Episode 170-Breather RMT/Michael Arishita-Blank Labels, Big Dreams: The Rise of Blanks Nutrition

A brief synopsis of the episode's main discussions and takeaways as well as extended references

Author

Jeff Sankoff
May 09, 2025

Table of Contents

Breather, the device that trains your respiratory muscles. Will it boost your endurance?

The Medical Mailbag looks at the second device to purportedly build up your respiratory muscle strength-the Breather. In a much earlier episode I looked at the Aerofit, a little more tech heavy example of a device that did the same thing. At that time, I could not find any evidence to recommend it. What would we find when asked to look into the Brather that markets itself as ‘the oldest and most popular RMT device’ out there? Unsurprisingly, what has been published does not back up the hype.

The idea behind RMT is that if you make your diaphragm and intercostal muscles stronger you will breathe easier and more deeply and allow for improved blood flow to the periphery where your hard working skeletal muscles can benefit. It turns out that while this sounds good in theory, experiments have not really borne this out. Using an RMT device does not in fact result in any measurable improvements in performance nor does it reduce relative perceived exertion (RPE) that is itself very much a function of respiratory effort.

RMT is not terribly expensive and it certainly won’t cause any harm so we don’t come out completely against it but we definitely do not believe that it will give any benefit whatsoever and couple athletes to spend their money elsewhere.

Michael Arishita: Professional triathlete, enterpeneur

Michael Arishita is the founder of Blank’s Nutrition and a professional triathlete

About Mike according to Mike: Pro triathlete since 2016, founder of Blank’s Sports Nutrition. I was a pre med guy through college and used my MCAT background to build out the biochemical backbone for the hydrogel / launch blanks.

Michael Arashida, a professional triathlete, shares his journey from a pre-med student to a successful athlete and entrepreneur with Blanks Nutrition. With a background in biochemistry and an MBA in healthcare administration, Michael's transition into the world of triathlon was anything but ordinary. He grew up in San Antonio, Texas, where basketball was his first love, but it didn't take long for him to discover his running prowess, leading to a serendipitous introduction to triathlons during college. Fast forward eight years of racing and a wealth of knowledge about sports nutrition gained from being sponsored by top brands, he identified a gap in the market: sports nutrition that is both effective and affordable. This epiphany led him to create Blanks, a brand that prides itself on offering customizable and sustainable nutrition products, aiming to revolutionize the way athletes fuel their bodies.

Episode takeaways:

  • Michael Arashida transitioned from a pre-med biochemistry background to a professional triathlete, embracing the chaos of life and sport.

  • The podcast discusses the return of the Ironman World Championship to Kona, stirring up mixed feelings among triathletes and fans alike.

  • Ironman surveyed athletes and found strong support for a single-day championship event, despite the split format's ups and downs.

  • Michael's startup, Blanks Nutrition, aims to fill a unique gap in the market with customizable, sustainable sports nutrition products.

  • Listeners are reminded that hard work is the only true shortcut to success in triathlon, and gimmicky devices won't magically improve performance.

References used for the MMB

The Breather EST. 1980 

Product Website

Key Points

  • Product Claims:

    • Single user device with 6 inspiratory & 5 expiratory settings; lifespan of up to 2 years

    • The Breather Fit: $59.95

    • The Breather Fit with Case: $75.95

    • Small, portable, easy-to-use, with adjustable resistance

    • Helps aging individuals stay active and independent; reduces snoring; support for asthma or sports performance

    • Scientifically proven respiratory muscle trainer that improves lung strength and capacity, blood pressure, heart function, endurance, and vocal strength

    • FDA registered

    • First & #1 selling RMT device

    • Used by patients with COPD, CHF, dysphagia, and neuromuscular disease

  • Cited Evidence for Athletes

    • Systematic review and meta-analysis by Illi et al. (2012) on the effect of respiratory muscle training (RMT) on exercise performance shows 11% improvement in overall performance when combining inspiratory and expiratory muscle training and 23% increase in VO2 max and improved breathing strength/walking distance in active youth who incorporated high-resistance inspiratory muscle training

