 19/07/04 to 18/07/06 — Project grant —
Title: Development of a novel inspiratory muscle training device
3. HaB International Ltd. 09/04 to 08/07 PhD Bursary (Stephen How) —
Title: The effects of acute and chronic pressure-threshold inspiratory
muscle loading upon upper and lower airway function.
Details of the impact
POWERbreathe® is an exercise product, patented by McConnell, which trains
the breathing muscles. Prior to its commercial launch in 1997, no consumer
breathing training products existed. Wide-ranging benefits include,
ubiquitous improvements in exercise tolerance and breathlessness. The
ground breaking status of POWERbreathe® has necessitated education of the
market, relying heavily upon the group's body of research. This scientific
heritage also allows marketing claims to comply with UK and international
advertising standards. POWERbreathe® is the global market-leading brand of
breathing training products, and sales have grown steeply since it was
acquired by POWERbreathe International Ltd (PBI) in 2000 (data available
directly from PBI); UK channels include household names such as Amazon,
Boots and John Lewis. POWERbreathe® has received extensive media coverage
and positive product reviews. The global reach of POWERbreathe® is
demonstrated by sales through PBI's overseas subsidiaries and distributors
in 43 countries. It's also noteworthy that POWERbreathe®'s success has
spawned a number of copycat products, brought to market by new companies,
which also cite the group's research in their marketing. Whilst the
group's research has become part of a larger body of knowledge, it has
contributed key papers, providing the mainstay of marketing support for
the breathing training product category. In May 2011, McConnell published
a monograph on the IMT for sportspeople. The medical market is also
supported by the group's outputs, especially its elucidation of underlying
mechanisms. The significance of this body of literature to clinical
practice is illustrated by a watershed event in 2006, when the
POWERbreathe® Medic became the first exercise training equipment
approved by the Prescription Pricing Authority for NHS prescription.
Clinical collaborations have also resulted in outputs supporting novel
clinical applications such as postural control (REF2) and low back pain
(REF2), as well as more traditional applications such as asthma (REF2). In
May 2013, McConnell published a monograph supporting the implementation of
IMT in healthcare settings.
Insights provided by the group's research (section 3, #6) were exploited
through two KTPs to extend the POWERbreathe® product range, and in 2010
the world's first electronic inspiratory muscle trainer was launched. The
development resulted in a new patent (McConnell is an inventor) and a
royalty bearing licence agreement. The product won the Plastic's Industry
2010 "Consumer Product Design of the Year" award, and was featured on the
European Respiratory Society annual meeting Buyers' guide 2011. In July
2013, McConnell also began providing consultancy services to a global,
market-leading respiratory medical company. The company wishes to develop
a novel product, specifically for patients undergoing mechanical
The reach of the impact created by the group's research has been
maximised via: 1. peer-reviewed journal papers; 2. conference
presentations; 3. articles in consumer publications; 4. presentations to
opinion formers and the general public; 5. a book on "breathing training"
for sports people (>6k sales in 24 mo); 6. a book on respiratory muscle
training for clinicians; 7. a sports website [breathestrong.com] and a
clinical website [physiobreathe.com]; 8. social media [Twitter, Facebook,
Blog]; 9. iPhone Apps (>1k sales in 18 mo). The reach of breathing
training, and its underpinning by the group's research is evidenced by
metrics such as:
- 1.2 million hits from a Google search using "Powerbreathe"
- 115k hits from a Google search using "POWERbreathe Romer"
- 38k hits from a Google search using "POWERbreathe McConnell"
- 68k hits from a Google search using "IMT McConnell COPD"
- 53k hits from a Google search using McConnell's book title, "Breathe
Strong, Perform Better"
- 1,500 new monthly visitors to McConnell's breathestrong.com website
- Google keyword search of the phrase "breathing training" yields over
51k hits, the top 3 rankings of which are occupied by breathestrong.com
(1 and 2) and POWERbreathe.com (3)
POWERbreathe® has two principal markets: 1. sport, fitness and wellbeing;
and 2. medical. Beneficiaries in the former group range from elite
sportspeople, to older people. Recreationally active people use
POWERbreathe® because it makes exercise feel easier. Athletes typically
experience improvements in time trial performance of 2-5% within 6 weeks,
making IMT an integral part of elite competition preparation.
Publically-known Olympic and World Champions include the gold medal
winning men's eight from the Athens Olympics and England's 2003 Rugby
World Cup winners, as well as the current Rabobank cycling team. Dr Steve
Ingham, Head of Technical Development at English Institute of Sport,
included IMT as one of his "Top 10 applications of sports physiology" in
his pre-Olympic Blog. In 2012, McConnell's work on breathing training was
featured in The Wellcome Trust's "In the Zone" project. POWERbreathe® is
also part of the curriculum of OCR Advanced Subsidiary GCE in Physical
Education. Beneficiaries in a clinical setting include people with
breathlessness and exercise intolerance (e.g., respiratory and cardiac
patients). In 2012, the POWERbreathe® K-Series product (developed through
KTP) was selected for use in a six nation (Belgium, Holland, Germany,
Austria, Switzerland, Canada) multi-centre randomised, controlled trial of
IMT in patients with chronic obstructive pulmonary disease. Economic
benefits accrue from sales by manufacturers of all breathing training
products and their supply chains.
Sources to corroborate the impact
Evidence of the use of the group's research in promotion of breathing
training products —
Evidence of the impact of the group's research and knowhow upon
POWERbreathe International Ltd.'s business, and the reach and
significance of POWERbreathe® —
Evidence of impact amongst the general public and in schools —
Evidence of impact in elite sport —
Evidence of impact in a clinical setting —
- Prescription Pricing Authority listing of POWERbreathe® Medic www.powerbreathe.com/media/wysiwyg/pdfs/PB_Med_Broch.pdf
- Piepoli MF et al. (2011). Eur J Heart Fail 13,
347-357. DOI 10.1093/eurjhf/hfr017
This Position Statement
recommends IMT and mentions POWERbreathe® specifically.
- New POWERbreathe K-Series medical product featured on the front cover
of European Respiratory Society Buyers' guide 2011 (see pdf evidence
- McConnell, AK. (2013) Inspiratory Muscle Training: Theory &
Practice, Reed Elsevier.
Book on the application of respiratory
muscle training to clinical practice.
- Multi-centre trial of IMT in patients with COPD led by Prof. Rik
Gosselink, KU Leuven. Charususin N et al. (2013). Inspiratory muscle
training protocol for patients with chronic obstructive pulmonary
disease (IMTCO study): a multicentre randomised controlled trial. BMJ
open 3. DOI 10.1136/bmjopen-2013-003101
POWERbreathe® K-Series product was selected for use in this
McConnell AK. (1994). Inspiratory muscle training device.
- Spurling DA, Lam DHY, Skelton A, McConnell AK, Cecelja F &
Broomhead P. (2009). Dynamic inspiratory muscle training device.