    • Shei et al. (2018) show that training respiratory muscles with resistance breathing increased athletes' distance covered before fatigue while carrying load by 20%, and relative to those using sham respiratory muscle trainers that look similar but provide no resistance, or none, swimmers adding RMT to training had 17% improvement in endurance

    •  Bausek et al. (2019) show that ranger recruits who used Breather Fit decreased 2-mile run-time by an average of 39 seconds

    • Volianitis et al. (2001) showed that rowers who trained their respiratory muscles improved 5000m row speed and distance in a 6-min test

    • Kilding et al. (2009) showed that training the inhale musculature improved 50m, 100m, and 200m swim times

    • Training respiratory muscles for 2 weeks improved total sprint time and speed for pro soccer players in Silva et al. (2019)

  • Evidence for Health:

    • Inspiratory muscle strength training for 6 weeks shows 7% reduction in systolic BP, 3% reduction in diastolic BP, and 45% increase in artery diameter according to Craighead et al. (2021)

    • Other evidence cited for improved cardiac and pulmonary strength as well as speech and swallowing abilities

Effect of Respiratory Muscle Training on Performance in Athletes: A Systematic Review with Meta-Analyses

Ghanbari et al. (2013)

Key Points

  • This study systematically reviewed articles published in English that included athletes as participants to assess the effect of RMT on respiratory muscle and sports performance. 

  • Mechanisms postulated to explain reported improvements in athletic performance as a result of RMT include the following:

    • Decrease in rating of perceived breathlessness (RPB)

    • Decrease in rating of perceived exertion (RPE)

    •  Attenuation of the metaboreflex phenomenon, which is a reflex that occurs when muscle metabolism is compromised by exercise

      • Sensory nerve fibers in working muscle are activated and send signals to the brainstem, which results in a cardiovascular and respiratory response to optimize blood flow and oxygen delivery to muscles

  • Previously, while studies have demonstrated improved respiratory muscle strength and endurance after RMT, contradicting results on the effectiveness of RMT to improve sports performance have been reported

  • Inspiratory muscle fatigue, the decrease in maximal inspiratory pressure over time as a result of the physical demands, occurs in marathon runners, triathletes, rowers, cyclists, and swimmers

  • This review demonstrated that IMT/RMT increases respiratory muscle strength and endurance and also improves athletic performance in some sports

    • Cyclists, included in 7 reports, showed consistent trends in favor of IMT/RMT training with improvements in time trials, time to exhaustion, and VO2 max

    • Special forces training showed no effect of IMT/RMT

    • Other sports in this review showed an improvement in at least 1 outcome of sports performance

    • Swimmers and divers showed the least consistent effect of RMT in sports performance, with only 1 study showing significant improvements in the time to exhaustion

      • This may be due to RMT already being induced in regular training by the water pressure on the thorax

    •  This study reported the challenges of differentiating recreational and elite athletes due to differences in reporting across studies

  • However, the inconsistency in the training protocols and methods of evaluating sports performance makes it difficult to identify the optimal RMT protocol as well as the types of sports where RMT shows the most improvements in athletic performance

  • Threshold devices used in interventions among the 21 articles assessed in this study included POWERbreathe, PowerLung, and the Respiratory Threshold Model 2.

Methods: Searched electronic databases from 1946 to 2011. Gray literature, including government reports also searched. Articles included if participants were healthy athletes without disability; age 15-40; randomized controlled trial comparing IMT or RMT to control, sham, or placebo group; study reported respiratory muscle strength, endurance, or performance; and published in English. Meta-analyses performed. Subgroup analysis was performed for some sports.

Results: Search yielded 6,923 citations of which 21 articles met the inclusion criteria. 426 participants were involved. No differences were found from meta-analyses comparing low-intensity sham, control, and placebo groups. Analysis of 9 studies that assessed performance by fixed distance time trials showed an effect favoring IMT/RMT across all sports (p<0.0000), suggesting that the training has the potential to improve sports performance. IMT/RMT increased the time to exhaustion, more so in intermittent sprint sports and swimming relative to cycling and endurance track sports (p<0.0000). “Meta-analyses showed that IMT/RMT was favorable for RPB and RPE (p<0.0000 and p=0.003). IMT/RMT participants also had greater improvements in maximal inspiratory pressure than control (p < 0.0000) which differed among sports (p < 0.0000). Furthermore, meta-analyses demonstrated an overall greater improvement in the maximum voluntary ventilation after IMT/RMT than control group (p = 0.002).

The effectiveness of respiratory muscular training in athletes: A systematic review and meta-analysis

Xavier et al. (2025)

Key Points

  •  RMT, which is based on the principle that respiratory muscles adapt to generate a state of overload, includes breathing exercises that work against external pressure. 

  • Studies suggest that RMT programs have the potential to increase and/or improve levels of maximum inspiratory pressure, expiratory volume, forced vital capacity, peak flow, scores in VO2 max tests, and athletic performance, particularly in soccer players. 

  • However, based on this review, which included 27 studies from 2000 to 2022 with 563 athletes, no statistically significant results in lung function of sports, such as swimming, cycling, rowing, basketball, and track and field were observed when comparing outcomes between RMT and control of the pre- and post-intervention periods, potentially due to baseline pulmonary function being close of physiological limits in highly trained athletes.

  • This review reports that swimmers training at intensive levels may not observe as meaningful results using RMT because studies have previously shown that swimming training already improves cardiorespiratory capacity by increasing lung volume, maximal O2 consumption, aerobic capacity, and respiratory strength in addition to altering the elasticity of the lung and chest walls. 

  • Nevertheless, improving respiratory muscle strength helps to delay the onset of respiratory fatigue, improve oxygen delivery, and increase endurance, which are directly linked to prolonged exercise duration and improved performance metrics, so it may be a viable strategy to incorporate it into training routines.

  • According to Mcconnel and Sharp (2005), the device most commonly used for RMT was POWERbreathe, which can adapt the inspiratory resistance to the pulmonary pressure curve, stabilize the load during exercise, make it more comfortable, and offer greater loading possibilities during exercise.

  • Durmic et al. (2015) state that since athletes tend to have high lung capacity, higher training loads may lead to better results, leading them to choose POWERbreathe

  • To better assess the long-term effectiveness of RMT on clinical outcomes, more studies are needed.

Introduction: RMT, which is based on the principle that respiratory muscles adapt to generate a state of overload, includes breathing exercises that work against external pressure. Shei et al. (2018) suggest that RMT is particularly effective in improving pulmonary function and maximizing athletic performance in endurance sports, and has been incorporated into training regimens for swimmers, soccer players, and cyclists. While individual studies have reported positive results, the interventions of the studies vary. This systematic review aimed to summarize the effectiveness of RMT in athletes based on muscle strength, lung function, and performance. 

Methods: Only randomized controlled trials were included. RMT was considered any type of exercise to gain/maximize the resistance/strength of the respiratory muscles. Included experiments using Threshold, POWERbreathe, and other equipment designed to make this training modality viable regardless of whether it was used in conjunction with other therapies.Search performed on Medline, Lilacs, AENTRAL, physiotherapy Evidence Database, and EMBASE from baseline to October 2022 without date or language restrictions. Two reviewers extracted data. Authors were contacted to collect missing data. Short-, medium-, and long-term effects considered.

Results: 27 studies from 2000 to 2022 included in final analysis, including 563 athletes. 25 of the articles included in meta-analysis. RMT was performed in various ways. 55.5% of RCTs used the POWERbreathe device. 20%, 16%, & 12% of the studies included swimmers, runners, and cyclists. RMT programs are effective in increasing and/or improving levels of MIP, FEV, FVC, peak flow, scores in VO2 max tests, and improving athletic performance, particularly in soccer players. Weekly session varied from 2 to 14 sessions/wk, averaging 6.51. According to McConnell and Sharp (2005), the device most commonly used for RMT was POWERbreathe, which is able to adapt the inspiratory resistance to the pulmonary pressure curve, stabilizing the load during exercise, making it more comfortable and offering greater loading possibilities during exercise. Significant results not seen in swimming athletes with RMT training compared to control group. Soccer athletes showed most significant gains including improved physical performance. There were also no statistically significant results in lung function of sports, such as cycling, rowing, basketball, and track and field, when comparing outcomes between RMT and control the pre- and post-intervention periods. 

Breathing Better: Professors’ research into respiratory muscle training devices

Utica University article

Key Points

  • Professor Elmarakby, Associate Professor of Physical Therapy, whose expertise lies in cardiopulmonary PT previously published a study showing “that uing a respiratory muscle training device such as Powerbreathe, before and after coronary artery bypass graft was important to improve lung functions, diaphragmatic strength and arterial oxygen levels, to reduce post-operative complications such as pneumonia and to reduce one’s hospital stay”.

  • Along wth Professor Siniscaro, Associate Professor of Health Sciences, he investigated the effect of two RMT devices (Powerbreathe Plus & Elevation Training Mask) on athlete lung functions, respiratory muscle strength, aerobic capacity, and exercise performance. 

    • Current statistical analysis indicates both have a clinically significant effect on diaphragmatic function and aerobic capacity of collegiate lacrosse teams.

  • The effectiveness of specific RMT devices in improving aerobic capacity has not yet been widely peer-reviewed

  • Considering these claims in relation to other studies, it may be necessary to consider what sport you are involved in as well as your training level to assess the potential benefits of incorporating RMT devices.

A Review on Respiratory Muscle Training Devices 

Menzes et al. (2018)

Key Points

  • Previous studies attempting to describe all respiratory muscle training (RMT) devices did not include some with proven efficacy.

  • This study examined the mechanisms and characteristics of all available RMT devices on th market to discuss their merits and limitations.

  • Search conducted in databases, books, websites selling products related to rehabilitation, reference lists of retrieved paper. 

  • Respiratory devices fall into two categories: 

    • Imposing a resistance training stimulus that subjects the muscles to an external load

      • Passive flow resistance

      • Dynamically adjusted flow resistance

      • Pressure threshold valve

    • Imposing an endurance training stimulus 

      • Inherent flow resistance

      • Elasticity of the respiratory system

  • These devices were developed to increase the strength and endurance of the respiratory muscles

  • Shown to be effective in improving clinical outcomes in the following: 

    • pulmonary function (forced vital capacity, forced expiratory volume in the first second, peak expiratory flow, maximum voluntary ventilation, forced expiratory flow between 25% and 75% of vital capacity, vital capacity, tidal volume, expiratory reserve volume, inspiratory reserve volume, and inspiratory capacity)

    • Dysphagia

    • Perceived exertion

    • Cough/swallow 

    • Diaphragm thickness

    • Chest expansion

    • Respiratory complications

    • Levels of activity

  • 14 devices available on the market and reported by published studies that this study assessed

    • The Breather Fit RMT device is not reported in the study

Respiratory muscle training: a bibliometric analysis of 60 years’ multidisciplinary journey

Ramli et al. (2023)

Key Points

  • RMT involves inspiration/expiration exercises to stimulate the respiratory muscles

  • Increasing intensity, time, and frequency of training overloads muscle fibers and enhances their strength/resistance while also potentially improving endurance 

  • Studies have reported that among healthy participants, RMT can also reduce blood lactate during exercise, sympathetic activation, and muscle fatigue

  • Research on RMT has been increasing over the past 6 decades, with a dominant number of publications being authored by those with a background in medicine

  • Most publications implemented conventional RMT training (resistive and pressure threshold training) while others utilized interventions such as singing


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